ABSTRACT
A 28-year-old man with type 1 diabetes mellitus was admitted for shock and coma due to diabetic ketoacidosis. Despite aggressive treatment and management of the patient's underlying clinical issues, the patient remained in a comatose state. Further investigations revealed an excess consumption of psychotropic agents; however, there was no evidence of an insulin overdose. Physicians should be aware that, in patients who are highly dependent upon insulin, an overdose of psychotropic agents can lead to hypoxic-ischemic brain injury.
Subject(s)
Azepines/poisoning , Diabetic Ketoacidosis/complications , Diphenhydramine/poisoning , Drug Overdose/complications , Persistent Vegetative State/chemically induced , Psychotropic Drugs/poisoning , Adult , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 1/drug therapy , Diabetic Coma/etiology , Drug Overdose/etiology , Humans , Hypoglycemic Agents/therapeutic use , Insulin/therapeutic use , Male , Shock/etiology , Suicide, AttemptedABSTRACT
BACKGROUND: "Bath salts" or synthetic cathinone toxicity remains a potentially deadly clinical condition. We report a delayed leukoencephalopathy with persistent minimally conscious state. METHODS: Case report. RESULTS: A 36-year-old man presents with delayed encephalopathy, dysautonomia, fulminant hepatic failure, and renal failure from severe rhabdomyolysis after consuming bath salts. MRI showed diffusion restriction in the splenium of the corpus callosum and subcortical white matter. CONCLUSIONS: The combination of acute leukoencephalopathy, rhabdomyolysis and fulminant hepatic failure may point to bath salt inhalation and should be known to neurointensivists.
Subject(s)
Alkaloids/poisoning , Benzodioxoles/poisoning , Cosmetics/poisoning , Leukoencephalopathies/chemically induced , Liver Failure/chemically induced , Persistent Vegetative State/chemically induced , Pyrrolidines/poisoning , Renal Insufficiency/chemically induced , Adult , Humans , Male , Rhabdomyolysis/chemically induced , Synthetic CathinoneABSTRACT
Consciousness is the physiological state of the central nervous system, during which an individual maintain arousal (level of consciousness, vigilance) and realize the internal thoughts as well as the external stimuli (awareness, consciousness content). The toxicity of multiple xenobiotics may lead to impairment of both consciousness categories, presenting clinically as consciousness disturbances, quantitative and qualitative, respectively. Based on the behavioral criteria, different consciousness disorders are diagnosed, among others: brain death, coma, vegetative state, minimally conscious state, akinetic mutism. In the present paper, pathophysiology, clinical picture, as well as basic diagnostic and therapeutic principles of conscious disturbances are described, especially in poisoned patients.
Subject(s)
Persistent Vegetative State/chemically induced , Persistent Vegetative State/diagnosis , Poisoning/complications , Poisoning/diagnosis , Humans , Persistent Vegetative State/therapy , Poisoning/therapy , Xenobiotics/poisoningSubject(s)
Diagnostic Errors , Malpractice/legislation & jurisprudence , Acetaminophen/adverse effects , Acetylcysteine/administration & dosage , Acetylcysteine/poisoning , Adolescent , Adult , Aortic Dissection/diagnosis , Aortic Dissection/etiology , Aortic Aneurysm/diagnosis , Aortic Aneurysm/etiology , Appendicitis/diagnostic imaging , Asthma/diagnosis , Child , Child, Preschool , Cystic Fibrosis/diagnosis , Drug Labeling/legislation & jurisprudence , Drug Overdose , Emergencies , False Negative Reactions , Fatal Outcome , Female , Heart Rate, Fetal , Humans , Ibuprofen/adverse effects , Lymphoma, Non-Hodgkin/complications , Lymphoma, Non-Hodgkin/diagnosis , Male , Marfan Syndrome/complications , Mediastinal Neoplasms/complications , Mediastinal Neoplasms/diagnosis , Medication Errors/legislation & jurisprudence , Nuchal Cord/diagnosis , Nuchal Cord/nursing , Patient Safety/legislation & jurisprudence , Persistent Vegetative State/chemically induced , Pleurisy/diagnosis , Pregnancy , Respiratory Sounds/etiology , Social Media/legislation & jurisprudence , Stevens-Johnson Syndrome/etiology , Suicide , Tomography, X-Ray Computed , Transportation of Patients/legislation & jurisprudence , Unnecessary Procedures , Young AdultABSTRACT
BACKGROUND: 4-bromo-2,5-dimethoxyphenethylamine (2C-B) is a designer-drug variant of 3,4-methylenedioxymethamphetamine (ecstasy) whose recreational use has increased significantly over the last 10 years. Neurologic consequences of 2C-B usage are currently unknown. CASE REPORT: A 43-year-old woman experienced severe headaches within 48 hours of taking liquid 2C-B, after which time she developed progressive encephalopathy and quadraparesis, which did not improve over several months. MRA and cerebral angiogram imaging demonstrated profound vascular abnormalities of large, medium, and small-caliber vessels with subsequent watershed infarction. Brain biopsy and cerebrospinal fluid studies ruled out an inflammatory process. CONCLUSIONS: This case demonstrates an idiosyncratic and devastating neurologic response to 2C-B, a recreational drug whose popularity has increased with widespread availability of online guides for its synthesis.
