1/12. Hemorrhagic shock and encephalopathy syndrome: neurologic features.Hemorrhagic shock and encephalopathy syndrome (HSES) is a severe disease that affects previously healthy infants of less than 1 year of age and is associated with significant mortality and neurologic morbidity. It is characterized by sudden onset of shock, convulsions and coma, bleeding due to severe coagulopathy, fever, diarrhea, metabolic acidosis, and hepatorenal dysfunction. central nervous system involvement with recurrent seizures and brain edema is the most common cause of high mortality and neurological morbidity. In this report, we describe four patients of HSES and review the initial and follow-up neurological features, electroencephalography findings, and the results of neuroradiological examinations of this catastrophic illness.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
2/12. Primary renal sarcoma with inferior vena cava thrombus presenting with tumor rupture.Primary renal sarcoma represents approximately one per cent of all primary tumors of the kidney in adults. We report an unusual case of primary renal sarcoma with inferior vena cava (IVC) thrombus. This patient presented with hemorrhagic shock due to tumor rupture. Emergent radical nephrectomy and vena caval thrombectomy were performed. Histological examination proved a clear cell sarcoma.- - - - - - - - - - ranking = 7keywords = coma (Clic here for more details about this article) |
3/12. Hemorrhagic shock due to intrathoracic rupture of an osteosarcoma of the rib.A 13-year-old girl presented with dyspnea and chest pain. Chest radiography showed a massive left pleural effusion. Computed tomography revealed a tumor of the fourth rib. A large bloody effusion was drained. Her anemia worsened (hemoglobin: 4.8 g/dl), and hemorrhagic shock ensued. An emergency thoracotomy was performed. Bleeding from the ruptured tumor was identified. The fourth rib, the tumor, and the adjacent tissues were resected. Histopathologic examination revealed a ruptured primary osteosarcoma of the rib with pleural dissemination.- - - - - - - - - - ranking = 5keywords = coma (Clic here for more details about this article) |
4/12. Bilateral and unilateral spontaneous massive hemothorax as a presenting manifestation of rare tumors.Spontaneous true hemothorax is quite a rare manifestation of a presenting disease. This is a report of two patients, one with bilateral spontaneous massive hemothorax as a presenting manifestation of angiosarcoma involving the lungs and pleura, and the other with unilateral spontaneous hemothorax and hemorrhagic shock as a presenting manifestation of 'cystic' chondroblastoma. Differential diagnosis of spontaneous true hemothorax and its evaluation and management are discussed.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
5/12. Dynamic changes in regional CBF, intraventricular pressure, CSF pH and lactate levels during the acute phase of head injury.The authors measured regional cerebral 133xenon (133Xe) blood flow (rCBF), intraventricular pressure (IVP), cerebrospinal fluid (CSF) pH and lactate, systemic arterial blood pressure (SAP), and arterial blood gases during the acute phase in 23 comatose patients with severe head injuries. The IVP was kept below 45 mm Hg. The rCBF was measured repeatedly, and the response to induced hypertension and hyperventilation was tested. Most patients had reduced rCBF. No correlation was found between average CBF and clinical condition, and neither global nor regional ischemia contributed significantly to the reduced brain function. No correlation was found between CBF and IVP or CBF and cerebral perfusion pressure (CPP). The CSF lactate was elevated significantly in patients with brain-stem lesions, but not in patients with "pure" cortical lesiosn. The 133Xe clearance curves from areas of severe cortical lesions had very fast initial components called tissue peaks. The tissue peak areas correlated with areas of early veins in the angiograms, indicating a state of relative hyperemia, referred to as tissue-peak hyperemia. Tissue-peak hyperemia was found in all patients with cortical laceration or severe contusion but not in patients with brain-stem lesions without such cortical lesions. The peaks increased in number during clinical deterioration and disappeared during improvement. They could be provoked by induced hypertension and disappeared during hyperventilation. The changes in the tissue-peak areas appeared to be related to the clinical course of the cortical lesion.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
