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1.
Undersea Hyperb Med ; 48(1): 53-56, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33648033

RESUMO

Paroxysmal autonomic instability syndrome with dystonia (PAISD) is a possible complication that worsens the prognosis of hypoxic-ischemic encephalopathy related to non-fatal drowning. There are case reports of hyperbaric oxygen (HBO2) therapy enhancing recovery in such cases. We report a case of a 5-year-old boy admitted to the Pediatric Intensive Care Unit after a non-fatal drowning. He was transferred under mechanical ventilation and sedation, with hemodynamic instability and hypothermia. On admission he had a Glasgow Coma Score of 6. On the fifth day of admission he presented episodes of dystonia with decerebration posture, diaphoresis, tachycardia and hypertension, sometimes with identified triggers, suggesting PAISD. The episodes were difficult to control; multiple drugs were needed. Electroencephalography showed diffuse slow wave activity, and cranioencephalic magnetic resonance imaging showed hypoxia-related lesions, suggesting hypoxic-ischemic encephalopathy. Early after admission the patient started physiotherapy combined with normobaric oxygen therapy. Subsequently he started HBO2 therapy at 2 atmospheres, with a total of 66 sessions. Dystonia progressively subsided, with gradual discontinuation of therapy. He also showed improvement in spasticity, non-verbal communication and cephalic control. This case highlights the diagnostic and therapeutic challenges of PAISD and the potential benefit of HBO2 therapy, even in the subacute phase, in recovery of hypoxic-ischemic encephalopathy.


Assuntos
Afogamento , Oxigenoterapia Hiperbárica/métodos , Hipóxia-Isquemia Encefálica/terapia , Pré-Escolar , Estado de Descerebração/etiologia , Distonia/etiologia , Humanos , Oxigenoterapia Hiperbárica/estatística & dados numéricos , Hipóxia-Isquemia Encefálica/diagnóstico por imagem , Hipóxia-Isquemia Encefálica/etiologia , Masculino , Modalidades de Fisioterapia
2.
Paediatr Respir Rev ; 35: 93-94, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32800451

RESUMO

Cystic fibrosis liver disease (CFLD) affects a large proportion of cystic fibrosis (CF) patients; however encephalopathy is a rare complication. While classical hepatic encephalopathy can be a feature of end-stage liver disease, "hyperammonemic encephalopathy" can be precipitated in previously stable CFLD by various triggers including systemic corticosteroids. We describe one such case and review the relevant literature.


Assuntos
Encefalopatias Metabólicas/metabolismo , Fibrose Cística/metabolismo , Hiperamonemia/metabolismo , Cirrose Hepática/metabolismo , Adolescente , Encefalopatias Metabólicas/etiologia , Encefalopatias Metabólicas/fisiopatologia , Confusão/etiologia , Confusão/fisiopatologia , Transtornos da Consciência/etiologia , Transtornos da Consciência/fisiopatologia , Fibrose Cística/complicações , Estado de Descerebração/etiologia , Estado de Descerebração/fisiopatologia , Encefalopatia Hepática/metabolismo , Encefalopatia Hepática/fisiopatologia , Humanos , Hiperamonemia/etiologia , Cirrose Hepática/etiologia , Masculino
3.
J Clin Neurosci ; 68: 338-341, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31358429

RESUMO

Opisthotonus as a presenting feature in neurosurgical patients is rare, with few reports describing such presentations. Only four reports of opisthotonos secondary to posterior fossa mass were identified. An unclear pathophysiology, and broad aetiology contribute to clinical misdirection. While posterior fossa lesions commonly present with signs of raised intracranial pressure, or cerebellar dysfunction, this case describes the presentation of an infant with opisthotonic posturing, ataxia and autonomic dysfunction secondary to a large pilocytic astrocytoma. Despite initial treatment of hydrocephalus, opisthotonus only resolved with complete surgical resection of the posterior fossa mass. At follow-up, the child remains well and without signs of hypertonicity or other signs or symptoms. Presentations involving opisthotonus are rare, and active exclusion of posterior fossa pathology is necessary. In this case, urgent surgical resection allowed for a positive patient outcome. Description of such a case may contribute to understanding of similar presentations in the neurosurgical context.


