1/17. Delayed methotrexate clearance in a patient with sickle cell anemia and osteosarcoma.A 15-year-old girl with homozygous sickle cell anemia (HbSS) and osteosarcoma is described. Delayed clearance of methotrexate (MTX) after the second course of high-dose MTX (HDMTX) led to the development of renal and hepatic toxicities. Rescue was accomplished with high-dose leucovorin, intravenous carboxypeptidase G2, and thymidine. Although the renal and hepatic abnormalities resolved, focal tonic-clonic seizures developed, accompanied by abnormal brain imaging. Four weeks after this episode, all clinical and biochemical abnormalities resolved. Preexistent end-organ damage associated with HbSS may compromise the ability to deliver high-dose chemotherapy with curative intent in patients with malignant disease.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
2/17. Encephalopathy complicating high-dose melphalan.High-dose melphalan (HDM) with peripheral blood stem cell transplant (PBSCT) is a common treatment for patients with multiple myeloma (MM) and more recently also with AL amyloidosis (ALA). We report two female patients with severe renal failure who underwent treatment with HDM for MM (patient 1) and ALA (patient 2). Both patients developed severe encephalopathy with generalised tonic-clonic seizures and a glasgow coma scale (GCS) of 3/15. Causes for coma such as infections, metabolic disturbances, cerebral ischaemia or haemorrhage were excluded. Patient 1 died on day 25 post transplant while comatose. Patient 2 recovered from her comatose state 18 days after transplantation. To our knowledge this is the first report on a possible role of high-dose melphalan in the development of encephalopathy.- - - - - - - - - - ranking = 0.6keywords = coma (Clic here for more details about this article) |
3/17. Acute isoniazid neurotoxicity during preventive therapy.OBJECTIVE: To describe rare side effects of treatment with isoniazid. DESIGN: Descriptive case report. SETTING: Medical intensive care unit in a university medical center. PATIENT: A 14-yr old previously healthy girl receiving preventive isoniazid therapy who suddenly developed generalized tonic-clonic seizures and coma. INTERVENTIONS: Patient was sedated and mechanically ventilated. She also received pyridoxine intravenously. MEASUREMENTS AND MAIN RESULTS: An isoniazid overdose was not confirmed. Computed tomography of the brain and electroencephalogram revealed nothing abnormal. seizures gradually disappeared within 2 hrs after sedation and treatment with pyridoxine. The patient was discharged on day 14 without consequences and has been well for 10 mos. No seizures reappeared after isoniazid was discontinued. CONCLUSIONS: We caution against possible isoniazid neurotoxicity in healthy individuals using recommended preventive doses.- - - - - - - - - - ranking = 0.2keywords = coma (Clic here for more details about this article) |
4/17. Severe neurotoxic reaction associated with oral ingestion of low-dose diethyltoluamide-containing insect repellent in a child.N,N-Diethyl-m-toluamide (deet) is the major component of almost all tick repellent products. Reports of severe adverse reactions following voluntary ingestion are rare and primarily involve adults. This report describes a case of a toxic reaction after ingestion of low doses (80 mg/kg) of deet in a child. The signs and symptoms were coma and seizures within 2 hours of ingestion. The patient recovered without sequelae. It is concluded that even scant doses of deet may provoke severe encephalopathy in small children, and caution should be used when leaving this chemical unattended.- - - - - - - - - - ranking = 0.2keywords = coma (Clic here for more details about this article) |
5/17. Primary fibrosarcoma of brain.This is a case presentation of a young patient with an intracranial space-occupying lesion following multiple episodes of generalised tonic clonic seizures for the last 20 years. Such a long latency period between the onset of fits and the discovery of an intracranial lesion is highly unusual in malignant brain tumours. This lesion was excised completely and proved to be a primary lesion of the brain - fibrosarcoma. These rare tumours of mesenchymal origin in the central nervous system are very rare.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
6/17. Periodic lateralized epileptiform discharges in influenza B-associated encephalopathy.An 18-year-old woman presented with coma, hemicomvulsions, and transient periodic lateralized epileptiform discharges (PLEDs). Serological tests were positive for influenza B, and cerebrospinal fluid PCR for herpes simplex virus dna was negative. magnetic resonance imaging later showed abnormal signal intensity in the temporal lobe ipsilateral to the PLEDs. Influenza-associated encephalopathy may cause hemiconvulsions and PLEDs, and can mimic herpes simplex encephalitis.- - - - - - - - - - ranking = 0.2keywords = coma (Clic here for more details about this article) |
7/17. Long lasting impaired cerebral blood flow after ecstasy intoxication.Four hours after having taken 10 ecstasy tablets a Grand Mal seizure occurred in a 19-year-old woman followed by coma, hyperthermia, tachycardia, tachypnea, and renal failure. After awakening she was oriented but presented with helplessness, disconcertion, hallucinations, panic attacks, and amnesic syndrome. Computed tomography and magnetic resonance imaging scans of the brain were normal. [99Tc]-hexamethylpropyleneamine oxime (HMPAO)-single photon emission computed tomography (SPECT), 20 days after intoxication, showed reduced, inhomogeneous, supratentorial tracer uptake bilaterally. electroencephalography (EEG) disclosed diffuse slowing and occasionally generalized sharp waves. valproic acid was begun. Except for slight amnesia, neuropsychological deficits had disappeared and [99Tc]-HMPAO-SPECT normalized, 29 days later. Decreased cortical blood flow was explained by vasoconstriction following ecstasy-induced depletion of serotonin.- - - - - - - - - - ranking = 0.2keywords = coma (Clic here for more details about this article) |
8/17. Alveolar soft-part sarcoma presenting with multiple intracranial metastases.A 28-year-old man presented with history of raised intracranial pressure and one episode of generalized tonic clonic seizures. Computed Tomogram revealed multiple contrast enhancing intracranial lesions. biopsy of one of the lesions was reported as metastatic alveolar soft part sarcoma. He was advised whole brain radiotherapy.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
9/17. Localized subepidermal bullae after intravenous phenobarbital.The occurrence of subepidermal bullae and sweat gland necrosis in barbiturate-induced coma is well recognized. We report the case of a patient who received intravenous phenobarbital for refractory seizures and subsequently sustained subepidermal bullae without sweat gland necrosis in the skin around and proximal to the intravenous site. Although this may have been secondary to extravasation, a different mechanism of barbiturate-induced bulla formation may exist.- - - - - - - - - - ranking = 0.2keywords = coma (Clic here for more details about this article) |
10/17. The eyes in hysterical states of unconsciousness.Forced downward deviation of the eyes has been described as a useful sign in patients with hysterical coma and seizures. Two patients are described emphasizing the value of this test in prolonged feigned seizured states as well as in hysterical syncopal episodes.- - - - - - - - - - ranking = 0.2keywords = coma (Clic here for more details about this article) |
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