Bradicardia extrema por infarto talámico paramediano bilateral / Extreme bradycardia due to bilateral paramedian thalamic infarction

RESUMEN Alteraciones autonómicas agudas por infartos cerebrales se han descrito con frecuencia comprometiendo la región insular, dentro de las anormalidades se han documentado alteraciones de severidad variable del ritmo cardíaco, incluyendo la bradicardia extrema sintomática; en la literatura solo hay un reporte de caso de bradi-cardia extrema asociado a un infarto talámico paramediano bilateral, a continuación, describimos un segundo caso de un infarto talámico con la misma presentación.

SUMMARY Acute autonomic disturbances due to cerebral in farcts has been describe frequently with association of the insular cortex, within the describe abnormalities had been document a variety of cardiac disturbances including extreme symptomatic bradycardia; In the literature just exist a case report of extreme bradycardia associate with a bilateral paramedian thalamic infarct, in the following article, we describe a second case of this infarct with the same presentation.

A Survey of Patients whose Consciousness Levels have been Judged as 1 on the Japan Coma Scale by Emergency Life-saving Technicians / 日本プライマリ・ケア連合学会誌

<p><b>Introduction: </b>We retrospectively examined the grounds for judging the consciousness level as 1 on the Japan Coma Scale (JCS) made by emergency life-saving technicians (ELSTs).</p><p><b>Methods: </b>The survey involved the sick and injured who were transferred to the hospital by ambulance during the 25-month period from July 1st, 2011, and who were able to respond to questions asked by hospital staff to make records after ELSTs had judged their consciousness level as 1 on the JCS.</p><p><b>Result: </b>A survey involving 105 cases was conducted to examine grounds for judgment of consciousness level of the sick and injured as 1 on the JCS. "Vacant or blank expression", "delay in reactions" or "delay in responses" were cited as the grounds by 61.0 and 47.6%, respectively.</p><p><b>Conclusion: </b>When ELSTs judged the consciousness level of the sick and injured as 1 on the JCS, they made the above observations of the patients. Although these factors are useful for evaluating the status of consciousness, they are not certain. In some cases, ELSTs may have judged the consciousness level as 1 when it should have been judged as 2 or 3 on the JCS. Therefore, it is suspected that some ELSTs may not recognize disorientation appropriately.</p>