Effect of Comprehensive Rehabilitation on Ischemic-hypoxic Encephalopathy at Recovery Stage / 中国康复理论与实践

@#Objective To investigate the effect of comprehensive rehabilitation on ischemic-hypoxic encephalopathy at recovery stage. Methods From January, 2014 to December, 2016, the general data, rehabilitation evaluation, main problems, rehabilitation methods and the functional scores from 28 patients with ischemic-hypoxic encephalopathy were retrospectively analyzed.Results The patients improved in the scores of Mini-Mental State Examination, motor function and balance of Fugl-Meyer Assessment, Holden Gait Classification and modified Barthel Index after rehabilitation (Z>2.588, P<0.05).Conclusion The patients with ischemic-hypoxic encephalopathy may be benefited from comprehensive rehabilitation in cognition, motor function, walking and activities of daily living, etc.

Caso de hemoptisis masiva en el transoperatorio, manejo de la hipoxia en ventilación unipulmonar / A case of massive hemoptysis during transoperative; hypoxia handling in one-lung ventilation

Introducción: relatar un caso de hemoptisis masiva en el transoperatorio de cirugía pulmonar para establecer el manejo de la hipoxia en ventilación unipulmonar y con esto evitar devastadoras consecuencias. Caso clínico: paciente masculino de 46 años de edad con antecedente de varios episodios de hemoptisis, se sometió a lobectomía superior izquierda, presentando episodio de hemoptisis masiva en el transoperatorio, se siguió algoritmo de hipoxia en ventilación unipulmonar; a pesar de ello mantiene hipoxia prolongada por lo que se presentan secuelas importante de encefalopatía hipoxia. Conclusión: todo anestesiólogo que realice cirugías de pulmón debe estar en la capacidad de dominar el manejo de cualquier evento de hipoxia en ventilación unipulmonar.

Introduction: to relate a clinical case in OR of a pulmonary surgery for review the management of hypoxia in unipulmonar ventilation and with this realize that we could have catastrophic consequences. Clinic case: male patient, 46 years of age with a history of several episodes of hemoptysis underwent left upper lobectomy, presenting episode of intraoperative massive hemoptysis. Algorithm of hypoxia in one lung ventilation was followed nevertheless maintains prolonged hypoxia with important consequences of hypoxic encephalopathy. Conclusion: every anesthesiologist that have in OR a pulmonary surgery must have the knowledge of hypoxia in unipulmonar ventilation management.

Reversible Delayed Hypoxic Encephalopathy Showing Marked Improvement With Serial Brain MRI

No abstract available.

A case of a Man Performed Therapeutic Hypothermia to the Hypoxic Encephalopathy due to Hot Spring Drowning / 日本温泉気候物理医学会雑誌

Case Report: The patient was a 70-year-old man with a chief complaint of impaired consciousness. He had visited a hot spring in Yamagata Prefecture. While he was bathing in a hot spring, he lost consciousness and nearly drowned. There was no eye witness. Other guests discovered him floating in the bathtub. He was not breathing and received chest compression by a guest. Subsequently, the patient resumed spontaneous respiration. When the emergency medical team arrived, and Japan Coma Scale (JCS) was 300 and Glasgow Coma Scale (GCS) was E1V1M1. The patient was transported to our hospital, and JCS was 200 at admission. Plain chest x-ray and CT imaging revealed infiltrative opacities in the bilateral lungs, suggesting pneumonia. Head CT imaging was unable to identify the underlying cause of loss of consciousness and showed no hypoxic changes. He continued to have impaired consciousness after arrival at the hospital, and it was determined that he had postresuscitation hypoxic encephalopathy. He was immediately treated with cerebral hypothermia. Midazolam was used for sedation, fentanyl for analgesia, and vecuronium for prevention of shivering. In the emergency room, the patient underwent gastric lavage with cold water and infusion of cold fluid. An Arctic Sun® was placed on the patient after admission to the ICU. A target body temperature of 34°C was reached approximately 4 hours after arrival. His temperature was maintained at 34°C for 24 hours and warmed to 36°C in the next 48 hours. Lung disorder caused by aspiration of hot spring water was treated with antibiotics (tazobactam/piperacillin and azithromycin) and positive-pressure ventilation by a mechanical ventilator. This treatment prevented the lung disorder from increasing in severity. Sedation was discontinued after the body temperature was warmed. Subsequently, the patient’s state of consciousness was improved to the premorbid level, and he eventually was able to return to his normal life. Discussion: When patients nearly drown in a hot spring, their body temperatures are often elevated because they have been in hot water for a long time. Their body temperatures must be lowered quickly to a target level using various cooling methods. Immunity is lowered in a hypothermic state, and pneumonia will inevitably develop due to aspiration of hot spring water. Thus, appropriate management is necessary, including the use of antibiotics. Conclusion: Cerebral hypothermia was effective for postresuscitation hypoxic encephalopathy caused by near drowning in a hot spring.