Assuntos
Astrocitoma/complicações , Estado de Descerebração/etiologia , Neoplasias Infratentoriais/complicações , Astrocitoma/patologia , Astrocitoma/cirurgia , Humanos , Lactente , Neoplasias Infratentoriais/patologia , Neoplasias Infratentoriais/cirurgia
5.
Pediatrics ; 139(1)2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27940505

RESUMO

A 14-year-old previously healthy female was transferred from a local emergency department after being found unresponsive at home. Parental questioning revealed she had fever and pharyngitis 2 weeks before presentation. Past mental health history was negative, including concern for past or present suicidal ideation/attempts, suspected substance use, or toxic ingestion. In the emergency department, she was orotracheally intubated due to a Glasgow Coma Scale of 3. She was hemodynamically stable and euglycemic. Electrocardiogram showed sinus tachycardia. She underwent a noncontrast head computed tomography that was normal and subsequently underwent a lumbar puncture. She had a seizure and was given a loading dose of diazepam and fosphenytoin that led to cessation of extremity movements. She was subsequently transferred to the PICU for additional evaluation. Initial examination without sedation or analgesia demonstrated dilated and minimally responsive pupils, intermittent decorticate posturing, and bilateral lower extremity rigidity and clonus, consistent with a Glasgow Coma Scale of 5. Serum studies were unremarkable with the exception of mild leukocytosis. Chest radiograph only showed atelectasis. She was empirically started on antibiotics to cover for meningitis pending final cerebral spinal fluid test results. The pediatric neurology team was consulted for EEG monitoring, and the patient was eventually sent for computed tomography angiogram and magnetic resonance angiogram/venogram. We will review diagnostic evaluation and management of an adolescent patient with acute encephalopathy with decorticate posturing of unclear etiology.


Assuntos
Encefalopatia Aguda Febril/induzido quimicamente , Encefalopatia Aguda Febril/etiologia , Encefalopatia Aguda Febril/terapia , Amitriptilina/análogos & derivados , Bupropiona/toxicidade , Estado de Descerebração/induzido quimicamente , Estado de Descerebração/etiologia , Síndrome da Serotonina/diagnóstico , Tentativa de Suicídio , Cloridrato de Venlafaxina/toxicidade , Encefalopatia Aguda Febril/diagnóstico por imagem , Adolescente , Amitriptilina/toxicidade , Encéfalo/diagnóstico por imagem , Estado de Descerebração/diagnóstico por imagem , Diagnóstico Diferencial , Serviço Hospitalar de Emergência , Feminino , Escala de Coma de Glasgow , Humanos , Unidades de Terapia Intensiva Pediátrica , Comunicação Interdisciplinar , Colaboração Intersetorial , Angiografia por Ressonância Magnética , Imageamento por Ressonância Magnética , Automedicação , Tentativa de Suicídio/prevenção & controle , Tomografia Computadorizada por Raios X
7.
BMJ Case Rep ; 20152015 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-26561222

RESUMO

The control of body posture is a complex activity that needs a very close relationship between different structures, such as the vestibular system, and the muscle and joint receptors of the neck. Damage of even one of these structures can lead to abnormal postural reflexes. We describe a case of a woman with a left pontine ischaemia who developed a 'dystonic' extensor posture of the left limbs while turned on the right side. This clinical picture differs from previous reports on the subject, and may relate to ischaemic damage of a pontine structure involved in posture control, or of adjacent neural connections to be yet identified. To the best of our knowledge, this is the first case reported in the literature. Clinical examples of an altered interplay between vestibular and neck receptors are rare.


Assuntos
Estado de Descerebração/diagnóstico , Isquemia , Ponte/irrigação sanguínea , Convulsões/patologia , Vestíbulo do Labirinto/irrigação sanguínea , Idoso de 80 Anos ou mais , Estado de Descerebração/etiologia , Estado de Descerebração/fisiopatologia , Feminino , Humanos , Pescoço , Ponte/patologia , Postura , Reflexo Anormal , Convulsões/etiologia , Fases do Sono , Tomografia Computadorizada por Raios X , Vestíbulo do Labirinto/patologia
8.
Clin Radiol ; 70(3): 278-85, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25527191

RESUMO

AIM: To determine the pathomorphological and clinical background to decerebrate posturing in humans following serious traumatic brain injury. MATERIALS AND METHODS: One hundred and twenty patients who had been unconscious for more than 24 h underwent diagnostic MRI within 8 days after trauma. The presence of decerebrate rigidity as the clinical parameter was correlated to MRI findings, such as traumatic lesions in defined brain areas. Significance was presumed as p < 0.05. RESULTS: On the day of MRI 43 (36%) patients exhibited decerebrate posturing: 19 (23%) cases were unilateral and 24 (77%) bilateral. There was a significant correlation between midbrain lesions and the presence of rigidity. If a midbrain lesion was found in the absence of pontine lesions, decerebrate rigidity could be concluded (p < 0.05). There was no significant correlation to the rigidity in the case of midbrain lesions accompanied by pontine lesions, and no correlation to the rigidity could be detected for other regions of the brain. Both the occurrence of decerebrate posturing and the detection of brainstem lesions at MRI correlated with the Glasgow Outcome Scale. The combination of both parameters improved the probability of predicting the outcome. CONCLUSION: The rate of decerebrate posturing increases significantly in the presence of midbrain lesions. The presence of pontine lesions appears to be of secondary importance. The chances of predicting the Glasgow Outcome Scale are improved by the combination of clinical information (decerebrate posturing) and radiological parameters (type of brainstem lesion).


