1/4. rehabilitation outcome in a patient awakened from prolonged coma.BACKGROUND: This article describes the rehabilitation of a patient recovering from a prolonged coma (defined as lasting longer than 4 weeks). The case is noteworthy because it exemplifies the possibilities and difficulties entailed in treating these patients, who are often regarded as too severely impaired to justify intensive rehabilitation efforts. CASE REPORT: The patient is a 28-year old Polish male, unmarried, who suffered serious closed head injuries in an automobile accident in April of 1999. He was in a comatose state for more than two months, with a GCS score of 5. When admitted for rehabilitation he was bedridden, with global aphasia, agraphia, limb apraxia, and executive dysfunction. The rehabilitation program developed for him is described in detail. RESULTS: Over the course of rehabilitation, which began in December 1999 and continues to this writing, the patient has regained locomotion capabilities (though with impairments), and his speech has improved considerably. The apraxia has largely resolved, and he is able to write his name and copy words. He is now capable of performing many activities of daily living. CONCLUSIONS: A comprehensive program of rehabilitation characterized by a strategic, heuristic approach is capable of achieving a good outcome even in very difficult cases, such as prolonged coma.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
2/4. Posttraumatic cerebral hemispheric disconnection syndrome.Gross and microscopic lesions of the corpus callosum and neighboring structures are common in severe closed head injury. This report is the first, to our knowledge, to confirm neuropathologically the occurrence of extensive traumatic destruction of the corpus callosum in a patient with left-sided apraxia and agraphia. It also demonstrates that large traumatic lesions of the corpus callosum may occur without prolonged posttraumatic coma, vegetative state, or death. In our patient, coexisting extracallosal hemispheric lesions may have modified the effects of callosal pathology. Cases of this type may be more common than generally appreciated, but since symptoms of hemispheric disconnection are not apparent in ordinary behavior, specific tests of callosal function must be employed if disconnection phenomena are to be detected in the posttraumatic period.- - - - - - - - - - ranking = 0.14285714285714keywords = coma (Clic here for more details about this article) |
3/4. Oculomotor apraxia in a case of Gaucher's disease with homozygous T1448C mutation.We report a 10-month-old male infant with Type 2 Gaucher's disease. In addition to gradual arrest of neurological development, laryngospasm, opisthotonus, and limb rigidity, he presented characteristic oculomotor apraxia. history taking revealed that he had had abnormal horizontal gaze and had to turn his head to follow an object instead of moving the eyes alone. His eyes were in a divergent position while he was in a deep coma; however, when consciousness improved, he could open eyes with neutral eye position. Due to the impairment of reflex saccades, the doll's eye phenomenon was not reliable in evaluating the brainstem function when he was in the comatose stage. His leukocyte glucocerebrosidase activity was very low, but the typical Gaucher cell was absent in the sample of bone marrow aspiration. Molecular analysis by amplification refractory mutation system (ARMS) screening proved that he was a homozygote for T1448C mutation. To our knowledge, the T1448C gene frequency of Chinese Gaucher's disease is high. Thus, the ARMS screening method is applicable for further genetic diagnosis of Chinese Gaucher patients. Finally, this successful genetic diagnosis makes it possible in the future to perform prenatal diagnosis.- - - - - - - - - - ranking = 0.28571428571429keywords = coma (Clic here for more details about this article) |
4/4. Hypoxic brain injury with motor apraxia following an anaphylactic reaction to hymenoptera venom.Hypoxic brain injury can be a complication following several well known situations or disorders. The neurological and neuropsychological characteristics of patients who suffer hypoxic brain injury depend on the mechanism of injury and the structures of the brain that are particularly vulnerable to hypoxia. Injury to the hippocampus with resultant memory impairment is a well described clinical feature. Motor apraxia has not been described as a common feature following hypoxic injury. This paper describes an unusual case of hypoxic brain injury that resulted from an anaphylactic reaction to hymenoptera venom. The patient presented with severe ideomotor apraxia as he emerged from coma after cardiorespiratory arrest. Surprisingly, the patients memory was relatively preserved in relation to other cognitive impairments. A brief discussion of the pathophysiology of hypoxic brain injury and the patient's rehabilitation outcome is presented.- - - - - - - - - - ranking = 0.14285714285714keywords = coma (Clic here for more details about this article) |