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At least 1,441 records · Page 80Linked to original sources
PubMed1978

Brainstem lesion with coma for five years following manipulation of the cervical spine.

A woman, aged 38, lost consciousness immediately after manipulation of the cervical spine and remained in coma for nearly 5 years in a combined decorticate and decerebrate state. Cerebral angiography revealed impaired circulation in the vertebrobasilar system. The EEG initially showed generalized cerebral dysrhythmia but tended, over the years, to become more normal with desynchronized fast activity of low voltage. Neuropathological examination postmortem revealed a large cystic lesion in the pressure equalization area of the carotid and basilar circulation in the upper pons, mesencephalon, posterior hypothalamus and basal thalamus. No definite stenosis or occlusion was seen in the cerebral vessels on angiography or at the postmortem examination. The mechanism of the lesion is considered to have been temporary interference with the blood flow in the vertebrobasilar system during manipulation of the cervical spine sufficient to cause ischemia and subsequent infarction of the brainstem. The pathogenesis of vascular lesions of the brain stem following manipulation of the cervical spine is discussed briefly.

Adult↗
PubMed1994

[Considerations of subjective and interpersonal factors in physical and social prognosis after severe craniocerebral trauma with prolonged coma. Observation of an individual outcome after 11 years].

The prognosis following severe craniocerebral trauma is affected by a broad variety of factors. Based on an individual fate 11 years post craniocerebral trauma with persistent coma, some thoughts are presented concerning relevance of subjective and interpersonal factors for the patient's vital and social prognosis and discussed in light of the social energy concept posited by the Dynamic Psychiatry school.

Activities of Daily Living↗
PubMed1975

[Diabetic coma. A report of 752 cases between 1931 and 1973].

752 diabetic comata (150 non-ketoacidotic and 602 ketoacidotic) from the period between 1931 and 1973 were investigated with regard to type of coma, age, sex, blood sugar, body type, previous therapy, presence of infections and their location and lethality. The blood sugar rose from 521 mg percent in the period from 1931-1940 to 701 mg percent in the period from 1971-73, and age from 33.9 to 53.7 years. Patients without ketoacidosis had higher blood sugar and were older than those with ketoacidosis. Lethality was higher in women than in men. Mortality was higher with obesity (28.8 percent compared to 20.1 percent). 23.9 percent of them were "manifestation" comata of which 43.1 percent died. The lowest lethality was found in the 453 diabetics who had been treated with insulin (14.6 percent). Infections were demonstrable in 431 patients (57.3 percent). Of these, 30.1 percent died, of patients without infections 19.6 percent died. Mortality was 74.6 percent where infections were present in two or more organs.

Adult↗
PubMed1975

[New developments in insulin therapy of diabetic coma (author's transl)].

The experiences of English teams with continuous intravenous infusion of small doses of insulin (6-10 IU/h) for the treatment of diabetic ketoacidosis are reported. This form of therapy is based on recent knowledge of the physiological degree of the serum insulin level (20-200 muU/ml) and the quantity required to saturate the insulin receptors. The advantages of this treatment are in the low therapeutic risk: hypopotassemia, hypoglycemia and cerebral edema, which are disadvantages of conventional therapy of diabetic coma, are avoided.

Brain Edema↗
PubMed1975

Modern methods of management of diabetic coma and precoma.

Recent understanding of mechanisms concerned in the production of the diabetic comas has improved, and this has led to important changes in general concepts and practice of management. We attempt to outline these and to present a didactic scheme for therapy, as in general use at Groote Schuur Hospital.

Bicarbonates↗
PubMedDate not supplied

[The prognostic value of EEG and ENG recording in deep coma].

The eeg and eng test were performed in 53 patients admitted in deep coma. The eeg patterns was analysed using Hockaday's scale and the eng test was appreciated by Nathanson-Bergman's scale. It was noticed that grade IV and V by Hockaday's scale and stage IV by Nathanson-Bergman's scale suggested malignant prognosis. Grade III in Hockaday's scale and stage II in Nathanson-Bergman's scale were unrelated to prognosis.

Adolescent↗
PubMed1976

Peritoneal dialysis in hypernatraemic, ketoacidotic diabetic coma.

Hypertonic dehydration in a 13-year-old boy with ketoacidotic diabetic coma has been treated successfully with peritoneal dialysis and isotonic fluids. Modes of treatment with either hypotonic or isotonic fluids are discussed, as is the feasibility of peritoneal dialysis. We recommend isotonic solutions composed of equal parts of 5.5% glucose and 0.9% sodium chloride combined with peritoneal dialysis in order to secure a relatively slow correction of the hypertonic state.

Adolescent↗
PubMed1993

[A case of progressive systemic sclerosis with Sjögren's syndrome presenting with coma, convulsion and bilateral thalamic hypodensity on computed tomography].

