Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “COMA”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 19 recordsLinked to original sources
PubMed1990

Nontraumatic coma. Glasgow coma score and coma etiology as predictors of 2-week outcome.

In 1987 and 1988, we carried out a prospective study of patients older than 10 years with nontraumatic coma in the intensive care units of Columbia-Presbyterian Medical Center, New York, NY. Of 188 patients with Glasgow Coma Scale (GCS) determinations within 72 hours, 61% were dead or in persistent coma by 2 weeks from onset. Age, sex, and ethnicity did not influence outcome. The 2-week outcome for patients with initial GCS of 3 to 5 was 14.8% awake; 85.2% were dead or in persistent coma. For the GCS 6 to 8 group, 53.1% were awake and 46.9% were dead or in persistent coma. Hypoxic or ischemic coma had the worst 2-week outcome (79% dead or comatose); coma caused by metabolic disease or sepsis (68%), focal cerebral lesions (66%), and general cerebral diseases (55%) were intermediate, while drug-induced coma had a favorable outcome (27% dead or comatose). The independent predictors of 2-week outcome were the first GCS and drug-induced coma. The predicted probability of waking at 2 weeks was eight times better for drug-induced coma than other causes when GCS was held constant. Patients with an initial GCS score of 6 to 8 were seven times more likely to waken than those with a score of 3 to 5. The motor subscore alone was a significant independent predictor of 2-week outcome. Modification of coma score to include etiology may give more accurate predictions of 2-week outcome after nontraumatic coma.

Adolescent↗
PubMed1993

A physiological coma scale: grading of coma by combined use of brain-stem trigeminal and auditory evoked potentials and the Glasgow Coma Scale.

Forty-five comatose patients were prospectively studied by means of clinical examination and evoked potentials. In each patient, clinical data included Glasgow Coma Scale (GCS) score, age, pupillary response to light, corneal reflex, and eye movements. Neurophysiological evaluation was based on brain-stem trigeminal evoked potentials (BTEPs) and brain-stem auditory evoked potentials (BAEPs). For each physiological test, a progressive grading system was designed. This system was based on the evaluation of central conduction times along the trigeminal and the auditory pathways within the brain-stem. The accuracy of the clinical and the neurophysiological indicants in predicting "favorable" or "unfavorable" outcome was assessed singly and in combination. Of the clinical indicants, the GCS provided the most accurate prognosis (80%). Similar results were provided by the BAEP and the BTEP, with significant improvement in the confidence of outcome prediction. No significant difference in the accuracy of outcome predictions could be found between combined clinical data and neurophysiological data. However, the combination of clinical and neurophysiological data markedly increased both the accuracy and the confidence of outcome prediction, reaching 86% correct predictions at the over 90% confidence level with only 2% false pessimistic errors. According to these findings, a clinical-physiological coma scale, the trigeminal-auditory Glasgow (Coma Scale) score (TAG score) was designed. The TAG score demonstrated the highest accuracy at each confidence level as compared to other single indicants. We concluded that the TAG score may improve the evaluation of deep comatose patients and assist the physician in the management of such patients.

Adolescent↗
PubMed1993

A novel determinant (comA) essential for natural transformation competence in Neisseria gonorrhoeae and the effect of a comA defect on pilin variation.

A novel genetic determinant (comA) has been identified and found to be required for the transformation of piliated Neisseria gonorrhoeae. Mutants in comA of strain MS11 grow normally and are DNA-uptake proficient but blocked in the translocation of DNA into the cytoplasm. Here we show by site-specific mutagenesis and genetic complementation that only one of two open reading frames identified in comA is essential for competence: it encodes a protein (ComA) with a predicted size of 74 kDa. The comA gene maps upstream of the iga locus and is transcribed in the opposite orientation, probably under the control of a putative sigma 54-type promoter. While DNA probes specific for the N. gonorrhoeae iga locus reveal only a little cross-reactivity with commensal Neisseria species, the neighbouring comA gene appears to be present in most of them. ComA fusion proteins were obtained by in vitro translation. The synthesized gene products migrated atypically in SDS gels indicating its strong hydrophobicity. Several transmembrane alpha-helices were predicted from the amino acid sequence of ComA which, in the context of an observed sequence similarity with other inner membrane proteins, suggests a location for the protein in the inner membrane. Using piliated and non-piliated comA mutants the consequences of transformation deficiency on pilin phase variation were assessed. We show that the comA defect affects some but not all types of DNA rearrangements associated with pilE variation. The results are in agreement with previous observations supporting the notion that multiple recombination pathways contribute to the variability of pilE.

