Fever, unilateral convulsion status, disturbance of consciousness / 中华实用儿科临床杂志

There was a 6-years-old girl who was hospitalized for " four episodes of convulsions within four hours" . On admission, the main manifestations of the patient were unilateral convulsion status, fever and disturbance of consciousness.After improvement of consciousness, physical examination revealed hemiplegia on the convulsive side.Viral encephalitis was considered at admission.However, there were no abnormalities in routine and biochemical examinations of cerebrospinal fluid(CSF), and there were no abnormalities in immune antibodies and pathogen high-throughput sequencing of CSF, which excluded central nervous system infection.According to the craniocerebral magnetic resonance imaging, extensive edema in the right cerebral hemisphere was demonstrated.Diagnosis was considered to be idiopathic hemiconvulsion hemiplegia syndrome(IHHS). The antiepileptic drug was adjusted as phenobarbital, and the seizures were reduced.But one month later, intractable epilepsy occurred, and the final diagnosis was idiopathic hemiconvulsion-hemiplegia-epilepsy syndrome(IHHES). The clinical manifestations were fever, unilateral convulsion status, and disturbance of consciousness.The diagnosis should be combined with CSF examination and imaging characteristics and other considerations.IHHS may develop to IHHES in the later stage.

Fever, unilateral convulsion status, disturbance of consciousness / 中华实用儿科临床杂志

There was a 6-years-old girl who was hospitalized for "four episodes of convulsions within four hours".On admission,the main manifestations of the patient were unilateral convulsion status,fever and disturbance of consciousness.After improvement of consciousness,physical examination revealed hemiplegia on the convulsive side.Viral encephalitis was considered at admission.However,there were no abnormalities in routine and biochemical examinations of cerebrospinal fluid(CSF),and there were no abnormalities in immune antibodies and pathogen high-throughput sequencing of CSF,which excluded central nervous system infection.According to the craniocerebral magnetic resonance imaging,extensive edema in the right cerebral hemisphere was demonstrated.Diagnosis was considered to be idiopathic hemiconvulsion hemiplegia syndrome(IHHS).The antiepileptic drug was adjusted as phenobarbital,and the seizures were reduced.But one month later,intractable epilepsy occurred,and the final diagnosis was idiopathic hemiconvulsion-hemiplegia-epilepsy syndrome (IHHES).The clinical manifestations were fever,unilateral convulsion status,and disturbance of consciousness.The diagnosis should be combined with CSF examination and imaging characteristics and other considerations.IHHS may develop to IHHES in the later stage.

The 464th case: sudden convulsion and coma in a patient with acute leukemia / 中华内科杂志

A 46-year-old female patient was diagnosed as mixed phenotype acute leukemia with chief complaints of intermittent gingival swelling and bleeding for 1 week. The induction chemotherapy was not effective. During the second course chemotherapy, the patient had sudden convulsion and coma. She was transferred to the intensive care unit with worsened condition after transient improvement. Her final diagnosis was secondary adrenocortical insufficiency, adrenal crisis, intractable hyponatremia and cerebral edema.

A Patient Treated with Small-dose Strong Opioids Experienced Photophobia, Disturbance of Consciousness, and Miosis

Strong opioids are useful for managing cancer pain, and common side effects include nausea, vomiting, drowsiness, and constipation. Opioid overdose is known to cause respiratory depression and disturbance of consciousness. We observed a 79-year-old man with stage IVB hepatocellular carcinoma with metastasis to the rib and cancer-related pain being treated with strong opioids who, in spite of receiving a small dose and start volume, experienced strong nausea, photophobia, disturbance of consciousness, and miosis. Oxycodone was stopped to manage the strong nausea, and morphine was stopped to manage the photophobia. Furthermore, fentanyl patch was stopped to manage the disturbance of consciousness and miosis. He did not experience respiratory depression. Thus, photophobia, disturbance of consciousness, and miosis can appear as side effects even at small doses of strong opioids. The results reveal two important clinical issues: (1) photophobia can arise as a side effect of strong opioids, and (2) if photophobia, miosis, disturbance of consciousness arise in opioid-treated patients, they require careful monitoring.

Risk factors for healthcare-associated infection in patients with aneurysmal subarachnoid hemorrhage / 中国感染控制杂志

Objective To investigate risk factors for healthcare-associated infection (HAI) in patients with aneurysmal subarachnoid hemorrhage(aSAH)in the department of neurology of a hospital.Methods Clinical data of 47 patients with aSAH who were admitted to a hospital from January 2014 to January 2015 were retrospectively analyzed.Results Of 47 patients with aSAH,17 developed 19 times of HAI,HAI rate was 36.17%,case infection rate was 40.43%.The main infection site was lower respiratory tract (n = 17,89.47%),followed by urinary tract (n=2,10.53%);2 patients had both lower respiratory tract infection and urinary tract infection.17 patients were performed pathogenic detection,13 pathogenic isolates were isolated from 9 patients.Multivariate non-conditional logistic regression analysis revealed that risk factors for HAI in patients with aSAH were disturbance of consciousness (OR,24.878 [95%CI ,3.996 - 156.040])and intensive care unit admission(OR, 8.645 [95%CI ,1.419-52.670]).The prognosis of patients with HAI was poorer than those without HAI(Z =4.108,P < 0.001 ).Conclusion Patients with aSAH are at high risk of HAI,it is necessary to take targeted prevention and control measures for reducing the occurrence of HAI and promoting good prognosis.

