Medications Used for Patients With Disorders of Consciousness and the Impact on Level of Consciousness

Objective: The aim of this study is to compare the secretion level of nocturnal melatonin and the characteristics of the peripheral part of the visual analyzer in patients with chronic disorders of consciousness (DOC). Materials and Methods: We studied the level of melatonin in 22 patients with chronic DOC and in 11 healthy volunteers. The fundus condition was assessed using the ophthalmoscopic method. Results: The average level of nocturnal melatonin in patients with DOC differed by 80% from the level of indole in healthy volunteers. This reveals a direct relationship between etiology, the level of consciousness, gaze fixation, coma recovery scale-revised score and the level of melatonin secretion. Examination by an ophthalmologist revealed a decrease in the macular reflex in a significant number of DOC patients, which in turn correlates negatively with the time from brain injury and positively with low values of nocturnal melatonin.

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Evaluation of structural variations in the pituitary gland, hormonal status and laboratory markers of the central nervous system functioning in patients with chronic disorders of consciousness

Journal of obstetrics and women s diseases ◽

10.17816/jowd77930 ◽

2021 ◽

Vol 70 (5) ◽

pp. 23-36

Author(s):

Ekaterina A. Kondratyeva ◽

Alina O. Ivanova ◽

Maria I. Yarmolinskaya ◽

Elena G. Potyomkina ◽

Natalya V. Dryagina ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Blood Serum ◽

Minimally Conscious State ◽

Conscious State ◽

Disorders Of Consciousness ◽

Unresponsive Wakefulness Syndrome ◽

Level Of Consciousness ◽

Chronic Disorders ◽

Minimally Conscious ◽

Chronic Disorders Of Consciousness

BACKGROUND: Consciousness is the state of being awake and aware of oneself and the environment. The disorders of consciousness result from pathologies that impair awareness. The development of effective comprehensive personalized interventions contributing to the recovery of consciousness in patients with chronic disorders of consciousness is one of the most pressing and challenging tasks in modern rehabilitation. AIM: The aim of this study was to understand structural problems of the pituitary gland, blood levels of gonadotropins and melatonin as well as brain damage markers in the blood and cerebrospinal fluid in patients with chronic disorders of consciousness and to analyze the levels of the above markers among different groups of patients depending on the level of impaired consciousness. MATERIALS AND METHODS: We examined 61 chronic disorders of consciousness patients and identified three groups depending on the level of consciousness including 24 patients with unresponsive wakefulness syndrome, 24 patients with a minus minimally conscious state, and 13 patients with minimally conscious state plus. We performed magnetic resonance imaging of chiasmatic-sellar region and determined blood serum levels of follicle-stimulating and luteinizing hormones and melatonin, as well as urinary level of 6-sulfatoxymelatonin and the content of brain derived neurotrophic factor (BDNF), apoptosis antigen (APO-1), FasL, glutamate, and S100 protein in the blood serum and cerebrospinal fluid. RESULTS: The patients were examined in the age ranging from 15 to 61 years old. Patient groups were homogeneous by the level of consciousness in terms of age and duration of chronic disorders of consciousness by the time of examination. The patients did not differ in the pituitary volume regardless of the level of consciousness. No significant differences were found between the groups with different levels of consciousness when studying the levels of melatonin in the blood serum and its metabolite in the urine. A peak in melatonin secretion was detected at 3 a.m. in 54.5 % of the patients, which can be considered as a favorable prognostic marker for further recovery of consciousness. Hypogonadotropic ovarian failure was found in 34 % of the patients, with normogonadotropic ovarian failure in the remaining patients. Serum APO-1 and BDNF levels were significantly higher in patients with minimally conscious state relative to those with unresponsive wakefulness syndrome. Significantly lower levels of glutamate in the cerebrospinal fluid were detected in women with unresponsive wakefulness syndrome compared to patients with minimally conscious state. CONCLUSIONS: Further in-depth examination and accumulation of data on patients with chronic disorders of consciousness may provide an opportunity to identify highly informative markers for predicting outcomes and to develop new effective approaches to rehabilitation of consciousness in this category of patients.

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RECOVERY OF CONSCIOUSNESS: OPPORTUNITIES FOR NEUROPSYCHOLOGICAL ASSESSMENT AND REHABILITATION

Moscow University Psychology Bulletin ◽

10.11621/vsp.2021.03.06 ◽

2021 ◽

pp. 102-128

Author(s):

Ekaterina V. Fufaeva ◽

Yuri V. Mikadze ◽

Anastasiia N. Cherkasova ◽

Maria S. Kovyazina ◽

Maria E. Baulina ◽

...