Amino Acid Sequence↗
PubMed1987

Coexisting alpha pattern coma, theta pattern coma and spindle coma.

Abnormal ectopic rhythms, such as alpha-theta activities and spindles, occur in comatose patients. A case is presented in which the EEG of a comatose patient showed coexisting alpha-theta pattern activities and spindles. It is concluded that the coexistence of these rhythmic patterns in the EEG of a comatose patient implies continued physiologic functioning of a thalamocortical system deafferented by brainstem dysfunction and a lesser degree of cortical dysfunction.

Alpha Rhythm↗
PubMed1984

Brain methanethiol and ammonia concentrations in experimental hepatic coma and coma induced by injections of various combinations of these substances.

In normal rats in a coma induced by NH+4 alone or by methanethiol alone, the brain and blood levels of ammonia or methanethiol are much higher than those observed in rats in experimental hepatic coma. When various smaller dosage combinations of NH+4, methanethiol, and octanoic acid were injected simultaneously, coma occurred at lower brain and blood concentrations of ammonia and methanethiol. Brain ammonia and methanethiol concentrations in normal rats receiving 0.75 mmol NH+4 plus 0.15 mmol octanoic acid plus 18 mumol methanethiol were comparable with those observed in 24 rats in hepatic coma after fulminant hepatic failure caused by acute massive ischemic liver necrosis. The normal rats became comatose. In these rats and in the rats in hepatic coma, the ammonia level in the brain was increased threefold and the methanethiol level in the brain was increased fivefold. Because these levels of ammonia and methanethiol were sufficient to induce coma in normal rats, they should also have been sufficient to induce coma in rats with damaged livers. Therefore, the accumulation of ammonia and methanethiol in the central nervous system after the acute massive ischemic necrosis may have been sufficient to account for the coma that ensued, without the involvement of other factors.

Ammonia↗
PubMed1982

[Valve of symptomatic therapy with memantine in cerebral coma. II. Development of stretch synergisms in coma with brain stem symptoms].

1,3-Dimethyl-5-aminoadamantane (DMAA, D-145, memantine, Memantine) was used in a group of 25 patients of both sexes in coma and with brain stem symptoms for symptomatic therapy. Only adults in whom a severe obtuse craniocerebral trauma was present were included in the study. The mean treatment time was 9.5 days, and the mean observation period 25 days. The clinical courses were established in accordance with Frowein's classification of coma. As expected, coma forms 3-4 exhibited only insubstantial changes during the observation period. About 30% of the coma-3 patients underwent a development to the apallic syndrome. Contrary to our expectations, a development to coma 1 took place in just under half of the coma-3 patients under memantine therapy during the observation period. The efficacy of the memantine treatment was also checked electromyographically. Both a marked reduction of the spontaneous rhythmic discharges and a reduction of the stimulus-dependent stretch movements were found in the superficial EMG of quadriceps muscle. In the transition stages of coma 3-4 the effects of the aminoadamantane therapy were demonstrable only in the EMG. The results are interpreted in the sense of a suppressing action of the substance on the gamma system of positional and posture motor activity.

Amantadine↗
PubMed1991

P300 auditory event-related potentials in nontraumatic coma. Association with Glasgow Coma Score and awakening.

Auditory event-related potentials (ERPs) were performed in 20 patients with nontraumatic coma to determine the presence of a P300 ERP in coma and its association with the Glasgow Coma Score and awakening (Glasgow Outcome Score, > or = 3). A standard "oddball" paradigm was used: frequent tone, 1 kHz; rare tone, 2 kHz and 4 Hz; probability, 20%. The Glasgow Coma Score was determined concurrently with the P300 ERP. Thirty percent (6/20) of the comatose patients had a P300 ERP. The mean Glasgow Coma Score was significantly higher for those with a P300 ERP. Eighty-three percent (5/6) of those with a P300 ERP awoke. Presence of a P300 ERP was associated significantly with awakening, but absence of a P300 ERP did not preclude it.

Adult↗
PubMed1982

[Valve of symptomatic therapy with memantine in cerebral coma. I. Correlation with coma stages and EEG spectral patterns].