Magnetic Resonance Imaging for the Prediction of Delayed Neuro-psychiatric Sequelae in Patients with Carbon Monoxide Poisoning

PURPOSE: Delayed neuropsychiatric sequelae (DNS) encompass a broad spectrum of neurological deficits, cognitive impairments, and affective disorders which commonly occur after a recovery from acute carbon monoxide (CO) poisoning. The early identification of patients with a high risk of DNS might improve their quality of care. Thus, we studied the role of magnetic resonance imaging (MRI) for the prediction of DNS. METHODS: This retrospective study included 41 patients with CO poisoning from January 2009 to June 2012. Magnetic resonance imaging (MRI) was performed within seven days after CO poisoning. Positive MRI findings were defined as focal or diffuse signals in fluid-attenuated inversion recovery (FLAIR), diffusion weighted imaging (DWI), and T2 weighted imaging (T2WI). DNS was considered present when patients had clinical symptoms and signs of DNS within 3 months after CO poisoning. Clinical and biohumoral data were collected; univariate and multivariate statistical analyses were performed to identify the predictive role of MRI for DNS. RESULTS: DNS occurred at a rate of 58.5%, with abnormal MRI findings associated with the development of DNS in the multivariate analysis. The sensitivity of MRI to DNS was 82.6%. In contrast, a normal MRI was seen in eighteen patients (43.9%). MRI revealed abnormalities in the deep white matter (41.5%), globus pallidus (34.1%), cerebral cortex (12.2%), medial temporal lobe (MTL)/hippocampus (7.3%), and cerebellum (4.9%). Among the MRI abnormalities revealed, lesions in the deep white matter were significantly associated with DNS development. Abnormal findings of the globus pallidus, cerebral cortex, MTL/hippocampus, and cerebellum were not associated with DNS development. CONCLUSION: This study demonstrates the utility of early MRI for the prediction of DNS. Future studies will be required to ascertain the prevention of DNS with hyperbaric treatment in CO poisoning.

Role of Diffusion-Weighted Imaging as a Prognostic Indicator in Acute Hypoxic Encephalopathy / 대한임상신경생리학회지

BACKGROUND: Diffusion-weighted image (DWI) might be useful to predict the prognosis of acute hypoxic encephalopathy. The aim of our study was to test whether the early change and extent of DWI abnormalities can be an indicator of the clinical outcome of hypoxic encephalopathy. METHODS: Forty-four patients who were diagnosed as hypoxic encephalopathy due to the cardiorespiratory arrest were retrospectively identified. Clinical variables were determined, and the DWI abnormalities were counted by four areas: cortex, subcortical white matter, cerebellum and deep grey matter, and were divided into three groups by the extent of lesions. Prognosis was classified as 'poor' (Glasgow coma scale (GSC) at 30 days after arrest or =9). RESULTS: GCS at day 3 (p<0.001), presence of seizure (p=0.01), and presence of lesion (p<0.001) were significantly different in prognosis, but statistically there is no association with the extent of lesions and prognosis (p=0.26). CONCLUSIONS: Presence of early DWI changes could predict the clinical outcome of hypoxic encephalopathy after cardiorespiratory arrest.

