1/40. Unexpected death in persons with symptomatic epilepsy due to glial brain tumors: a report of two cases and review of the literature.Two cases of unexpected death in persons with epileptic seizures due to a brain tumor are presented which encompassed an astrocytoma WHO grade II and an anaplastic astrocytoma WHO grade III. A 35-year-old man was found somnolent and disoriented at home. A computed tomography (CT) scan revealed a tumor of the right frontal lobe suggestive for an oligodendroglioma. During an angiographic examination the patient experienced an epileptic seizure. Some weeks later, the man was found dead in front of his house with a fresh bite mark of the tongue. Neuropathological examination revealed an astrocytoma WHO grade II of the right frontal lobe. A 47-year-old man plunged into a swimming-pool and was found submerged some minutes later. After resuscitation he survived comatose for 8 days but finally died due to severe hypoxic brain damage. He had been operated on a brain tumor of the temporal lobe 1 year before the accident. Neuropathological examination revealed residual tumor tissue at the operation site corresponding to an anaplastic astrocytoma WHO grade III. Although rare, death in persons with epileptic seizures due to brain tumors is an important mechanism of death encountered by the forensic pathologist.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
2/40. Asynchronous pentobarbital-induced burst suppression with corpus callosum hemorrhage.OBJECTIVE: We describe the electroencephalographic (EEG) findings in a 9-year-old girl, who presented with generalized tonic-clonic status epilepticus requiring pentobarbital anesthesia, and correlate these findings with clinicoradiologic evidence of a ruptured AVM with hemorrhage into the body of the corpus callosum. methods: EEG analysis accompanied by clinical assessment, CT and MRI scans, and cerebral angiography were performed. RESULTS: With pentobarbital coma, the EEG showed burst suppression with prominent interhemispheric asynchrony. Suppression epochs >2 s in duration and with amplitude <20 microV in all channels were identified. In 12 min of the EEG analyzed, 6 unilateral and 20 bilateral epochs occurred. Of the 20 bilateral suppression epochs, interhemispheric asynchrony of >1 s was noted at onset for 5 epochs and at offset for one. Chi-square analysis revealed an equal tendency for unilateral suppressions to occur over either hemisphere, and for suppression in one hemisphere to begin before the other. CONCLUSIONS: We conclude that the corpus callosum plays a critical role in interhemispheric synchronization of cortical neuronal electrical activity and propose that: (1) normally, the corpus callosum modulates interhemispheric synchronization of cortical inhibition; and (2) with corpus callosal disruption, cortical areas are 'released' from such synchronization.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
3/40. Hypotensive hemorrhagic necrosis in basal ganglia and brainstem.Hypotensive hemorrhagic necrosis of the basal ganglia and brainstem has only occasionally been described. Three such cases are reported. Cardiac arrest had occurred in all cases, and it took at least 1 hour to restore adequate circulation. The patients remained comatose for 2 days to 2 weeks until death. Persistent hypotension causing ischemia in the distribution of deep perforating arteries is considered to have been the key underlying mechanism. hemorrhage is thought to have been caused by extravasation of red blood cells through damaged blood vessels.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
4/40. The late neurological, psychological, and social aspects of severe traumatic coma.Thirty patients who had survived a heavy head trauma and a post-traumatic coma, lasting for more than one week, were investigated 8 to 14 years after the trauma. The patients have been followed up from a social, psychological, and neurological point of view. Fifty per cent of these patients are considered to be well rehabilitated. All the investigated patients showed slight to severe reduction in mental capacity. Eighty per cent of the patients had neurological defects which were not as important with respect to social rehabilitation as was the mental capacity reduction.- - - - - - - - - - ranking = 5keywords = coma (Clic here for more details about this article) |
5/40. ginkgo biloba precipitating epileptic seizures.BACKGROUND: The herbal remedy ginkgo biloba is promoted as a treatment for a variety of ailments including memory loss and dementia, poor concentration and mood, glaucoma, 'cerebral insufficiency' and 'peripheral circulatory disturbances'. It is gaining worldwide popularity, particularly as a potential treatment for dementia. case reports: Two patients with well-controlled epilepsy presented with recurrent seizures within 2 weeks of commencing extract of Ginkgo biloba. The herbal remedy was discontinued and both patients are seizure-free several months later. DISCUSSION: ginkgo biloba may have precipitated seizures in these two patients. This and other potential adverse effects should be highlighted on the packaging of the drug.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
6/40. Coma probably induced by lorazepam-valproate interaction.Both valproate (VPA) and lorazepam (LZP) are primarily cleared from the body by glucuronidation. Concomitant administration of VPA has been reported to reduce the elimination of LZP. However, it remains unknown whether this drug interaction is clinically significant. We report a patient with epilepsy who showed that VPA-LZP interaction could result in severe encephalopathy such as coma.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
7/40. Epileptic disorder as the first neurologic manifestation of blue rubber bleb nevus syndrome.Blue rubber bleb nevus syndrome is an uncommon neurocutaneous disorder characterized by distinctive vascular malformations on the body surface. vascular malformations of internal organs (typically the gastrointestinal tract) are also frequently present. However, malformations of the central nervous system have only rarely been described. We report a case of blue rubber bleb nevus syndrome in a 5-month-old boy with cutaneous manifestations characteristic of this process present from birth and multiple cerebral angiomas detected by magnetic resonance imaging. At age 1(1/2) months, the patient showed myoclonic seizures and complex partial seizures that were refractory to various antiepileptic regimens. At age 5 months, electroencephalograms (EEGs) showed continuous generalized slow spike-waves, predominantly in the right temporal region; however, EEGs normalized after induction of coma with intravenous midazolam. At age 13 months, the patient suffered from occasional seizures and slightly retarded psychomotor development. epilepsy is rare in this syndrome but as in other neurocutaneous syndromes (e.g., sturge-weber syndrome) can compromise psychomotor development; thus, every effort should be made to control seizures.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
8/40. Hydantoin derivatives and malignancies of the haemopoietic system.Two patients are described who developed malignant lymphoma (lymphosarcoma) after diphenylydantoin therapy because of epilepsy. Malignant lymphoma in a few patients receiving this medication has been described earlier. The literature has been reviewed and discussed recently by Rausing and Trell (2).- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
9/40. Detection by HPLC-ICP of metallothionein in serum of an epileptic child with valproate-associated hepatotoxicity.A patient who developed valproate-associated hepatotoxicity had significantly lower serum levels of total protein, albumin and selenium than the controls. This study shows that with the beginning of the hepatic coma metallothionein (MT) appeared in the serum mainly in the form of Zn-thionein, which altered the Zn distribution pattern of the serum in a characteristic manner. HPLC-ICP3 was successfully applied to the simultaneous speciation of elements and characterization of MT by the use of one gel permeation column.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
10/40. Mechanism of topiramate-induced acute-onset myopia and angle closure glaucoma.DESIGN: Interventional case report. methods: In an institutional practice setting, two women, aged 25 and 45, developed acute myopia after starting topiramate for epilepsy. One patient also developed bilateral angle closure glaucoma. RESULTS: Topiramate was discontinued. anterior chamber shallowing was noted in both patients at presentation. ultrasonography showed ciliochoroidal effusion. Baseline measurements of anterior chamber depth and lens thickness were obtained. CONCLUSIONS: Topiramate may be associated with ciliochoroidal effusion with forward displacement of the lens-iris diaphragm and anterior chamber shallowing, resulting in acute myopia and angle-closure glaucoma. Increased lens thickness contributes only minimally (9%-16%) to anterior chamber shallowing.- - - - - - - - - - ranking = 6keywords = coma (Clic here for more details about this article) |
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