Cases reported "Coma"

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11/102. Bispectral index monitoring during hypoglycemic coma.

    Bispectral index (BIS) monitoring is gaining wide acceptance as a gauge of the hypnotic effect of anesthetics. However, change in BIS in relation to the mental status of diabetic patients due to hypoglycemia has not been reported to date. We describe a case in which BIS was found to correlate with a patient's level of consciousness and changes in blood glucose levels.
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ranking = 1
keywords = status
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12/102. Ulcerative colitis, status epilepticus and intractable temporal seizures.

    Three patients with ulcerative colitis (UC) and without any other risk factors, developed intractable status epilepticus de novo. Intractable temporal lobe seizures followed and were investigated 7-19 years later. Two had bi-temporal abnormalities and catastrophic memory loss and the third, severe temporoparietal damage. Status occurred in the context of steroid taper, fasting and abdominal surgery respectively, and it is unlikely that it was merely due to coincidence. encephalitis or vasculitis were suspected in all cases, but without evidence; metabolic factors may have been present. status epilepticus in UC may lead to catastrophic sequelae.
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ranking = 353.50370742167
keywords = status epilepticus, epilepticus, status
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13/102. Intrathecal saline infusion in the treatment of obtundation associated with spontaneous intracranial hypotension: technical case report.

    OBJECTIVE AND IMPORTANCE: Spontaneous intracranial hypotension is an increasingly recognized cause of postural headache. However, appropriate management of obtundation caused by intracranial hypotension is not well defined. CLINICAL PRESENTATION: A 43-year-old man presented with postural headache followed by rapid decline in mental status. Imaging findings were consistent with the diagnosis of spontaneous intracranial hypotension, with bilateral subdural hematomas, pachymeningeal enhancement, and caudal displacement of posterior fossa structures and optic chiasm. INTERVENTION: Despite treatment with lumbar epidural blood patch, worsening stupor necessitated intubation and mechanical ventilation. Contrast-enhanced magnetic resonance imaging and computed tomographic myelography of the spine failed to demonstrate the site of cerebrospinal fluid fistula. The enlarging subdural fluid collections were drained, and a ventriculostomy was performed. Postoperatively, the patient remained semicomatose. To restore intraspinal and intracranial pressures, intrathecal infusion of saline was initiated. After several hours of lumbar saline infusion, lumbar and intracranial pressures normalized, and the patient's stupor resolved rapidly. Repeat computed tomographic myelography accomplished via C1-C2 puncture demonstrated a large ventrolateral T1-T3 leak, which was treated successfully with a thoracic epidural blood patch. Follow-up magnetic resonance imaging demonstrated resolution of intracranial hypotension, and the patient was discharged in excellent condition. CONCLUSION: Spontaneous intracranial hypotension may cause a decline of mental status and require lumbar intrathecal saline infusion to arrest or reverse impending central (transtentorial) herniation. This case demonstrates the use of simultaneous monitoring of lumbar and intracranial pressures to appropriately titrate the infusion and document resolution of intracranial hypotension. Maneuvers aimed at sealing the cerebrospinal fluid fistula then can be performed in a less emergent fashion after the patient's mental status has stabilized.
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ranking = 3
keywords = status
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14/102. Unrecognized internal jugular vein obstruction: cause of fatal intracranial hypertension after tracheostomy?

    We report an unusual case of fatal intracranial hypertension following tracheostomy due to the obstruction of the internal jugular veins (left side: thrombosis after central venous cannulation, right side: hypoplastic vein) and their collaterals. Principal cerebral outflow through the internal jugular veins can be substituted by the internal and external vertebral vein plexus because blood drains from the brain by two major routes: the internal jugular veins and the vertebral venous plexus. We suggest transcranial color-coded duplex sonography as a simple bedside method to detect patients with significant reduction of venous drainage who are at risk of developing massive cerebral venous congestion as a result of reduced intracranial elastance.
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ranking = 0.00025379709226288
keywords = simple
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15/102. Ethical issues in transplantation: living related donation in the setting of severe neurological damage without brain death.

