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Richard L Mah, John F Connolly
Generally, prognostication of coma outcome currently combines behavioral, reflex, and possibly neuroimaging tests that are interpreted by an attending physician. Electroencephalography, particularly, event-related brain potentials (ERP) have received attention due to evidence demonstrating the positive predictive value of certain ERP including the mismatch negativity (MMN) and the P3a, for coma emergence. We describe a set of ERP paradigms designed to require and reflect increasing levels of cognitive processing with the added objective of determining the influence of each paradigm's context strength on its ability to elicit ERPs...
2018: PloS One
Konrad Oppelt, Doreen Hähnlein, Jürgen Boschert, Maike Küffer, Paul Alfred Grützner, Matthias Münzberg, Michael Kreinest
PRIMARY OBJECTIVE: We evaluated the neurologic, psychological and vegetative outcome, the health status and changes of the personal and occupational status of patients after traumatic brain injuries (TBIs). Correlations between outcome parameters and basic demographic factors and initial clinical status parameters of the patients were assessed. RESEARCH DESIGN: Monocentric, retrospective follow-up analysis. METHODS AND PROCEDURES: We evaluated the neurologic, psychological and vegetative outcome and health status of patients, who survived TBI with a mean follow-up time of 54 months...
July 19, 2018: Brain Injury: [BI]
Esraa El-Mayah, Mohamed Anis, Mohsen Salem, David Pinero, Mohamed Hosny
PURPOSE: To compare Q-adjusted femtosecond-assisted laser in situ keratomileusis (FS-LASIK) and small-incision lenticule extraction (SMILE) in terms of safety, efficacy, and predictability, as well as in terms of changes in dry eye parameters, corneal biomechanics, higher-order aberrations (HOAs), and corneal asphericity. METHODS: A total of 60 eyes were enrolled in this prospective comparative study: 30 underwent SMILE and 30 underwent FS-LASIK. Changes in manifest refraction, uncorrected distance visual acuity and corrected distance visual acuity, corneal topography, corneal hysteresis (CH), and corneal resistance factor (CRF) (Ocular Response Analyzer, ORA), and dry eye parameters were evaluated during a 3-month follow-up...
July 17, 2018: Eye & Contact Lens
Ahmet Korkut Belli, Önder Özcan, Funda Dinç Elibol, Cenk Yazkan, Cem Dönmez, Ethem Acar, Okay Nazlı
Objective: The spleen is the most vulnerable organ in blunt abdominal trauma. Spleen-preserving treatments are non-operative management with or without splenic angioembolization, partial splenectomy, and splenorrhaphy. The aim of the present study was to determine the rate of SPTs and to evaluate the usefulness of Injury Severity Score after traumatic splenic injury. Material and Methods: We searched our institution's database between May 2012 and December 2015...
2018: Turkish Journal of Surgery
Samuel R Brown, Carlos Fernandez, Robert Bertellotti, Juan Antonio Asensio
A 53-year-old man was admitted to our trauma center after sustaining thoracoabdominal injuries, secondary to a rear-end motor vehicle collision. As he stepped out of his vehicle, he was struck by a tractor trailer at 55 mph. The following were the initial vital signs on his arrival: heart rate 140 beats/min, blood pressure 142/80 mm Hg, respiratory rate 28 breaths/min, temperature 36.8°C, and oxygen saturation 93%. The Glasgow Coma Scale score was 15 and the Injury Severity Score was 59. He was evaluated and resuscitated per the advanced trauma life support protocols...
2018: Trauma surgery & acute care open
David M Williams, Natasha Shrikrishnapalasuriyar, David E Price, Jeffrey W Stephens
We present a case of a 44-year-old man, civil servant, who presented to the emergency department (ED) following an episode of collapse. He was usually fit and well and while at work he had developed a headache with pins and needles over his face and subsequently collapsed. On arrival to ED, he had a Glasgow Coma Scale (GCS) of 4/15. There was no history of note apart from being prescribed citalopram for depression. Laboratory investigations revealed severe hypophosphataemia (phosphate 0.19 mmol/L) and no other electrolyte abnormality...
July 18, 2018: BMJ Case Reports
Alberto Salas Ballestín, Juan Carlos de Carlos Vicente, Guillem Frontera Juan, Artur Sharluyan Petrosyan, Cristina M Reina Ferragut, Amelia González Calvar, Maria Del Carmen Clavero Rubio, Andrea Fernández de la Ballina
OBJECTIVE: The aim of this study was to evaluate the prognostic factors of patients admitted to a pediatric intensive care unit (PICU) after drowning. METHODS: Retrospective observational study from January 1992 to December 2004 and prospective study from January 2005 to December 2015 were conducted in a tertiary children's hospital PICU. The data analyzed refer to the patient, event, type of resuscitation performed, and clinical situation after resuscitation and at arrival to the PICU; results of additional tests; and clinical evolution and neurological status at discharge from the PICU (categorized as death, severe encephalopathy, or normal)...
