Prognosis of patients in prolonged coma after severe carbon monoxide poisoning

Background: Late recovery in patients following prolonged coma from carbon monoxide poisoning have been reported, but the probability is unclear. The purpose of this research was to assess the prognosis of patients in prolonged coma after severe carbon monoxide poisoning and related clinical and imaging features. Methods: There were 13 patients who had been in a state of coma for >7 days after acute carbon monoxide poisoning in the retrospective observational study, and demographic data, clinical data, laboratory data, complications, and image data were collected. Outcome was assessed by means of the Glasgow outcome scale after 1 year. The relationship between complications and imaging manifestations and prognosis was also analyzed. Results: One year after severe carbon monoxide poisoning, two patients (15.4%) had died (GOS 1), nine (69.2%) were in a persistent vegetative state (GOS 2), one (7.7%) was moderately disabled (GOS 4), and one (7.7%) achieved a good recovery (GOS 5) with minimal disability. Conclusions: Most patients with prolonged coma after severe carbon monoxide poisoning had a poor prognosis, although the younger patients had a better prognosis. Respiratory failure, hypotension and renal failure during the course of the disease were associated with a poor prognosis. The prognosis of patients with injuries in two sites in early CT was poor. Multiple lesions (≥3) and extensive white matter damage (Fazekas grade (PVH or DWMH) = 3) on MRI of chronic phase were also associated with a poor prognosis.

Selective Serotonin Reuptake Inhibitor Therapy Reduces Time to Emergence and Arousal from TBI-induced Prolonged Coma: A Pilot Study

Objective: Traumatic Brain Injury (TBI) continues to be a significant cause of death and disability in the United States and is commonly due to sudden, forceful impacts to the head. This may lead to disruption of neurological and neurochemical functioning of the brain, resulting in coma (Glascow Coma Scale score (GCS) ≤ 8). The objective of this study is to evaluate the potential effect of Selective Serotonin Re-uptake Inhibitors(SSRI), sertraline, on improvement in the level of consciousness and motor function in patients with prolonged, refractory coma after severe TBI. It has been theorized that the administration of SSRIs may shorten the time to emergence from comain trauma victims presenting with low GCS scores. Methods: The data from 14 trauma patients with severe TBI and Refractorycoma (RC) as defined by a GCS score <8 (coma) for >6 days admitted to the surgical intensive care unit (SICU) at a busy urban level 1 trauma center was retrospectively collected and screened. The patients were started on sertraline between 7 to 21 days after sustaining TBI-induced coma, principally based on attending judgment and preference, and were compared to a control group of similar TBI-induced prolonged coma patients admitted to the ICU during the study period who did not receive SSRI therapy. Results: In the study, 100% of the SSRI group became aroused to a GCS >8 and 66.7% (6/9) emerged to a minimally conscious state or regained consciousness based on a GCS scores >9 or 9T over a period of 11.9 days after initiation of therapy whereas 60% of control patients (3/5) emerged from coma. Conclusion: SSRI therapy using Sertraline may be associated with shorter time to emergence and improved reactiveness in patients with prolonged refractory coma states post-TBI.

Prolonged Coma after Pituitary Macro- adenoma Surgery: A Case Report with Short Literature review

Prolonged coma after surgery of pituitary macro-adenoma with apoplexy, often previously unnoticed, is rare and not well reported complication. A 65 year male presented with complaints of headache and blurred vision since few months. Brain MRI was done and it reported macro- adenoma with pituitary apoplexy. Right pterional craniotomy was done following total excision of tumor. Patient developed whole body seizure at first day of surgery and went to prolonged coma.

Brain Death

This chapter considers the issue of brain death. The cornerstone of the diagnosis of brain death is a careful and sure clinical neurologic examination. In addition, a thorough evaluation of clinical history, neuroradiologic studies, and laboratory tests needs to be carried out to rule out potential confounding variables. The diagnosis of brain death rests on two major and indispensable tenets. The first is that the cause of brain nonfunction must be inherently irreversible. The second is that the vital structures of the brain necessary to maintain consciousness and independent vegetative survival are damaged beyond all possible recovery. It looks at how to determine that brain death has occurred. It goes on to outline the clinical signs for brain death. The chapter also looks at the differences between brain death and prolonged coma. Finally, it explains the management of the brain dead patient.

A Patient with Intermediate Syndrome with Toxic Encephalopathy Following Organophosphate Poisoning

OP poisoning is the common cause of mortality and morbidity in Bangladesh. Although acute cholinergic crisis is the common form of presentation of such cases, the intermediate syndrome and delayed encephalopathy can be also presented in op compound. A 14 year old adolescent presented with acute onset of intermediate syndrome and simultaneous early encephalopathy after ingestion of combination of Chlorpyrifos with Cypermithrin known popularly as market name of ‘Mortar’. The patient was provided supportive care and few days of ICU care with complete recovery. The interesting feature of the case was absence of cholinergic crisis and hence patient was not treated with atropine or pralidoxime.The simultaneous combination of presenting features, prolonged coma and even on absence of specific antidote complete recovery was the highlighting points of this unique case. Bangladesh J Medicine Jan 2019; 30(1) : 41-43