    The waiting list for renal transplantation has grown at an alarming rate over the last 2 decades, resulting in increased waiting times and deaths on the waiting list. To increase the number of available organs for transplantation, aggressive public education programs have been developed. The federal government has strengthened hospital regulations ensuring referral of all potential donors to organ recovery agencies, and living donor programs no longer limit donation to genetically related donors and recipients. We present a case that illustrates the complex ethical issues that are integral to the field of transplantation and the allocation of a scarce resource: a 50-year-old man who has a daughter with end-stage renal disease has suffered a severe cerebral vascular accident but is neither brain-dead nor a candidate for "non-heart-beating" donation. Given his poor prognosis, should the father be able to donate his kidney to the daughter in his compromised condition?
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ranking = 0.00039950583468977
keywords = complex
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16/102. Reversible coma caused by risperidone-ritonavir interaction.

    Medications that act on the central nervous system are frequently used in people infected with human immunodeficiency virus (hiv). Actually, drug interactions are an important factor in the treatment of patients with (hiv) infection and because of the complexity of the current drug regimens, clinicians should be trained in order to recognize and manage drug interactions. Herein, we present an hiv infected male admitted for manic behavior and treated with risperidone who developed a profound coma secondary to increased levels of risperidone because of a possible drug interaction with ritonavir and indinavir. Subsequently, we discuss this interaction, rarely described in the literature. risperidone is a cytochrome P450 (CYP2D6) enzyme substrate and weak inhibitor and a CYP3A4 substrate. Possible interactions with CYP2D6 inhibitors (amiodarone, fluoxetine or ritonavir) and CYP3A4 inhibitors (indinavir and ritonavir) can increase its serum concentrations and produce significant adverse effects. In conclusion, this drug combination should be administered with caution and routinely examined for signs and symptoms of risperidone toxicity. Dosages should be reduced as needed. Finally, we think that in patients taking multiple medications, plasma levels of risperidone should be monitored especially if drug interactions are possible.
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ranking = 0.00039950583468977
keywords = complex
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17/102. Use of an anesthesia cerebral monitor bispectral index to assess burst-suppression in pentobarbital coma.

    A seven-year-old child with generalized status epilepticus who was placed in a barbiturate coma was monitored with the bispectral index monitor in addition to the standard full channel electroencephalogram. This child had a low bispectral index number and high suppression ratio on the bispectral index monitor when the desired level of pentobarbital coma was induced. There was excellent correlation of the bispectral index monitor to the suppression ratio. The burst rate also correlated well to the bispectral index number and to the suppression ratio. Therefore the bispectral index monitor could allow the patient in barbiturate coma to leave the intensive care unit for diagnostic or therapeutic procedures and may one day replace the full-channel electroencephalogram in the management of patients in barbiturate coma.
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ranking = 67.193049279505
keywords = status epilepticus, epilepticus, status
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18/102. Case report: hypoglycemia and diffusion-weighted imaging.

    The effect of severe hypoglycemia on the brain is well known, ranging from alterations of mental status to profound coma and death. We describe a case of global diffusion abnormalities eventually resulting in death. This otherwise healthy patient presented with seizures and a serum glucose level less than 20 mg/dL. Testing suggested that the hypoglycemia was likely caused by exogenous insulin or perhaps insulin receptor antibodies. magnetic resonance imaging on the day after admission showed regions of restricted diffusion in the temporal and occipital lobes as well as in the basal ganglia. Despite the large body of literature concerning the pathophysiology of hypoglycemia and its clinical implications, little is known regarding its radiologic correlations.
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ranking = 1
keywords = status
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19/102. Ingestion of tea tree oil (melaleuca oil) by a 4-year-old boy.

    A 4-year-old boy ingested a small quantity of tea tree oil. Within 30 minutes, he became ataxic and shortly thereafter progressed to unresponsiveness; he was endotracheally intubated by paramedics. His neurologic status improved gradually over 10 hours, and he remains well on follow-up. tea tree oil is an increasingly popular topical antiseptic that is available in a wide variety of products, often without warning labels. Healthcare providers should be aware of the common uses of tea tree oil, as well as its potential toxicity.
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ranking = 1
keywords = status
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20/102. ammonia induced encephalopathy from valproic acid in a bipolar patient: case report.

    valproic acid is widely used as a mood stabilizer. We report a case of an adult with bipolar disorder taking therapeutic doses of valproic acid, who presented to the emergency department with coma related to hyperammonemia as a complication of valproic acid treatment. valproic acid was discontinued which resulted in rapid clinical recovery. valproic acid induced coma was likely related to a urea cycle enzymopathy. Clinicians should consider hyperammonemia in all patients who present with coma and other mental status changes while on valproic acid. In such patients, ammonia level should be obtained in addition to liver function tests.
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ranking = 1
keywords = status
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