1.3-Dimethyl-5-aminoadamantane (DMAA, D-145, memantine, Memantine) was used in a group of 45 patients of both sexes in our intensive care ward for the purpose of symptomatic therapy. The patients included in the study had been suffering from obtuse craniocerebral trauma and post-traumatic cerebrovascular complications. We evaluated only those cases in which the initial duration of the coma had been not less than 3 days. The mean treatment period was 9.5 days and the observation was continued over an average of 25 days. The clinical course was recorded on the basis of Frowein's coma classification introduced by the European Association of Neurosurgical Societies. In addition, we observed the development of any cerebroorganic psychosyndrome or the emergence of an apallic syndrome. As expected, apart from individual exceptions, a regression of the coma stages 1 to 3 was observed in the course of the observation period. The significant improvement of coma stages 2 and 3 already during the treatment with memantine should be emphasized. There was a transient increase in the category-1 coma group and in the patients with cerebro-organic psychosyndromes. In correlation with the development of the clinical course, an increase significant at the 5% confidence level was found in the documentation of the EEG spectral patterns in the "normal findings/slight over-all change" evaluation, as opposed to a significant reduction of the "moderate/pronounced over-all change" EEG finding (same confidence limit). The tolerance of memantine was generally graded as very good to good. No side effects that would have led to discontinuation of the treatment were observed, and in particular there was no impairment of the blood coagulation or of the metabolic activity of the liver cells. In long-term cerebro-electric check-ups it was found that no spasm potentials are produced at the doses used here, nor was there any promotion of the propagation of epileptic attack patterns when these had been present.

Adolescent↗
PubMed1984

Visual evoked potentials in a rabbit model of hepatic encephalopathy. II. Comparison of hyperammonemic encephalopathy, postictal coma, and coma induced by synergistic neurotoxins.

To assess neuronal mechanisms of potential importance in the pathogenesis of hepatic encephalopathy, visual evoked potentials were recorded in rabbits with acute hyperammonemic encephalopathy, postictal coma, and toxin-induced coma resulting from the administration of a combination of subcoma doses of three neurotoxins: ammonia, dimethyldisulfide, and octanoic acid. The patterns of visual evoked potentials in these three syndromes were compared with those of rabbits with hepatic encephalopathy due to galactosamine-induced fulminant hepatic failure. In the absence of seizures, the patterns of visual evoked potentials associated with hyperammonemic encephalopathy and toxin-induced coma were fundamentally different from those associated with any stage of hepatic encephalopathy due to galactosamine-induced fulminant hepatic failure. In contrast, the pattern of visual evoked potentials in early postictal coma induced by four different precipitating factors (including toxin-induced seizures) resembled that of late-stage hepatic encephalopathy due to galactosamine-induced fulminant hepatic failure. These findings suggest that the recording of visual evoked potentials may be of value in experimentally testing hypotheses of the pathogenesis of hepatic encephalopathy due to fulminant hepatic failure. They indicate that acute hyperammonemia is not a satisfactory model of hepatic encephalopathy due to galactosamine-induced fulminant hepatic failure, that the occurrence of seizures may lead to incorrect interpretation of experimental data from models of hepatic encephalopathy, and that the syndromes of hepatic encephalopathy due to galactosamine-induced fulminant hepatic failure and postictal coma may share similar neural mechanisms. Finally, the results of this study do not support the hypothesis that hepatic encephalopathy due to galactosamine-induced fulminant hepatic failure is mediated by the synergistic interaction of ammonia, mercaptans, and fatty acids on the brain.

Ammonia↗
PubMed1996

The Coma Exit Chart: assessing the patient in prolonged coma and the vegetative state.

The patient who remains in prolonged coma or in the vegetative state presents major problems in medicine, ethics and resource economics. Diagnosis and decision making are often difficult. A Coma Exit Chart can be developed using the parameters of the Glasgow Coma Scale to measure the exiting of the patient from prolonged coma or the vegetative state.

Awareness↗
PubMed2000

Comparison of APACHE II, MEES and Glasgow Coma Scale in patients with nontraumatic coma for prediction of mortality. Acute Physiology and Chronic Health Evaluation. Mainz Emergency Evaluation System.

