1/12. Decerebrate rigidity with preserved cognition and gait: a possible role of anoxic-ischemic brain damage.A case of stable decerebrate posture in the upper limbs following sudden loss of consciousness and prolonged coma is described. The patient recovered most of her cognitive functions and gait, without clinical, neurophysiological or neuroradiological evidence of brainstem lesion. MRI shows borderzone infarcts. It is suggested that anoxic-ischemic cortical damage, affecting specially corticoreticular neurons, could explain the development of decerebrate rigidity in patients without apparent brainstem lesion.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
2/12. Catecholaminergic polymorphic ventricular tachycardia: successful emergency treatment with intravenous propranolol.Catecholaminergic polymorphic ventricular tachycardia (VT) is a rare arrhythmogenic disorder, which may cause sudden death and whose relationships with mutations in cardiac ryanodine receptor gene have been recently established.The present article reports a catecholaminergic polymorphic VT case of a 9-year-old girl, without any previous history of syncope, who has been found unconscious while playing and referred comatose to pediatric intensive care unit.The electrocardiogram pattern showed runs of bidirectional and polymorphic VT degenerating into ventricular fibrillation, without QT interval abnormalities. Various attempts of cardioversion, lidocaine, and magnesium sulfate intravenous infusions were only partially effective.Owing to catecholaminergic polymorphic VT highly suggesting electrocardiogram pattern, intravenous propranolol was administered, achieving immediate VT interruption. Long-term nadolol therapy effectively prevented further arrhythmias, with no relapses up to 10 months later; a good neurologic recovery was also obtained.Genetic evaluation revealed in this patient-but not in relatives-a mutation in ryanodine receptor gene on chromosome 1.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
3/12. Reversible decerebrate posturing after profound and prolonged hypoglycemia.Decerebrate rigidity is one of several reversible neurological abnormalities which have been observed in the setting of metabolic coma. We present the case of a patient who recovered fully from prolonged decerebrate rigidity associated with hypoglycemic coma. This case emphasizes the possibility of recovery from severe, prolonged hypoglycemia.- - - - - - - - - - ranking = 2keywords = coma (Clic here for more details about this article) |
4/12. Hypothalamic-midbrain dysregulation syndrome: hypertension, hyperthermia, hyperventilation, and decerebration.Certain decerebrate lesions of brain stem or hypothalamus induce pharmacologically reversible hypertension and hyperthermia in animals. We observed three young patients with episodic decerebration, hyperthermia, hypertension, and hyperventilation during recovery from comas of different etiologies. The shared pathology on neurologic examinations and computed tomographic scans was hypothalamic-mesencephalic dysfunction, suggesting a diencephalic-brain-stem disconnection syndrome or brain-stem release mechanism. propranolol was the most effective drug tested, but only two patients responded, one dramatically. This novel clinical syndrome may have localizing and therapeutic significance in pediatric coma that needs to be further defined in future studies.- - - - - - - - - - ranking = 2keywords = coma (Clic here for more details about this article) |
5/12. Primary brainstem injury without persistent coma and decerebrate rigidity. Report of 2 cases.Two patients with blunt head injury were examined by CT scanning. It was found that there was brainstem hemorrhage with unremarkable changes in the other parts of the brain. physical examination showed signs of upper brainstem lesion such as discoordination, bilateral Babinski signs, and internuclear ophthalmic palsy without persistent coma and decerebrate rigidity. The diagnosis of primary brainstem injury, well healed, was established. Basing on the results of these 2 cases, we believe that primary brainstem injury does exist, but it is not necessarily associated with persistent coma and decerebrate rigidity. CT scanning for diagnosing such cases is emphasized.- - - - - - - - - - ranking = 6keywords = coma (Clic here for more details about this article) |
6/12. Characteristic oscillations of intracranial pressure after delayed lowering of blood pressure in patient with shearing injury.A comatose patient with severe shearing injury showed hyperthermia, leucocytosis and decerebration. Rapid disappearance of brain swelling as well as a transient fall of blood pressure were peculiar in his clinical course. Large pressure waves appeared more frequently after such attacks. The authors concluded that cerebral vasomotor instability was caused by a primary lesion throughout an area from the anterior hypothalamus to the upper brain stem. Pre-existing hypoxia in such primary lesions was augmented by hypotensive episodes. Frequent appearance of large pressure waves was thought to represent progressive vascular engorgement followed by an uncontrollable increase of the ICP.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
7/12. Exertional rhabdomyolysis associated with decerebrate posturing.A case is presented in which decerebrate posturing after a head injury led to rhabdomyolysis and renal failure. Exertional rhabdomyolysis is caused by an energy deficient state in overworked musculature that leads to a loss of integrity of the muscle cell. The resultant myoglobin in serum leads to acute renal failure. This condition should be suspected in a comatose patient with fever, brown discoloration of the urine, and edema of the extremities. Laboratory results will show orthotoluidine positive urine with a clear serum, elevated serum creatine phosphokinase, and serum creatinine elevation out of proportion to blood urea nitrogen. Management consists of fluids and diuretics with dialysis if necessary. rhabdomyolysis with head injury and decerebracy may occur more frequently than has been previously reported.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
8/12. Traumatic decerebracy with preserved consciousness and voluntary movement.Decerebrate rigidity is a frequent occurrence in cases of craniocerebral trauma. It is almost always accompanied by coma and usually denotes a poor prognosis. Primary focal brain stem lesions due to trauma are uncommon and may be accompanied by other diffuse cerebral lesions. This report reviews the anatomical basis and clinical findings of a unilateral brain stem lesion in a patient with traumatic decerebracy and preserved consciousness. The anatomical pathways and possible physiological mechanism are discussed, and a few comments on the prognosis of such lesions are given.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
9/12. Evaluation of the comatose patient.This article has emphasized a basic approach to coma. First, the patient must have airway, breathing, and circulation protected. If the etiology of coma is in doubt, a broad metabolic screen is necessary. Table 5 demonstrates the major differences between structural and metabolic coma. Usually, history alone is sufficient to make an accurate diagnosis. If history or neurologic examination suggests a structural cause for the coma, then a cranial CT scan is mandatory. An electroencephalogram is often helpful, particularly in metabolic coma, and at times may even show structural abnormalities not demonstrated by CT scan. Rapid assessment and treatment is critical because coma is the clinical manifestation of brain failure, and often irreversible injury will occur if treatment is slow or incorrect.- - - - - - - - - - ranking = 10keywords = coma (Clic here for more details about this article) |
10/12. A tongue stent for prevention of oral trauma in the comatose patient.This paper presents the need for and offers a solution to the problem of factitial tongue and other intra-oral injuries in comatose and decerebrate patients. The neurophysiology of jaw movement in the comatose patient is the basis for the design of an intraoral prosthesis which in two patients has prevented discoordinate mandibular chewing movements and facilitated healing of preexisting factitial lesions. The authors delineate in detail the fabrication, insertion, and maintenance of this protective prosthesis and emphasize the need for joint effort between the intensive care, neurosurgical, and oral surgical teams.- - - - - - - - - - ranking = 6keywords = coma (Clic here for more details about this article) |
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