Clinical observation of noninvasive positive pressure ventilation(NIPPV) for acute exacerbation of chronic obstructive pulmonary disease with respiratory failure and disturbance of consciousness / 中国医学装备

Objective:TTo observe the clinical efficacy of noninvasive positive pressure ventilation(NIPPV)for AECOPD with respiratory failure and disturbance of consciousness.Methods:A total of 58 AECOPD patients with respiratory failure and consciousness in our hospital from 2011 July to August 2015 were randomly divided into NIPPV group and control group. The control group was received conventional therapy, and NIPPV was added to the NIPPV group. The heart rate(HR), respiratory rate(RR), Glasgow coma score(GCS) and blood gas analysis of patients before and after 24 h, 72 h of treatment, and the adverse reactions in NIPPV group were observed.Results: The PaCO2, RR, HR at 24 h and 72 h were significantly lower and PaO2 and GCS were significantly increased in NIPPV group. Compared to the control group, PaO2, PaCO2, HR and GCS after 24 h and 72 h were different (t=11.29,t=9.19,t=9.21,t=11.23,t=10.30,t=7.28, t=10.34,t=6.69;P0.05). Some patients in NIPPV group had initial discomfort, facial skin hyperemia erosion, mild gastrointestinal discomfort and fear, which were improved after symptomatic treatment.Conclusion: NIPPV treatment for AECOPD patients with respiratory failure and disturbance of consciousness which can effectively correct respiratory acidosis and CO2 retention. The spontaneous breathing and arterial oxygen level of patient can be gradually recovered, which are better than the conventional treatment.

The correlation between Nacotrend and the degree and prognosis of disturbance of consciousness in craniocerebral injured patients / 中国医师进修杂志

Objective To explore the value of Nacotrend and the degree and prognosis of disturbance of consciousness in craniocerebral injured patients. Methods Forty craniocerebral injured patients were observed and Nacotrend index (NI) and Glasgow Coma Scale (GCS) were evaluated 24 h after the operation. After followed up for 3 months, the patients with Glasgow coma scale (GOS) 4-5 scores were enrolled into in good recovery group and the patients with GOS 1-3 scores were enrolled into bad recovery group. The correlation of NI and prognosis was analyzed. Results There were 17 cases in the good recovery group, and 23 cases in the bad recovery group. Pearson correlation coefficient of NI and GCS was 0.721, P<0.01. The level of NI in good recovery group was 64.26±12.73, in bad recovery group was 29.57±8.12, and there was significant difference (P<0.05). Conclusion NI can be used in coma patients for consciousness grading assessment and also can correctly evaluate the prognosis.

A case of reversible disturbance of consciousness following leptomeningeal metastases

<b>Introduction：</b>Hyponatremia, which is frequently present in patients with end-stage cancer, causes delirium and disturbance of consciousness and is considered a poor prognostic factor. We report a case of hyponatremia with hypopituitarism in association with leptomeningeal metastasis, resulting in reversible disturbance of consciousness. <b>Case report：</b>A 77 year-old female received chemotherapy at our hospital for postoperative recurrence of lung cancer, and best supportive care due to a side effect. After transfer to another hospital, she experienced a sudden disturbance of consciousness and was returned to our hospital. A detailed examination resulted in a diagnosis of hyponatremia from hypopituitarism following leptomeningeal metastasis involving the cerebral ventricles. Hyponatremia was improved by NaCl supplement and hormone replacement, followed by recovery from disturbance of consciousness. <b>Discussion：</b>QOL of patients with end-stage cancer can be improved through the active treatment of reversible causes of disturbance of consciousness.<b> Conclusion：</b>When severe hyponatremia is detected in cancer patients, it is important to consider the possibility of hypopituitarism with brain metastasis or meninges dissemination in the differential diagnosis.

Clinical Study on the Effect of TRH in Patients with Prolonged Mild Disturbance of Consciousness

Authors report the clinical study on the usefulness of thyrotropin-releasing hormone tartrate(TRH-T) in the treatment of mild disturbance of consciousness. 20 patients suffering head trauma, subarachnoid hemorrhage, and intracerebral hemorrhage were given TRH-T intravenously for ten days. TRH-T was effective for the patients in whom the consciousness disturbance was mild, the duration in fixed consciousness level was short, and the brain was not distorted on CT scan. These features were most prominent in patients with subarachnoid hemorrhage. Three was no significant side effect, and TRH-T turned out to be safe.