Keyword(s):

Neuropsychological Assessment ◽

Brain Lesions ◽

Disorders Of Consciousness ◽

Diagnostic Tools ◽

Clinical Psychologist ◽

Neuropsychological Rehabilitation ◽

Rehabilitation System ◽

Level Of Consciousness ◽

Practical Guidelines ◽

Recovery Of Consciousness

Relevance. Neuropsychological rehabilitation and assessment are the priority tasks in practice of a clinical psychologist. The modern rehabilitation system can be considered as a partnership between patients, their families and different specialists participating in the rehabilitation process. The existing approaches to neurorehabilitation are aimed at the earliest possible intervention. It`s of particular importance for patients with disorders of consciousness, whose number has been increasing in connection with the development of medicine in recent decades. This leads to the need to develop tools for specialized neuropsychological assessment and methods of neuropsychological rehabilitation of patients in the early stages of recovery of consciousness. Objective. To summarize neuropsychological diagnostic and rehabilitation experience of working with patients with disorders of consciousness after brain lesions. Methods. We analyze practical guidelines, applied research and our own hands-on experience of working with patients with disorders of consciousness after brain lesions. Results. Based on the analysis, the recommended diagnostic tools are formulated that can be used to identify the current level of consciousness and to assess various parameters of psychic activity of patients with disorders of consciousness. In addition, the main directions and neuropsychological methods of rehabilitation work recommended for recovery of consciousness and continuing to be developed now are highlighted. Conclusion. A new diagnostic and rehabilitation material is presented, which is recommended for use in neuropsychological practice by practicing clinical psychologists with patients with disorders of consciousness after brain lesions.

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P136: What happens to bypassed trauma patients meeting Field Trauma Triage standards?

CJEM ◽

10.1017/cem.2020.340 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S113-S113

Author(s):

M. Austin ◽

J. Sinclair ◽

S. Leduc ◽

S. Duncan ◽

J. Rouleau ◽

...

Keyword(s):

Orthopedic Surgery ◽

Motor Vehicle ◽

Vital Signs ◽

Trauma Patients ◽

Level Of Consciousness ◽

Control And Prevention ◽

Ct Head ◽

Trauma Triage ◽

Record Review ◽

The Impact

Introduction: Prehospital field trauma triage (FTT) standards were reviewed and revised in 2014 based on the recommendations of the Centers for Disease Control and Prevention. The FTT standard allows a hospital bypass and direct transport, within 30 min, to a lead trauma hospital (LTH). Our objectives were to assess the impact of the newly introduced prehospital FTT standard and to describe the emergency department (ED) management and outcomes of patients that had bypassed closer hospitals. Methods: We conducted a 12-month multi-centred health record review of paramedic and ED records following the implementation of the 4 step FTT standard (step 1: vital signs and level of consciousness (physiologic), step 2: anatomical injury, step 3: mechanism and step 4: special considerations) in nine paramedic services across Eastern Ontario. We included adult trauma patients transported as urgent that met FTT standard, regardless of transport time. We developed and piloted a data collection tool and obtained consensus on all definitions. The primary outcome was the rate of appropriate triage to a LTH which was defined as: ISS ≥12, admitted to intensive care unit (ICU), non-orthopedic surgery, or death. We have reported descriptive statistics. Results: 570 patients were included: mean age 48.8, male 68.9%, falls 29.6%, motor vehicle collisions 20.2%, stab wounds 10.5%, transported to a LTH 76.5% (n = 436). 72.2% (n = 315) of patients transported to a LTH had bypassed a closer hospital and 126/306 (41.2%) of those were determined to be an appropriate triage to LTH (9 patients had missing outcomes). ED management included: CT head/cervical spine 69.9%, ultrasound 53.6%, xray 51.6%, intubation 15.0%, sedation 11.1%, tranexamic acid 9.8%, blood transfusion 8.2%, fracture reduction 6.9%, tube thoracostomy 5.9%. Outcomes included: ISS ≥ 12 32.7%, admitted to ICU 15.0%, non-orthopedic surgery 11.1%, death 8.8%. Others included: admission to hospital 57.5%, mean LOS 12.8 days, orthopedic surgery 16.3% and discharged from ED 37.3%. Conclusion: Despite a high number of admissions, the majority of trauma patients bypassed to a LTH were considered over-triaged, with a low number of ED procedures and non-orthopedic surgeries. Continued work is needed to appropriately identify patients requiring transport to a LTH.

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The impact of prolonged disorders of consciousness on the occupational life of family members

Neuropsychological Rehabilitation ◽

10.1080/09602011.2016.1248445 ◽

2016 ◽

Vol 28 (8) ◽

pp. 1375-1391

Author(s):

Karen Elliott ◽

Andrew McVicar

Keyword(s):

Family Members ◽

Disorders Of Consciousness ◽

The Impact ◽

Occupational Life

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Prognosis of bacterial meningitis in children

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x1996000300008 ◽

1996 ◽

Vol 54 (3) ◽

pp. 407-411 ◽

Cited By ~ 17

Author(s):

Irenio Gomes ◽

Ailton Melo ◽

Rita Lucena ◽

Marco Heleno Cunha-Nascimento ◽

Adriana Ferreira ◽

...