July 16, 2018: Pediatric Emergency Care
Naomi Ketharanathan, Yumi Yamamoto, Ursula Karin Rohlwink, Enno Wildschut, Ron A A Mathôt, Elizabeth C M de Lange, Saskia N de Wildt, Andrew C Argent, Dick Tibboel, Anthony Figaji
Evidence-based analgosedation in severe pediatric traumatic brain injury (pTBI) management is lacking and improved pharmacological understanding is needed. This starts with increased knowledge of factors controlling the pharmacokinetics (PK) of unbound drug at the target site (brain) and related drug effect(s). This prospective descriptive study tested a pediatric physiology-based pharmacokinetic software model by comparing actual plasma and brain extracellular fluid (brainECF) morphine concentrations with predicted concentration time profiles in severe pTBI patients (Glasgow Coma Scale ≤ 8)...
July 18, 2018: Journal of Neurotrauma
Raymond Stegeman, Kaya D Lamur, Agnes van den Hoogen, Johannes M P J Breur, Floris Groenendaal, Nicolaas J G Jansen, Manon J N L Benders
Background: Perinatal and perioperative brain injury is a fundamental problem in infants with severe congenital heart disease undergoing neonatal cardiac surgery with cardiopulmonary bypass. An impaired neuromotor and neurocognitive development is encountered and associated with a reduction in quality of life. New neuroprotective drugs during surgery are described to reduce brain injury and improve neurodevelopmental outcome. Therefore, our aim was to provide a systematic review and best-evidence synthesis on the effects of neuroprotective drugs on brain injury and neurodevelopmental outcome in congenital heart disease infants requiring cardiac surgery with cardiopulmonary bypass...
2018: Frontiers in Neurology
C W Yong, W H Ng, S H Yap, J D'Souza, A T-C Ow
Delayed awakening after general anaesthesia due to psychogenic coma is a phenomenon that rarely presents to the oral and maxillofacial surgeon. A case of psychogenic coma following general anaesthesia for dental extractions is presented here. It is recommended that patients at risk of conversion disorder should be counselled about the risks of psychogenic coma. Early diagnosis of this condition could lead to better patient management.
July 14, 2018: International Journal of Oral and Maxillofacial Surgery
Claudia Frellesen, Daniel Klein, Patricia Tischendorf, Julian L Wichmann, Sebastian Wutzler, Johannes Frank, Hanns Ackermann, Thomas J Vogl, Moritz H Albrecht, Katrin Eichler
OBJECTIVE: To evaluate the diagnostic potential of the Glasgow Coma Scale (GCS), the mechanism of injury (MOI) and clinical examination (CE) for the indication of whole body computed tomography (WBCT) in pediatric polytrauma patients. MATERIALS & METHODS: 100 pediatric polytrauma patients with WBCT were analysed in terms of age, gender, (MOI), GCS, detected injury, FAST, CE and Injury Severity Score (ISS). Correlations between all clinical variables and patient groups with (p+) and without (p-) injury were assessed...
August 2018: European Journal of Radiology
Se Hyun Oh, Hui Dong Kang, Sang Ku Jung, Sangchun Choi
Cerebral arterial gas embolism (CAGE) shows various manifestations according to the quantity of gas and the brain areas affected. The symptoms range from minor motor weakness, headache, and confusion to disorientation, convulsions, hemiparesis, unconsciousness, and coma. A 46-year-old man was transferred to our emergency department due to altered sensorium. Immediately after a controlled ascent from 33 m of seawater, he complained of shortness of breath and rigid extremities, lapsing into unconsciousness...
July 17, 2018: Therapeutic Hypothermia and Temperature Management
Prerna Ranganathan, Raj Gopalan Kumar, Byung-Mo Oh, Milap Vrijlal Rakholia, Sarah Berga, Amy K Wagner
Early declines in gonadotropin production, despite elevated serum estradiol, among patients with severe traumatic brain injury (TBI) suggests amplified aromatization occurs post-injury. Our previous work identifies estradiol (E2) as a potent mortality marker. Androstenedione (Andro), a metabolic precursor to E2 and testosterone (T), is a steroid hormone, yet has not been explored in TBI. We evaluated daily serum Andro, estrone (E1), T, and E2 over the first three days post-injury for 82 subjects with severe TBI...
July 17, 2018: Journal of Neurotrauma
Jun Xiao, Jiahui Pan, Yanbin He, Qiuyou Xie, Tianyou Yu, Haiyun Huang, Wei Lv, Jiechun Zhang, Ronghao Yu, Yuanqing Li
Visual fixation is an item in the visual function subscale of the Coma Recovery Scale-Revised (CRS-R). Sometimes clinicians using the behavioral scales find it difficult to detect because of the motor impairment in patients with disorders of consciousness (DOCs). Brain-computer interface (BCI) can be used to improve clinical assessment because it directly detects the brain response to an external stimulus in the absence of behavioral expression. In this study, we designed a BCI system to assist the visual fixation assessment of DOC patients...