A case of a Man Performed Therapeutic Hypothermia to the Hypoxic Encephalopathy due to Hot Spring Drowning / 日本温泉気候物理医学会雑誌

<B>Case Report:</B> The patient was a 70-year-old man with a chief complaint of impaired consciousness. He had visited a hot spring in Yamagata Prefecture. While he was bathing in a hot spring, he lost consciousness and nearly drowned. There was no eye witness. Other guests discovered him floating in the bathtub. He was not breathing and received chest compression by a guest. Subsequently, the patient resumed spontaneous respiration. When the emergency medical team arrived, and Japan Coma Scale (JCS) was 300 and Glasgow Coma Scale (GCS) was E1V1M1. The patient was transported to our hospital, and JCS was 200 at admission. Plain chest x-ray and CT imaging revealed infiltrative opacities in the bilateral lungs, suggesting pneumonia. Head CT imaging was unable to identify the underlying cause of loss of consciousness and showed no hypoxic changes. He continued to have impaired consciousness after arrival at the hospital, and it was determined that he had postresuscitation hypoxic encephalopathy. He was immediately treated with cerebral hypothermia. Midazolam was used for sedation, fentanyl for analgesia, and vecuronium for prevention of shivering. In the emergency room, the patient underwent gastric lavage with cold water and infusion of cold fluid. An Arctic Sun<SUP>®</SUP> was placed on the patient after admission to the ICU. A target body temperature of 34°C was reached approximately 4 hours after arrival. His temperature was maintained at 34°C for 24 hours and warmed to 36°C in the next 48 hours. Lung disorder caused by aspiration of hot spring water was treated with antibiotics (tazobactam/piperacillin and azithromycin) and positive-pressure ventilation by a mechanical ventilator. This treatment prevented the lung disorder from increasing in severity. Sedation was discontinued after the body temperature was warmed. Subsequently, the patient’s state of consciousness was improved to the premorbid level, and he eventually was able to return to his normal life.<BR><B>Discussion:</B> When patients nearly drown in a hot spring, their body temperatures are often elevated because they have been in hot water for a long time. Their body temperatures must be lowered quickly to a target level using various cooling methods. Immunity is lowered in a hypothermic state, and pneumonia will inevitably develop due to aspiration of hot spring water. Thus, appropriate management is necessary, including the use of antibiotics.<BR><B>Conclusion:</B> Cerebral hypothermia was effective for postresuscitation hypoxic encephalopathy caused by near drowning in a hot spring.

Clinical features and rehabilitation effect of patients with ischemic-hypoxic encephalopathy at recovery stage / 中国康复理论与实践

@#ObjectiveTo explore the clinical features and rehabilitation effect of patients with ischemic-hypoxic encephalopathy at recovery stage. MethodsThe clinical features and ADL rehabilitation effect of 32 ischemic-hypoxic encephalopathy patients who were received rehabilitation therapy were retrospectively analyzed.ResultsThe extrapyramidal tract lesion was the most common clinical feature and most of the patients combined with cognitive function impairment. There was no significant improvement in ADL after rehabilitation (P>0.05).ConclusionsThe ADL rehabilitation effect of patients with ischemic-hypoxic encepha1opathy in the recovery stage is not effective. The key points of increasing ADL are to reduce hypertonic muscle and improve cognitive function.

The Effects of Botulinum Toxin Injections on the Persistent Contractions of Levator Labii Superioris Muscle in Patient with Encephalopathy

We report the case of a 40-year-old hypoxic encephalopathy patient who suffered from dry mouth and frequent poor oral hygiene secondary to a prominent nasolabial fold and elevated upper lip, exposing the canine teeth at rest. This expression was confirmed secondary to persistent contraction of the levator labii superioris muscle with electromyography (EMG) study. We have injected 6 units of Botulinum toxin A in levator labii superioris muscle with electromyographic guidance. Elevation of upper lip at rest causing exposure of canine teeth has been nearly disappeared 3 days after the injection. We suggest that chemical weakening of the levator labii superioris muscle using Botulinum toxin A could be possibly responsible for the dramatic reduction of elevated upper lip exposing canine teeth in patients with hypoxic encephalopathy.