Subject(s)
Brain Infarction/chemically induced , Cerebral Arteries/drug effects , Dimethoxyphenylethylamine/analogs & derivatives , Hallucinogens/adverse effects , Vasospasm, Intracranial/chemically induced , Adult , Brain Infarction/pathology , Brain Infarction/physiopathology , Cerebral Angiography , Cerebral Arteries/diagnostic imaging , Cerebral Arteries/pathology , Cocaine/adverse effects , Cognition Disorders/chemically induced , Cognition Disorders/pathology , Cognition Disorders/physiopathology , Dimethoxyphenylethylamine/adverse effects , Drug Interactions/physiology , Female , Headache/chemically induced , Humans , Magnetic Resonance Imaging , Marijuana Smoking/adverse effects , Persistent Vegetative State/chemically induced , Persistent Vegetative State/pathology , Persistent Vegetative State/physiopathology , Quadriplegia/etiology , Risk Factors , Time , Vasospasm, Intracranial/diagnostic imaging , Vasospasm, Intracranial/pathologySubject(s)
Attitude of Health Personnel , Critical Care/methods , Nursing Staff, Hospital/psychology , Persistent Vegetative State/nursing , Pregnancy Complications/nursing , Adaptation, Psychological , Attitude to Health , Empathy , Ethics Committees, Clinical , Family/psychology , Female , Fetal Viability , Heroin Dependence/complications , Humans , Intention , Persistent Vegetative State/chemically induced , Pregnancy , Pregnancy Complications/chemically induced , Professional-Family Relations , Resuscitation OrdersSubject(s)
Dizziness/chemically induced , Dizziness/prevention & control , Flumazenil/administration & dosage , Paclitaxel/adverse effects , Persistent Vegetative State/chemically induced , Persistent Vegetative State/prevention & control , Antidotes/administration & dosage , Antineoplastic Agents, Phytogenic/adverse effects , Antineoplastic Agents, Phytogenic/therapeutic use , Female , Humans , Infusions, Intravenous , Ovarian Neoplasms/complications , Ovarian Neoplasms/drug therapy , Paclitaxel/administration & dosage , Treatment OutcomeABSTRACT
Uncompleted suicide attempts are a significant cause of morbidity, which in catastrophic cases can be both medically and ethically challenging to manage. We discuss the case of a 63-year-old man who survived a suicide attempt by venlafaxine (Effexor) overdose, causing an intracranial hemorrhage and leaving him in an apparently awake but noncommunicative state. Ethical concerns arose when considering if he should be indefinitely maintained on life support. These include the difficulties of characterizing his level of consciousness and prognosis; establishing his decisional capacity regarding end-of-life decisions in a setting of depression and suicidality; and assessing the suitability of a surrogate decision-maker. In conclusion, we discuss whether the fact that his grave neurological condition was caused by a suicide attempt was relevant to the decision to continue or withdraw life support.
Subject(s)
Antidepressive Agents, Second-Generation/adverse effects , Cyclohexanols/adverse effects , Persistent Vegetative State/chemically induced , Suicide, Attempted , Advance Directives , Decision Making/ethics , Drug Overdose/complications , Ethics, Clinical , Humans , Life Support Care/ethics , Male , Middle Aged , Venlafaxine Hydrochloride , Withholding TreatmentABSTRACT
The authors report a case of a 71-year-old man who developed myoclonic status epilepticus and coma after daily ingestion of colloidal silver for 4 months resulting in high levels of silver in plasma, erythrocytes, and CSF. Despite plasmapheresis, he remained in a persistent vegetative state until his death 5.5 months later. Silver products can cause irreversible neurologic toxicity associated with poor outcome.
