RESUMO
The authors evaluated auditory evoked steady state rest potentials at 40 Hz (SSR40Hz) in 21 post-trauma coma patients and compared their predictive value for prognosis of survival and quality of life with the results of the electroencephalogram (EEG), the computed tomography (CT) scan, and the Glasgow Coma Scale. SSR40Hz potentials recorded immediately after trauma had a maximum (100%) sensibility and specificity for a fetal prognosis and a high value for life prognosis. Consequently they appear to be a useful parameter for deciding on organ explant procedures. The EEG was more reliable in predicting a quality of life prognosis.
Assuntos
Coma/fisiopatologia , Potenciais Evocados Auditivos/fisiologia , Adulto , Coma/etiologia , Coma/mortalidade , Eletroencefalografia , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Valor Preditivo dos Testes , Prognóstico , Qualidade de Vida , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X , Ferimentos e Lesões/complicaçõesRESUMO
In the present work authors describe an unusual case of pneumosinus dilatans caused willingly by a patient himself operated on a frontal-ethmoidal mucocele. They take the opportunity to summarize what it is known about the etiopathogenesis and the form of display of this uncommon disease.
Assuntos
Seio Etmoidal/patologia , Hérnia/diagnóstico , Doenças dos Seios Paranasais/diagnóstico , Seios Paranasais/patologia , Idoso , Diplopia/patologia , Diplopia/cirurgia , Hérnia/patologia , Herniorrafia , Humanos , Masculino , Mucocele/diagnóstico , Mucocele/patologia , Mucocele/cirurgia , Doenças dos Seios Paranasais/etiologia , Doenças dos Seios Paranasais/cirurgia , Seios Paranasais/cirurgia , Tomografia Computadorizada por Raios X , Manobra de ValsalvaRESUMO
21 patients in post-traumatic coma status were submitted to a auditory electrophysiological valuation together with EEG, TC, and "Glasgow Coma Scale" (GCS) with the purpose to obtain the relative prognostic value quoad vitam and quoad valetudinem. In particular it was carried out the brainstem auditory evoked potentials (ABR) and the auditory middle latency potentials (MLR and SSR-40 Hz). 12 patients survived and their clinical conditions were classified according to the "Glasgow Outcome Scale"; 9 of 21 patients died. With the aim of quoad vitam prognosis, the ABR showed a good reliability whereas GCS, EEG, TC and MLR proved not much usefulness. On the contrary the absence of SSR-40 Hz always coincided with the subsequent patients death. With the aim of GOS a meaningful relationship was found between the clinical outcome conditions from coma and the improvement in MLR and EEG.
Assuntos
Lesões Encefálicas/complicações , Coma/diagnóstico , Adolescente , Adulto , Idoso , Encéfalo/fisiopatologia , Lesões Encefálicas/fisiopatologia , Criança , Coma/etiologia , Coma/mortalidade , Eletroencefalografia , Potenciais Evocados Auditivos , Potenciais Evocados Auditivos do Tronco Encefálico , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
This study attempts to provide clinical evidence on the origin of SSR-40Hz auditory evoked potential studying posttrauma coma patients. The SSR-40Hz present two types of morphology: an acute narrow wave, defined as "sharp", and a slow wide curve defined as "rounded". In constant recording of auditory brainstem responses (ABR) the "sharp" wave correlated with the absence of middle latency responses (MLR), and the "rounded" with their presence. In some patients the morphology changed passing grom a "sharp" to a "rounded" wave and a tendency towards widening preceded the appearance of middle latency responses. Perhaps the functional electrophysiologic block may have diminished in sub-cortical neuronal areas not involved in MLR genesis.