Assuntos
Lesões Encefálicas/complicações , Lesões Encefálicas/patologia , Estado de Descerebração/etiologia , Estado de Descerebração/patologia , Imageamento por Ressonância Magnética/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Encéfalo/patologia , Tronco Encefálico/patologia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Mesencéfalo/patologia , Pessoa de Meia-Idade , Postura , Estudos Prospectivos , Adulto Jovem
10.
Rinsho Shinkeigaku ; 52(9): 656-9, 2012.
Artigo em Japonês | MEDLINE | ID: mdl-22989900

RESUMO

A 25-years-old man experienced fever and diarrhea. Ten days later he noticed difficulty walking (day 1). On admission neurological examination revealed lethargy, dysarthria and weakness of limbs. Oculocephalic response was not be elicited and extensor toe signs were positive. In spite of treatment with aciclovir and methylprednisolone, he continued to show progressive deterioration developing to coma with decorticate posture. Autonomic symptoms (hyperhidrosis, hypersalivation and fever) and groaning were observed. Brain magnetic resonance image and brainstem evoked potential presented no abnormality, but electroencephalographic study showed a spindle pattern indicating spindle coma. Laboratory tests including cerebrospinal fluids showed no specific results. High-dose immunoglobulin was administered from day 6, and his consciousness level improved. External ophthalomoplegia and ataxic gait were observed after he became more alert. Because he had IgG type anti-GQ1b antibodies in the serum, a diagnosis was made of Bickerstaff's brainstem encephalitis (BBE). Six months after discharge he had complete resolution of his symptoms. This is the first report of spindle coma observed in a case of serologically confirmed BBE.


Assuntos
Tronco Encefálico/imunologia , Coma/etiologia , Estado de Descerebração/etiologia , Encefalite/diagnóstico , Encefalite/imunologia , Imunoglobulinas Intravenosas/administração & dosagem , Adulto , Autoanticorpos/sangue , Biomarcadores/sangue , Coma/diagnóstico , Coma/tratamento farmacológico , Estado de Descerebração/tratamento farmacológico , Quimioterapia Combinada , Eletroencefalografia , Encefalite/complicações , Encefalite/tratamento farmacológico , Gangliosídeos/imunologia , Humanos , Imunoglobulina G/sangue , Masculino , Metilprednisolona/administração & dosagem , Resultado do Tratamento
11.
Am J Forensic Med Pathol ; 33(2): 159-62, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20562689

RESUMO

Recent studies of filmed hangings have documented the agonic sequences in these deaths. Considering this agonic sequence, one question comes to mind: which of these responses is an indicator of irreversible damage? Since decerebrate rigidity points toward lesions of the midbrain, it was initially thought that this posture could be an indicator of severe potentially irreversible damage. However, we here present a series of nonlethal filmed hangings by a 35-year-old male autoerotic practitioner, which will prove otherwise: in a film of an interrupted hanging, a decerebrate pattern of rigidity was observed at 20 seconds. However, the man later regained consciousness and seemed to present a full recovery without any noticeable symptoms. The scientific basis for the generalized assumption that death by hanging occur in 3 to 5 minutes will be reviewed. Though this estimation of the time is certainly precise and accurate enough for the needs of clinicians, it will be demonstrated that scientific evidence are not strong enough to be used in court. So how long does it take to suffer irreversible damage by hanging or by strangulation? The only honest and scientifically valid answer seems to be that we do not know.