Subject(s)
Adenocarcinoma/drug therapy , Argyria/complications , Colloids/poisoning , Epilepsies, Myoclonic/chemically induced , Prostatic Neoplasms/drug therapy , Silver/adverse effects , Status Epilepticus/chemically induced , Administration, Oral , Aged , Argyria/diagnosis , Argyria/therapy , Cerebral Cortex/chemistry , Cerebral Cortex/pathology , Colloids/administration & dosage , Coma/chemically induced , Complementary Therapies/adverse effects , Fatal Outcome , Humans , Male , Persistent Vegetative State/chemically induced , Plasmapheresis , Silver/administration & dosage , Silver/analysis , Treatment FailureABSTRACT
Baclofen (Lioresal) is a drug of choice to treat spasticity and is increasingly being administered intrathecally via an implantable pump in cases refractory to oral therapy. Emergency physicians will likely treat patients with baclofen withdrawal or overdose as this treatment becomes more widespread. The syndrome of baclofen withdrawal presents with altered mental status, fever, tachycardia, hypertension or hypotension, seizures, and rebound spasticity, and may be fatal if not treated appropriately. Baclofen withdrawal may mimic other diseases including sepsis, meningitis, autonomic dysreflexia, malignant hyperthermia, or neuroleptic malignant syndrome. Treatment consists of supportive care, reinstitution of baclofen, benzodiazepines, and diagnosis and eventual repair of intrathecal pump and catheter malfunction.
Subject(s)
Baclofen/adverse effects , Muscle Relaxants, Central/adverse effects , Sepsis/diagnosis , Substance Withdrawal Syndrome/diagnosis , Substance Withdrawal Syndrome/etiology , Child, Preschool , Clinical Protocols , Decerebrate State/chemically induced , Diagnosis, Differential , Emergency Treatment/methods , Equipment Failure , Fever/chemically induced , Humans , Infusion Pumps, Implantable/adverse effects , Injections, Spinal , Male , Muscle Spasticity/drug therapy , Persistent Vegetative State/chemically induced , Quadriplegia/drug therapy , Seizures/chemically induced , Substance Withdrawal Syndrome/therapy , Tachycardia/chemically inducedABSTRACT
Pregnancy in a patient in a persistent vegetative state presents challenging therapeutic questions about the level of supportive management required, the assessment of fetal well-being, the timing and mode of delivery and the anaesthetic management of labour and delivery. We report the case of a 29-yr-old woman who had a favourable fetal outcome despite suffering hypoxic brain damage after a suicide attempt by a drug overdose. She was managed until the onset of labour on an intensive care unit and had a spontaneous vaginal delivery assisted by epidural anaesthesia.
Subject(s)
Anesthesia, Epidural/methods , Anesthesia, Obstetrical/methods , Anesthetics, Local , Bupivacaine , Persistent Vegetative State/complications , Pregnancy Complications/therapy , Adult , Amnion/surgery , Decision Making , Drug Overdose , Female , Humans , Hypoxia, Brain/chemically induced , Hypoxia, Brain/complications , Labor, Induced , Oxytocin/administration & dosage , Persistent Vegetative State/chemically induced , Pregnancy , Pregnancy Complications/chemically induced , Suicide, AttemptedABSTRACT
A 5-year-old child with desmoplastic small round-cell tumor was treated with a protocol of very-high-dose, short-term chemotherapy, containing HD-CAV (cyclophosphamide, doxorubicin, vincristine, and mesna), ifosfamide, and etoposide. Two days after the initiation of ifosfamide, he exhibited new-onset lethal encephalopathy manifested by subacutely progressive cerebellar and then temporal and frontocortical degeneration leading to a vegetative state and eventually to death. A full work-up, including brain biopsy, was negative, excluding infections and metabolic or vascular causes. Ifosfamide is known to be capable of causing acute encephalopathy that can be severe but is generally reversible. This child showed a very atypical progressive, lethal course of ifosfamide toxicity. The possibility of this complication should be considered when high-dose ifosfamide treatment is planned for children.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/adverse effects , Cerebellum/drug effects , Cerebral Cortex/drug effects , Ifosfamide/adverse effects , Nerve Degeneration/chemically induced , Persistent Vegetative State/chemically induced , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Cerebellum/pathology , Cerebral Cortex/pathology , Child, Preschool , Dose-Response Relationship, Drug , Fatal Outcome , Humans , Ifosfamide/administration & dosage , Male , Nerve Degeneration/pathology , Persistent Vegetative State/pathologyABSTRACT
Methanol, a highly toxic substance, is used as an industrial solvent and in automobile antifreeze. Acute methanol poisoning produces severe metabolic acidosis and serious neurologic sequelae. We describe a 50-year-old woman with accidental methanol intoxication who was in a vegetative state. MRI showed haemorrhagic necrosis of the putamina and oedema in the deep white matter.