INTRODUCTION: There are numerous prehospital descriptive scoring systems, and it is uncertain whether they are efficient in assessing of the severity of illness and whether they have a prognostic role in the estimation of the illness outcome (in comparison with that of the prognostic scoring system Acute Physiology and Chronic Health Evaluation [APACHE] II). The purpose of the present study was to assess the value of the various scoring systems in predicting outcome in nontraumatic coma patients and to evaluate the importance of mental status measurement in relation to outcome. PATIENTS AND METHODS: In a prehospital setting, postintervention values of the Mainz Emergency Evaluation System (MEES) and Glasgow Coma Scale (GCS) were measured for each patient. The APACHE II score was recorded on the day of admission to the hospital. This study was undertaken over a 2-year period (from January 1996 to October 1998), and included 286 consecutive patients (168 men, 118 women) who were hospitalized for nontraumatic coma. Patients younger than 16 years were not included. Their age varied from 16 to 87 years, with mean +/- standard deviation of 51.8 +/- 16.9 years. Sensitivity, specificity and correct prediction of outcome were measured using the chi2 method, with four severity scores. The best cutoff point in each scoring system was determined using the Youden index. The difference in Youden index was calculated using the Z score. For each score, the receiver operating characteristic (ROC) curve was obtained. The difference in ROC was calculated using the Z score. P < 0.05 was considered statistically significant. RESULTS: For prediction of mortality, the best cutoff points were 19 for APACHE II, 18 for MEES and 5 for GCS. The best cutoffs for the Youden index were 0.63 for APACHE II, 0.61 for MEES and 0.65 for GCS. The correct prediction of outcome was achieved in 79.9% for APACHE II, 78.3% for MEES and 81.9% for GCS. The area under the ROC curve (mean +/- standard error) was 0.86 +/- 0.02 for APACHE II, 0.84 +/- 0.06 for MEES and 0.88 +/- 0.03 for GCS. There were no statistically significant differences among APACHE II, MEES and GCS scores in terms of correct prediction of outcome, Youden index or area under ROC curve. CONCLUSIONS: APACHE II is not much better than prehospital descriptive scoring systems (MEES and GCS). APACHE II and MEES should not replace GCS in assessment of illness severity or in prediction of mortality in nontraumatic coma. For the assessment of mortality, the GCS score provides the best indicator for these patients (simplicity, less time-consuming and effective in an emergency situation.

APACHE↗
PubMed1991

A comparative study of the Reaction Level Scale (RLS85) with Glasgow Coma Scale (GCS) and Edinburgh-2 Coma Scale (modified) (E2CS(M)).

In this work a new coma scale for the assessment of responsiveness in acute brain disorders, constructed near the year 1985 by Scandinavian investigators, the Reaction Level Scale (RLS85), is compared with two other coma scales namely: (i) the Glasgow Coma Scale: (GCS); (ii) the Edinburgh-2 Coma Scale, after modification: (E2CS(M)). The study proceeded in the form of a statistical analysis of assessments made on 46 patients according to RLS85 and GCS (i.e., when comparison was with GCS) and on 28 patients according to RLS85 and E2CS(M). In all 74 cases two physicians participating as "observers" carried out the assessments. They were both contacting the patient--not together but--successively within a time interval of less than 20'. Hence the data appeared as "pairwise" observations for any of the three scales above. The results of the analysis, arising from a rather strict statistical reasoning, can be summarized as follows: (1) The rank correlation coefficient r(s) between: (i) RLS85 and GCS sum score, (ii) RLS85 and E2CS(M), was found to be at a satisfactory level meaning that all three scales indicate almost the same "ranking order of severity". (2) Reliability was compared by taking into account as to what extent the two observers agreed on RLS85 and--simultaneously--disagreed on the other scale. The "sign" test was applied and as a result RLS85 proved to be more reliable than; (i) GCS (EMY profile), (ii) GCS sum score, and (iii) E2CS(M), in all the above mentioned at a high level of significance. (3) Apart from the test above, some values of the index kappa (kappa) of interobserver agreement were calculated. Those corresponding to RLS85 are considerably higher. In particular the overall value based on 74 pairwise assessments amounted to kappa = 0.733 associated with a standard error sigma(kappa) = 0.061. This was a satisfactory result regarding the features of RLS85. (4) As far as coverage is concerned, again--by the "sign" test--the predominance of RLS85 versus GCS (EMY profile) was accepted.

Acute Disease↗
PubMed2000

CHOP Infant Coma Scale ("Infant Face Scale"): a novel coma scale for children less than two years of age.

