1/8. serotonin syndrome. Presentation of 2 cases and review of the literature.serotonin syndrome is an underreported complication of pharmacotherapy that has been relatively ignored in the medical literature. We discuss 2 recent cases seen at our institution and 39 cases described in the English-language literature since 1995. We found that patients with serotonin syndrome most often (74.3%) presented within 24 hours of medication initiation, overdose, or change in dosage. The most common presenting symptoms and signs were confusion, agitation, diaphoresis, tachycardia, myoclonus, and hyperreflexia. The prevalences of hypertension, coma/unresponsiveness, seizures, and death were not as prominent in our study as previously reported, perhaps reflecting earlier recognition and intervention. The most common therapeutic intervention was supportive care alone (48% of patients). The use of 5-hydroxytryptamine (5-HT) antagonists such as cyproheptadine, however, has become more common and might reduce the duration of symptoms. Only 1 death occurred, and most patients (57.5%) had complete resolution of their symptoms within 24 hours of presentation. The increased use of serotonergic agents (alone and in combination) across multiple medical disciplines presents the possibility that the prevalence and clinical significance of this condition will rise in the future. Internists will need to be increasingly aware of and prepared for this pharmacologic complication. Prevention, early recognition of the clinical presentation, identification and removal of the offending agents, supportive care, and specific pharmacologic therapy are all important to the successful management of serotonin syndrome.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
2/8. Bilateral facial paralysis following ethylene glycol ingestion.Bilateral facial weakness, diminished hearing and dysphagia developed in a patient with a large overdose of ethylene glycol. Our case and two others previously reported draw attention to the fact that cranial nerve dysfunction, especially bilateral facial palsy, may occur in addition to encephalopathy, coma and renal failure with ethylene glycol ingestion.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
3/8. Comatose state maintained during eight years following a vascular ponto-mesencephalic lesion.A 24-year-old man survived for 8 years after a vascular lesion of the pons and midbrain. During these years a subresponsive comatose state with neurological signs extending from the oculomotor nuclei to the trigeminal and facial nuclei levels was present. A decorticated type of rigidity, with bilateral paralysis of the limbs accompanied by pyramidal signs, was also present. The EEG during the first months showed slow activity which afterwards gradually changed towards fast and alpha activities, maintained in the course of the years. The pathological diagnosis was a fibrous endarteritis, mainly in the territory of the basilar and vertebral arteries. The pons and midbrain, presenting a large cystic infarct, were serially studied to determine the anatomical extent of the lesion. After reviewing other examples from the literature, the clinical features of our case are discussed. The evolution of the EEG is related to different structures of the ponto-mesencephalic region with different functional activities.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
4/8. External ophthalmoplegia, alpha and spindle coma in imipramine overdose: case report and review of the literature.A 13-year-old boy with imipramine overdose developed seizures, respiratory arrest, and coma. Abnormalities of oculovestibular reflexes, electroencephalograms, and brainstem auditory evoked potentials were monitored in relation to measurements of drug levels. An alpha-coma electroencephalographic pattern evolved into one evidencing spindle coma and eventually into a normal pattern. Prolonged brainstem auditory evoked potentials also normalized as coma and oculocephalic reflex abnormalities resolved. In spite of the history that suggested hypoxic damage, the absence of reflex eye movements in a comatose patient and the presence of alpha- and spindle-coma electroencephalographic patterns, even with prolonged brainstem auditory evoked potentials, are not reliable prognostic indicators in tricyclic drug overdose.- - - - - - - - - - ranking = 10keywords = coma (Clic here for more details about this article) |
5/8. miller fisher syndrome, a brainstem encephalitis, mimics brain death.miller fisher syndrome is a rare focal encephalitis of the brainstem characterized by cranial nerve palsy, ataxia, and areflexia. While this condition usually is mild and self-limiting, as this case documents, findings may fulfill many of the criteria in the clinical examination for brain death. Unlike brain death, however, it is not associated with irreparable structural damage of the brain or, as is mandatory, does it fulfill a very important prerequisite of brain death, the exclusion of potentially reversible causes of coma. Treatment of miller fisher syndrome is supportive.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
6/8. Preserved cortical somatosensory evoked potentials in apnoeic coma with loss of brain-stem reflexes: case report.A comatose patient suffering from diffuse cerebellar haemorrhage developed apnoea and brainstem areflexia, i.e. the clinical signs of brain death. However, median nerve somatosensory evoked potential testing 2.5 h and 22 h after the onset of this clinical syndrome showed cortical potentials partly preserved; these were abolished 46 h after the beginning of the clinical signs of brain death. This case report underlines the need for electrophysiological confirmation of brain death in patients with primarily infratentorial lesions.- - - - - - - - - - ranking = 5keywords = coma (Clic here for more details about this article) |
7/8. vincristine treatment triggering the expression of asymptomatic charcot-marie-tooth disease.A 16-year-old male suffering from Ewing's sarcoma of the pelvis was treated with vincristine as part of his chemotherapeutic protocol. The boy was never known to suffer from any neurological problems. His father had a mild limp, attributed to prolonged "taxi driving," that was never investigated medically. The first course of treatment, which included 2 mg of vincristine, resulted in clinical improvement. However, at the same time the patient developed severe weakness of both upper and lower limbs, areflexia, and gradually a pes cavus deformity. Nerve conduction studies were suggestive of severe peripheral sensorimotor neuropathy, axonal and demyelinative. A definite diagnosis of Charcot-Marie-Tooth was confirmed by molecular analysis showing the typical duplication of 1.5 megabases at 17 p11.2. This unique manifestation of vincristine neurotoxicity is reported and discussed.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
8/8. Significance of positive spike burst in reye syndrome.We have previously reported a high incidence of 14-and 6-cps positive spike bursts in comatose patients with reye syndrome. To further demonstrate this association, positive spike bursts were obtained in three additional cases but only in certain stages during the acute phase of illness. They varied in frequency from 7 to 13 cps, presumably reflecting the degree of slowing of the background EEG activity. A loud noise or other stimuli often precipitated the bursts, particularly when high amplitude delta waves were prominant. We believe that the presence of the positive spike bursts in comatose patients may be of diagnostic significance in reye syndrome and that an undetermined metabolic or biochemical disturbance may be responsible for their appearance.- - - - - - - - - - ranking = 2keywords = coma (Clic here for more details about this article) |