6/12. Cerebral infarct in patients with hemorrhagic shock and encephalopathy syndrome.The syndrome of hemorrhagic shock and encephalopathy (HSE) was first described by Levin et al. in 1983 but not until recently has it been considered to be a newly identified devastating disorder. The main features of this syndrome consist of sudden onset of shock, coma, convulsions, coagulopathy, renal and hepatic dysfunction. The mortality rate is very high with surviving patients suffering from severe neurologic sequelae. In review of the literature, we did not find any reports of cerebral infarcts. Recently we managed two patients with this syndrome, both of whom had CT scan findings consistent with cerebral infarctions.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
7/12. Haemorrhagic shock encephalopathy.Three children suffered from acute onset of convulsions and progressive coma associated with hyperpyrexia, profound shock and generalized bleeding tendency. No causative agent could be identified. Despite aggressive resuscitation they all died. Post-mortem examination revealed cerebral oedema, petechial haemorrhages of the gut, lungs and kidneys, and a generalized depletion of lymphocytes in the lymphoid organs. Features were compatible with haemorrhagic shock encephalopathy, which is a highly fatal disease. The possible role of hyperpyrexia in its pathophysiology is discussed. More careful case identification and research in various possible aetiological factors may help elucidate its pathogenesis.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
8/12. Haemorrhagic shock and encephalopathy.Two infants are described with a fulminant disorder characterised by profound circulatory collaps and shock, generalised convulsions and unremitting coma, bleeding due to severe DIC, fever, diarrhoea, metabolic acidosis and renal and hepatic failure. Both infants died shortly after onset of the symptoms. autopsy mainly revealed haemorrhages in different organs, anoxaemic lesions in the brain and a normal structure of liver and pancreas. No causative agent could be demonstrated. We believe that both patients suffered from haemorrhagic shock and encephalopathy, a mostly fatal disorder which has recently been described. Although the clinical and biochemical features are very distinctive, this syndrome is probably heterogeneous and its differentiation from some other disorders may be difficult. Its pathogenesis is unknown but there are some indications that intravascular activity of trypsin may play a role. During a study of the two families we obtained abnormal results of immunologic tests in most members: the interpretation of this finding remains conjectural. Haemorrhagic shock and encephalopathy may occur more frequently than the restricted literature on this subject suggests. Future studies will have to deal with the question of identity and pathogenesis.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
9/12. Hemorrhagic shock and encephalopathy: further description of a new syndrome.Abrupt onset of coma, seizures, severe shock, and hyperpyrexia occurred in two previously healthy children. Their illnesses closely resembled a clinical syndrome of uncertain cause, the hemorrhagic shock and encephalopathy syndrome. Our patients had striking similarities to as well as certain differences from reported patients. Based on the similarities, we believe our two cases represent additional occurrences of the syndrome. Based on the differences, we conclude that the syndrome should be labeled "shock and encephalopathy syndrome" and that the prognosis may be improved by early aggressive treatment of shock.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
10/12. Support for the vasogenic theory of glaucoma: case reports and literature review.BACKGROUND: The influence of systemic disease, vascular abnormalities, hematologic and rheologic factors, pulsatile ocular blood flow, perfusion pressure, autoregulation, optic disc hemorrhage and the results of optic nervehead fluorescein angiographic studies are reviewed in the context of supporting evidence for the vasogenic theory of glaucoma. methods: Two case reports of patients with confirmed carotid artery occlusive disease and one case report of a patient with a history of hypovolemic blood loss are presented. RESULTS: These cases illustrate the importance of hypotensive crisis, perfusion pressure, collateral blood flow and the optic nerve head vascular autoregulatory mechanism in the pathogenesis of glaucoma and the differential diagnosis of pseudoglaucoma. CONCLUSIONS: Evaluation and consideration of both mechanical and vasogenic causes of the glaucomas is essential in the management of the glaucomas. It is also necessary to differential diagnose the "pseudo-glaucomas," and to manage them correctly.- - - - - - - - - - ranking = 10keywords = coma (Clic here for more details about this article) |
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