Assuntos
Asfixia/patologia , Lesões do Pescoço/patologia , Transtornos Parafílicos/psicologia , Gravação de Videoteipe , Acidentes , Adulto , Estado de Descerebração/etiologia , Patologia Legal , Humanos , Masculino , Fatores de Tempo , Inconsciência/etiologia
13.
J Chin Med Assoc ; 74(1): 37-9, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21292201

RESUMO

The corticospinal tract is not incriminated in decerebrate rigidity (DR). However, this has not yet been proven in humans. We applied transcranial magnetic stimulation (TMS) in a decerebrate patient to support the hypothesis. A patient suffering from pontine hemorrhage with the fourth ventricular extension was admitted unconscious and in a decerebrate posture. Five days later, she regained consciousness but remained in a decerebrate posture. Motor-evoked potentials (MEPs) to TMS were measured 1 week after she had regained consciousness, and this provoked muscle responses in her hands and feet bilaterally. During the follow-up, the patient's muscle tone became persistently flaccid, although her strength increased to varying degrees in different body and limb muscles. She remained bedridden for 3 years after the stroke and could neither turn on the bed by herself nor perform skilled movements using her hands. The findings of TMS confirmed the animal studies in that the mechanism of decerebrate rigidity did not come through a damage of the corticospinal pathway. This also implies that a preserved corticospinal tract function cannot guarantee a good motor recovery in a stroke patient.


Assuntos
Estado de Descerebração/fisiopatologia , Potencial Evocado Motor , Estado de Descerebração/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Atividade Motora , Tratos Piramidais/fisiopatologia , Acidente Vascular Cerebral/fisiopatologia , Estimulação Magnética Transcraniana
14.
Am J Forensic Med Pathol ; 32(2): 104-7, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20683242

RESUMO

The Working Group on Human Asphyxia has analyzed 14 filmed hangings: 9 autoerotic accidents, 4 suicides, and 1 homicide. The following sequence of agonal responses was observed: rapid loss of consciousness in 10 ± 3 seconds, mild generalized convulsions in 14 ± 3 seconds, decerebrate rigidity in 19 ± 5 seconds, beginning of deep rhythmic abdominal respiratory movements in 19 ± 5 seconds, decorticate rigidity in 38 ± 15 seconds, loss of muscle tone in 1 minute 17 seconds ± 25 seconds, end of deep abdominal respiratory movements in 1 minute 51 seconds ± 30 seconds, and last muscle movement in 4 minutes 12 seconds ± 2 minutes 29 seconds. The type of suspension and ethanol intoxication does not seem to influence the timing of the agonal responses, whereas ischemic habituation in autoerotic practitioner might decelerate the late responses to hanging.


Assuntos
Intoxicação Alcoólica , Asfixia/patologia , Lesões do Pescoço/patologia , Gravação de Videoteipe , Acidentes , Adulto , Estado de Descerebração/etiologia , Feminino , Hábitos , Homicídio , Humanos , Isquemia/etiologia , Masculino , Pessoa de Meia-Idade , Hipotonia Muscular/etiologia , Respiração , Convulsões/etiologia , Suicídio , Fatores de Tempo , Inconsciência/etiologia
15.
J Forensic Sci ; 55(5): 1278-81, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20487156

RESUMO

It has been proposed that filmed hangings may hold the key to a better understanding of human asphyxia, and The Working Group on Human Asphyxia was formed to systematically review and compare these video recordings. This study analyzed eight filmed hangings. Considering time 0 to represent the onset of the final hanging, rapid loss of consciousness was observed (at 8-18 sec), closely followed by convulsions (at 10-19 sec). A complex pattern of decerebrate rigidity and decorticate rigidity then followed. Between 1 min 38 sec and 2 min 15 sec, muscle tone seemed to be lost, the body becoming progressively flaccid. From then on, isolated body movements were observed from time to time, the last one occurring between 1 min 2 sec and 7 min 31 sec. As for the respiratory responses, all cases presented deep rhythmic abdominal respiratory movements (last one between 1 min 2 sec and 2 min 5 sec).


Assuntos
Asfixia/etiologia , Lesões do Pescoço/complicações , Gravação de Videoteipe , Acidentes Domésticos , Adulto , Constrição Patológica , Estado de Descerebração/etiologia , Medicina Legal , Humanos , Masculino , Hipotonia Muscular/etiologia , Transtornos Parafílicos , Mecânica Respiratória , Convulsões/etiologia , Suicídio , Inconsciência/etiologia
16.
Rev Esp Anestesiol Reanim ; 57(2): 119-20, 2010 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-20337005
17.
Eur J Gastroenterol Hepatol ; 22(6): 759-60, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19521243

RESUMO

Hepatic encephalopathy is a syndrome of neuropsychiatric dysfunction caused by portosystemic venous shunting with or without the presence of intrinsic liver disease. Clinical presentations are variable ranging from an abnormal sleep pattern to somnolence and deep coma. Decerebrate and decorticate posturing, have been rarely reported with hepatic encephalopathy. We report a case of a 59-year-old-man with a history of Child-Pugh B liver disease secondary to chronic alcoholism who was admitted because of coma. He had a transjugular intrahepatic portosystemic shunt 3 months prior to his presentation. He was found to have decerebrating posture. He was treated for hepatic encephalopathy with complete recovery and resolution of the neurologic findings. The physician should be aware that decerebration and decortication posture can occur with hepatic encephalopathy and can be reversible.