The Glasgow Coma Scale (GCS) is the most frequently used tool worldwide for assessing the severity of neurologic injury after brain trauma, although applying this scale to infants and younger children can be problematic. The CHOP Infant Coma Scale, or Infant Face Scale (IFS), is a novel scale for children under 2 years of age which differs from other pediatric coma scales in the following ways: (1) it relies on objective behavioral observations; (2) it assesses cortical as well as brainstem function; (3) it parallels the GCS in scoring but is based on infant-appropriate behaviors; and (4) it can be applied to intubated patients. We report the results of a prospective study designed to compare interrater reliability between the IFS and GCS in children less than 2 years of age. Seventy-five hospitalized children less than 2 years of age were assessed simultaneously by a pair of observers, representing a spectrum of health care professionals, who scored the children using both the IFS and GCS. Interrater reliability for each pair of observers for each scale was assessed using the kappa statistic. A second series of 10 infants in the intensive care unit with specific diagnoses of acute traumatic or hypoxic/ischemic brain injury were similarly assessed. In the 75 hospitalized infants with a variety of diagnoses, interrater reliability for the GCS was in the "almost perfect," "slight," and "fair" range for the eye-opening, motor, and verbal subtests, respectively. In contrast, the IFS showed interrater reliability in the "almost perfect," "substantial," and "almost perfect" ranges for the three subtests. When applied to infants in an intensive care unit with acute traumatic brain injury or hypoxia/ischemia, the GCS interrater reliability scores were in the "fair" range, while the IFS scores were in the "almost perfect" range. The IFS demonstrates improved interrater reliability in direct comparison to the GCS, particularly in the "verbal/face" component where most pediatric coma scales are deficient. The IFS may prove to be a simple and practical bedside index of brain injury severity in children less than two years of age.

Brain Injuries↗
PubMed2003

Role of Glasgow Coma Scale in pediatric nontraumatic coma.

OBJECTIVE: To assess the relationship between Modified Glasgow Coma Scale (MGCS), its components and survival in children with acute coma. DESIGN: Prospective observational study. SETTING: Tertiary care referral hospital. PATIENTS: Consecutive children (n = 270) with acute nontraumatic coma between 2 months to 12 years. METHODOLOGY: MGCS and brainstem reflexes were assessed at 6 hourly intervals for 72 hours from the time of admission. The lowest score of the MGCS and worst brain stem reflexes were used for the analysis. MAIN OUTCOME MEASURE: Survival. RESULTS: Total score (Spearman rank correlation coefficient IRI = O.577, ocular response (IRI = O.641), motor response (IRI = O.729), verbal response (lRI = 0.608), brain stem response (lRI = O.843) were all found to be associated with adverse outcome. Multivariate regression analysis revealed that ocular response and motor response were individually predictive of short-term outcome. CONCLUSION: A score incorporating the brain stem reflexes, ocular response and motor response in the assessment and prognostication of comatose patients needs to be evaluated.

Child↗
PubMed1976

The blink reflex in coma and after recovery from coma.

Comparative studies of the blink reflex in a series of head injuries through the stages of coma and recovery from coma in a series of miscellaneous hemispheral lesions, and in a normal series, reveals that, although the principal centre for the R1 component of the blink reflex seems to be localised in the upper pons, the seat of the R2 late component is in the reticular system. The reappearance of this late component of the blink reflex in our cases of coma although seeming to depend on the integrity of the mesencephalic formation, correlates with the recovery of the patient's alertness. On the other hand, habituation of this reflex depends on the integrity of global cognitive function, rather than on any localised centre. The roles of the cortex, selective attention, and emotional factors, are discussed. The recovery of the normal habituation of the blink reflex obtained by glabellar tapping was found to be a useful sign in the follow up of patients recovering from concussion and other lesions, such as subdural haematomas and brain tumours, with global mental impairment.

Adult↗
PubMed1985

Clinical relevance of long-latency SEPs and VEPs during coma and emergence from coma.

Follow-up measurements of long-latency visual (VEP) and somatosensory (SEP) evoked potentials were performed on 30 comatose patients. Twenty-seven of the patients had severe head injury, 2 had encephalitis and 1 was in a posthypoxic state. For the SEP study a mechanical vibration stimulus was used, applied 60 times at intervals of 10 sec. The same rate was used for visual stimulation. The late EP components were classified by a signal-to-noise ratio (SNR), whereby an SNR of less than 2.6 is characteristic of a questionable or unmeasurable EP and an SNR greater than 2.6 is evidence of a clearly existing EP; the clinical state was scored using the Glasgow Coma Scale (GCS); the patient outcome was assessed 6 months after the injury using the Glasgow Outcome Scale. The highest correlation (r = 0.72) was found between the clinical state, represented by the GCS, and the SEP. A similar correlation (r = 0.66) was obtained between the GCS and the vertex VEP. The occipital VEP showed no correlation. Emergence from coma and recovery was accompanied by an increase of the SEP and an increasing spread of the VEP over the whole scalp. Most patients with a clear long-latency SEP in coma had a favourable outcome; a missing or a questionable SEP indicated a poor outcome.

Adolescent↗