A 35-year-old female with progressive systemic sclerosis (PSS) and Sjögren's syndrome developed consciousness disturbance and generalized seizure after the episode of fever and erythema lasting for 3 weeks. Neurological examination disclosed deep coma and spastic tetraplegia with pathological reflexes. Laboratory data showed mild anemia, severe hypoproteinemia, hypoalbuminemia and increase of protein content in the cerebrospinal fluid. Cranial CT scans obtained after convulsion revealed diffuse brain swelling and bilateral symmetrical hypodensity involving the thalami and posterior limbs of the internal capsule. High-dose corticosteroid therapy and osmotherapy with correction of hypovolemia were started, because severe dehydration, hypoalbuminemia and cerebral vasculitis were suspected to change the vascular permeabilities. Neurological symptoms and CT findings were rapidly improved. Cerebral angiography 4 weeks after convulsion showed definite angitis. The patient was discharged 9 weeks after convulsion. In our case, a possible cause of the characteristic CT findings may be the disturbance of cerebral venous return due to hypovolemia and vasculitis. High-dose corticosteroid therapy may be recommended in patients with collagen disease, who show the bilateral symmetrical thalamic hypodensity on CT scans.

Adult↗
PubMed1993

Myxedema coma. A form of decompensated hypothyroidism.

This article describes the major pathophysiologic alterations that occur in patients with long-standing hypothyroidism and how these alterations may predispose them to the development of a decompensated state, commonly referred to as myxedema coma. Early recognition and the employment of appropriate interventions serve as the cornerstone for successful management of this condition. The use and limitations of thyroid hormone therapy for treatment of this condition are emphasized.

Aged↗
PubMed1993

[Deficiency in medium chain acyl coA dehydrogenase manifested as febrile coma].

A 21-month-old infant developed coma with hypotonia during a viral infection. Acyl CoA dehydrogenase deficiency was diagnosed on the basis of results of the chromatographic study of organic acids performed on a urine specimen collected during the acute episode. However, other disorders of mitochondrial and fatty acid oxygenation can generate similar symptoms. Emphasis is put on the need for collecting urine specimens in patients who develop alterations in consciousness and hypoglycemia without ketonuria during prolonged fasting or repeated vomiting due to a viral infection. Urine chromatography can suggest which enzyme is defective, although the diagnosis should always be confirmed by a study of fatty acid oxygenation in lymphocytes or fibroblasts.

Acyl-CoA Dehydrogenases↗
PubMed1993

[Acute aneurysm surgery and the Glasgow Coma Scale: relationship with 6-month outcome].

A series of 610 patients who had aneurysm surgery within 7 days of the hemorrhage were analyzed as to the relationship between the preoperative Glasgow Coma Scale (GCS) score and the outcome assessed by using the Glasgow Outcome Scale (GOS) at 6 months after surgery. The patient distribution in accordance with the GCS scores in descending order from 15 to 3 was as follows: 265, 109, 44, 24, 17, 20, 25, 15, 18, 12, 16, 23, and 22 cases, respectively. In general, the larger the GCS score, the better the outcome. Thus, the overall results proved to be significantly correlated with the GCS score prior to surgery (r = 0.608, P < 0.01). As for demarcation levels along the GCS axis in terms of the GOS, a significant difference in the outcome was observed at the level of GCS scores between 15 and 14 (P < 0.0001, Wilcoxon test). However, no borderlines were evident at any GCS levels other than 15/14. The problems of applying the GCS to the grading system of aneurysmal subarachnoid hemorrhage are discussed.

Adult↗
PubMed1993

[Vasospasm and its outcome after early surgery for ruptured cerebral aneurysms: relationship with the clinical grade based on the Glasgow Coma Scale].

Over a 9 year period, 270 patients who had early aneurysm surgery within 7 days after subarachnoid hemorrhage were analyzed regarding occurrence of vasospasm (VS) and its outcome. Occurrence of VS was recognized by ischemic neurological deterioration, with or without CT evidence of infarcts. Surgical outcome was assessed by the Glasgow Outcome Scale 6 months postoperatively. The results were correlated with age, aneurysm site, day of surgery, and preoperative clinical grade evaluated by the Glasgow Coma Scale (GCS). Thirty patients with the GCS sum score of less than 6 were excluded from the analysis of VS. Eighty two patients (34%) developed VS, of which 36 patients (15%) showed ischemic symptoms only, and 46 (19%) had infarct on CT. The incidence of symptomatic VS was 12% in GCS 15 group (117 patients), 23% in GCS 14-13 group (70 patients), and 11% in GCS 12-7 group (53 patients). That of VS with infarct was 14%, 23%, and 26% in GCS 15, GCS 14-13, and GCS 12-7 groups, respectively. Thus, there was a close correlation between the clinical grade based on the GCS and the incidence of VS, especially with infarct. The grade was also useful in predicting the surgical outcome. VS was more common in the older age group. The site of aneurysm or the day of surgery had no apparent influences on the incidence of VS or its outcome. Overall, the incidence of poor outcome due to VS proved to be 12%, which accounted for one-third of the cases in which there was poor outcome due to various causes.