Assuntos
Estado de Descerebração/diagnóstico , Estado de Descerebração/tratamento farmacológico , Encefalopatia Hepática/diagnóstico , Encefalopatia Hepática/tratamento farmacológico , Derivação Portossistêmica Transjugular Intra-Hepática/efeitos adversos , Alcoolismo/complicações , Estado de Descerebração/etiologia , Flumazenil/uso terapêutico , Encefalopatia Hepática/etiologia , Humanos , Cirrose Hepática Alcoólica/complicações , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
18.
J Clin Rheumatol ; 15(4): 181-4, 2009 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19455059

RESUMO

Central nervous system symptoms occur in a substantial portion of patients with systemic lupus erythematosus. However, coma is a rare presentation and is usually secondary to complications such as subarachnoid hemorrhage, seizure, or ischemia. Here, we present a 49-year-old woman with lupus erythematosus and a history of recurrent aseptic meningitis and mild subarachnoid hemorrhage who presented with altered mental status and lethargy that progressed rapidly over hours to the herniation syndrome of coma, extensor posturing, and unilateral pupillary dilation. Spinal fluid showed massive protein elevation (>1600), and head computed tomography revealed global cerebral edema. The clinical and radiologic findings rapidly reversed with intravenous corticosteroids and mannitol within 24 hours, and her mental status improved to baseline. Her course was complicated by 2 episodes of recurrent encephalopathy when corticosteroids were tapered; these resolved after resuming high dosing. Because of ongoing pancytopenia, chemotherapy immunosuppression was delayed, and instead she received intravenous immunoglobulin with improvement in the pancytopenia. She remained cognitively intact during subsequent corticosteroid tapering. Rapid development of coma in lupus patients may be due to a primary process of the disease impacting blood brain barrier integrity. Although rare, this potentially fatal complication may be reversible with acute corticosteroid administration.


Assuntos
Edema Encefálico/diagnóstico , Edema Encefálico/etiologia , Lúpus Eritematoso Sistêmico/complicações , Corticosteroides/uso terapêutico , Edema Encefálico/tratamento farmacológico , Coma/etiologia , Estado de Descerebração/etiologia , Diuréticos Osmóticos/uso terapêutico , Feminino , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Manitol/uso terapêutico , Pessoa de Meia-Idade , Recidiva
20.
Pediatr Emerg Care ; 25(5): 342-4, 2009 May.
Artigo em Inglês | MEDLINE | ID: mdl-19444033

RESUMO

We present the case of a 13-year-old boy with a ruptured cerebral arteriovenous malformation who had rapidly progressive cardiac failure leading to death. Serial electrocardiograms, cardiac enzymes, echocardiograms, and pulmonary artery catheter data confirmed severe ventricular dysfunction related to myocardial ischemia and infarction. Cardiac dysfunction after cerebral insult is commonly described in adults with aneurysmal subarachnoid hemorrhage and has been termed "neurogenic stunned myocardium" because of its transient nature in most of patients. In children, cardiovascular dysfunction has been described in a few reports and only after traumatic brain injury. No deaths have been reported. This case report illustrates the potentially lethal consequences of cardiovascular dysfunction in children after ruptured cerebral arteriovenous malformation with subarachnoid hemorrhage. Compromised cardiac function should be considered during the early evaluation and management of these patients and supportive care instituted to limit secondary brain injury from poor perfusion.


Assuntos
Insuficiência Cardíaca/etiologia , Malformações Arteriovenosas Intracranianas/complicações , Adolescente , Terapia Combinada , Estado de Descerebração/etiologia , Dopamina/efeitos adversos , Dopamina/uso terapêutico , Evolução Fatal , Hidratação/efeitos adversos , Cefaleia/etiologia , Parada Cardíaca/etiologia , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/diagnóstico , Humanos , Masculino , Manitol/uso terapêutico , Miocárdio Atordoado/etiologia , Artéria Pulmonar , Ruptura Espontânea , Convulsões/etiologia , Infecções Estafilocócicas/complicações , Hemorragia Subaracnóidea/etiologia , Troponina I/sangue , Ventriculostomia
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