July 17, 2018: Neuroscience Bulletin
Eelco F M Wijdicks
The Harvard criteria for the definition of irreversible coma or brain death were a product of a multidisciplinary committee chaired by anesthesiologist Beecher. The Harvard criteria included unreceptivity, unresponsiveness, no movements or breathing, no reflexes with further delineation of brainstem reflexes, and a flat electroencephalogram (repeated after 24 h with no change). The apnea test involved disconnection of the ventilator for 3 min. Hypothermia or any other central nervous system depressant had to be excluded...
July 16, 2018: Neurocritical Care
Edward A Michelson, J Stephen Huff, Mae Loparo, Rosanne S Naunheim, Andrew Perron, Martha Rahm, David W Smith, Joseph A Stone, Ariel Berger
Introduction: Mild traumatic brain injury (mTBI) is a common cause for visits to the emergency department (ED). The actual time required for an ED workup of a patient with mTBI in the United States is not well known. National emergency medicine organizations have recommended reducing unnecessary testing, including head computed tomography (CT) for these patients.10. Methods: To examine this issue, we developed a care map that included each step of evaluation of mTBI (Glasgow Coma Scale Score 13-15) - from initial presentation to the ED to discharge...
July 2018: Western Journal of Emergency Medicine
Takuya Murakami, Tetsu Akimoto, Mari Okada, Erika Hishida, Taro Sugase, Atsushi Miki, Marina Kohara, Hiromichi Yoshizawa, Takahiro Masuda, Takahisa Kobayashi, Osamu Saito, Shigeaki Muto, Daisuke Nagata
A 66-year-old women with no history of renal disease was admitted due to a coma and acute kidney injury with a serum creatinine level of 7.44 mg/dL which were ascribed to valacyclovir neurotoxicity and nephrotoxicity, respectively. She had received valacyclovir at a standard dosage for the treatment of herpes zoster and was finally discharged, having fully returned to her normal baseline mental status with a recovered serum creatinine level of 0.68 mg/dL. We feel that awareness of this pathology remains a challenge for physicians and therefore strongly recommend the further accumulation of experiences similar to our own...
2018: Drug Target Insights
Betul Seher Uysal, Ozge Sarac, Derya Yaman, Emine Akcay, Nurullah Cagil
PURPOSE: To assess changes in optical performance of the cornea in patients with keratoconus following treatment with corneal collagen cross-linking (CXL). MATERIALS AND METHODS: 111 eyes of 111 consecutive keratoconus patients with 12 month follow-up after CXL were included. The changes in the visual acuity, manifest refractive errors and corneal topographic parameters were evaluated. Sirius dual-scanning corneal tomography was used to determine the effectiveness of CXL on each patient's total corneal optical quality; preoperative and 12-month postoperative measurements were analyzed over a 4 mm stimulated pupil and were compared with regards to higher-order corneal aberrations (total amount of higher-order aberrations (HOAs), vertical coma, horizontal coma, vertical trefoil, oblique trefoil, and spherical aberration), vertical and horizontal modulation transfer function (MTF), and Strehl ratio of point spread function (PSF)...
July 17, 2018: Current Eye Research
SungHo Jang, HanDo Lee
OBJECTIVE:  To demonstrate the change of the ascending reticular activating system (ARAS) concurrent with the recovery of impaired consciousness following a shunt operation in a stroke patient. METHODS:  A 65-year-old female patient underwent coiling of a ruptured right posterior communicating artery and, subsequently, underwent right external ventricular drain (EVD) placement, left EVD placement, and lumbar drain placement for management of intraventricular hemorrhage...
July 16, 2018: Journal of Neurological Surgery. Part A, Central European Neurosurgery
Dale Ding, Padmini Sekar, Charles J Moomaw, Mary E Comeau, Michael L James, Fernando Testai, Matthew L Flaherty, Anastasia Vashkevich, Bradford B Worrall, Daniel Woo, Jennifer Osborne
BACKGROUND: Patients with spontaneous intracerebral hemorrhage (ICH) are predisposed to venous thromboembolic (VTE) complications, such as deep vein thrombosis and pulmonary embolism. OBJECTIVE: To evaluate, in a multicenter, retrospective cohort study, the rate of VTE complications in ICH patients during acute hospitalization, identify potential risk factors, and assess their association with functional outcome. METHODS: We retrospectively analyzed prospectively collected data from 19 centers and 41 sites that participated in the Ethnic/Racial Variations of Intracerebral Hemorrhage study, from August 2010 to February 2016...
July 13, 2018: Neurosurgery
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