Adult↗
PubMedDate not supplied

[Cerebral infarction, respiratory arrest, and coma after percutaneous catheterization of the right internal jugular vein].

The case of a 76 year old patient diagnosed of severe dysphagia by familiar oculopharyngeal muscular dystrophy is presented. Central venous catheterization (right internal jugular) was required for parenteral nutrition. A few minutes after catheterization, the patient developed respiratory arrest and coma and later cerebral vascular accident with left flaccid hemiplegia, with the ischemic lesion being focalized in the right parietooccipital region as well as in the left of the posterior fossa were observed. Aneurismatic dissection of the bilateral vertebral artery during lateralization of the head may be a cause of the lesions presented by the patient associated to arterial spasm or not. In central venous catheterization the possible complications derived from the position of the neck may carry must be taken into account.

Aged↗
PubMed1996

[Rhabdomyolysis related-acute renal failure in a patient with hyperosmolar nonketotic diabetic coma (HNKC): demonstration of myoglobin casts after normalization of renal function].

We report a patient with rhabdomyolysis secondary to hyperosmolar nonketotic diabetic coma (HNKC), who progressed to acute renal failure. A 43-year-old male with diabetes mellitus for three years was admitted to our hospital because of loss of consciousness. The laboratory findings at admission were as follows: serum glucose 1792 mg/dl, serum Na 129 mEq/1, BUN 71 mg/d1, serum creatinine 3.3 mg/d1, CPK 715 IU/1, plasma osmolality 370 mOsm/1, and negative urine ketone bodies. A diagnosis of HNKC was made. On the 2nd day, he had oliguria and the serum creatinine increased despite adequate treatment of HNKC by the administration of intravenous fluid and insulin. On the 4th day, CPK reached 47,300 IU/1, and serum myoglobin was also increased, indicating rhabdomyolysis. His renal function improved gradually and was almost normalized on the 20th day. Renal biopsy on the 23rd day showed myoglobin at the distal renal tubules, which appeared to be involved in the pathogenesis of renal failure by rhabdomyolysis. However, we found little abnormality association with diabetic nephropathy in the renal tissue. Since HNKC is known to induce acute renal failure rarely without diabetic nephropathy, these findings suggested that the acute renal failure was caused mainly by the rhabdomyolysis. Acute renal failure induced by rhabdomyolysis in patients with HNKC is rare, but fatal. The present study showed that the measurement of serum CPK and urine myoglobin was helpful for early diagnosis. Only 12 cases have been reported to have developed renal failure due to rhabdomyolysis among patients with HNKC. To our knowledge, we demonstrated for the first time that myoglobin at the distal renal tubules after renal function was normalized.

Acute Kidney Injury↗
PubMed1996

The addition of aminoacids and phosphate to hemodiafiltration solutions in newborns with hyperammonemic coma.

A child with carbamyl-phosphate-synthetase defect who died after prolonged continuous hemodiafiltration in deep coma proved to have high aminoacid losses despite aminoacid infusion. We think that this results from high small-solute clearance during hemodialysis. In order to prevent these inevitable catabolic side-effects we decided to add aminoacids to the dialysate and substitution fluid in these children with metabolic diseases. Additionally we propose to add phosphate in order to avoid depletion. The aim is to achieve anabolic or at least non-catabolic hemodiafiltration.

Amino Acids↗
PubMed1996

Prognostic value of Glasgow Coma Scale for tracheotomy in head injured patients.

The Glasgow Coma Scale (GCS), an indicator of the severity of head injury, may help identify the head injured patients who will eventually undergo tracheotomy. Authors' present retrospective study reveals that the likelihood of tracheotomy is significantly greater in patients with a GCS rating < 7 than in those with a GCS rating > 7 (p < 0.01). In order to minimize complications and make tracheotomy patients feeling more comfortable and communicable, this study argues for early tracheotomy in patients with a GCS score < 7, but never before 72 hours after injury, because it is a time necessary for patient stabilization and elimination of any illicit drugs or alcohol used prior to head injury.

Adolescent↗
PubMed1977

Hypocalcemic coma following two pediatric phosphate enemas.

Coma, tetany, dehydration, hypotension, tachycardia, and hyperpyrexia developed in a 2 1/2-year-old girl following two hypertonic phosphate pediatric enemas. She had marked hyperphosphatemia, hypocalcemia, hypernatremia, and acidosis. Hypocalcemia due to hyperphosphatemia can explain all of these findings. Calculations indicate that about one third of the phosphorus and sodium contents of the enema were absorbed. Physicians should be aware of the potentially lethal complication of this treatment, which is part of everyday practice.

Child, Preschool↗