Keyword(s):

Bacterial Meningitis ◽

Cranial Nerve ◽

Cranial Nerve Palsy ◽

Nerve Palsy ◽

Acute Bacterial Meningitis ◽

Subdural Effusion ◽

Level Of Consciousness ◽

Important Health ◽

Meningitis In Children ◽

The Impact

We studied the incidence and prognosis of acute neurologic complications in 281 children under 13 years of age with a diagnosis of acute bacterial meningitis. All the patients were examined daily by the same group of neurologists, using a standardized neurological examination. Patients with signs of encephalic lesions, unsatisfactory response to antibiotics or decreased level of consciousness were submitted to brain computer tomography. The overall lethality rate was 20.3% and cases whose causative agent was identified presented a higher lethality rate (23.7%) than those in which the agent was not found. The most important neurological abnormalities were meningeal signs (88.3%) followed by decreased consciousness (47.7%), irritability (35.2%), seizures (22.4%), fontanel bulging (20.6%) and cranial nerve palsy (14.2%). Seizures, cranial nerve palsy and the absence of meningeal signs were related to higher rates of lethality. Diminished consciousness, seizures, subdural effusion, abscess and hydrocephalus were the most important complications, respectively. We can conclude that acute bacterial meningitis continues to be an important health problem in developing countries and that public health measures will be necessary to minimize the impact of sequelae and reduce the mortality rate in children with that pathology.

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P008: Evaluation of outcomes after implementation of a provincial prehospital bypass standard for trauma patients – an Eastern Ontario experience

CJEM ◽

10.1017/cem.2019.199 ◽

2019 ◽

Vol 21 (S1) ◽

pp. S65-S66

Author(s):

M. Austin ◽

J. Sinclair ◽

S. Leduc ◽

S. Duncan ◽

J. Rouleau ◽

...

Keyword(s):

Injury Severity ◽

Univariate Analysis ◽

Vital Signs ◽

Trauma Centre ◽

Trauma Patients ◽

Level Of Consciousness ◽

Orthopedic Operation ◽

Eastern Ontario ◽

Record Review ◽

The Impact

Introduction: Trauma and injury play a significant role in the population's burden of disease. Limited research exists evaluating the role of trauma bypass protocols. The objective of this study was to assess the impact and effectiveness of a newly introduced prehospital field trauma triage (FTT) standard, allowing paramedics to bypass a closer hospital and directly transport to a trauma centre (TC) provided transport times were within 30 minutes. Methods: We conducted a 12-month multi-centred health record review of paramedic call reports and emergency department health records following the implementation of the 4 step FTT standard (step 1: vital signs and level of consciousness, step 2: anatomical injury, step 3: mechanism and step 4: special considerations) in nine paramedic services across Eastern Ontario. We included adult trauma patients transported as an urgent transport to hospital, that met one of the 4 steps of the FTT standard and would allow for a bypass consideration. We developed and piloted a standardized data collection tool and obtained consensus on all data definitions. The primary outcome was the rate of appropriate triage to a TC, defined as any of the following: injury severity score ≥12, admitted to an intensive care unit, underwent non-orthopedic operation, or death. We report descriptive and univariate analysis where appropriate. Results: 570 adult patients were included with the following characteristics: mean age 48.8, male 68.9%, attended by Advanced Care Paramedic 71.8%, mechanisms of injury: MVC 20.2%, falls 29.6%, stab wounds 10.5%, median initial GCS 14, mean initial BP 132, prehospital fluid administered 26.8%, prehospital intubation 3.5%, transported to a TC 74.6%. Of those transported to a TC, 308 (72.5%) had bypassed a closer hospital prior to TC arrival. Of those that bypassed a closer hospital, 136 (44.2%) were determined to be “appropriate triage to TC”. Bypassed patients more often met the step 1 or step 2 of the standard (186, 66.9%) compared to the step 3 or step 4 (122, 39.6%). An appropriate triage to TC occurred in 104 (55.9%) patients who had met step 1 or 2 and 32 (26.2%) patients meeting step 3 or 4 of the FTT standard. Conclusion: The FTT standard can identify patients who should be bypassed and transported to a TC. However, this is at a cost of potentially burdening the system with poor sensitivity. More work is needed to develop a FTT standard that will assist paramedics in appropriately identifying patients who require a trauma centre.

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Preservation of Language Processing and Auditory Performance in Patients With Disorders of Consciousness: A Multimodal Assessment

Frontiers in Neurology ◽

10.3389/fneur.2020.526465 ◽

2020 ◽

Vol 11 ◽

Author(s):

Stefania Ferraro ◽

Anna Nigri ◽

Ludovico D'Incerti ◽

Cristina Rosazza ◽

Davide Sattin ◽

...

Keyword(s):

Language Processing ◽

Language Impairment ◽

Minimally Conscious State ◽

Superior Temporal Gyrus ◽

Conscious State ◽

Disorders Of Consciousness ◽

Post Injury ◽

The Core ◽

Core Language ◽

The Impact

The impact of language impairment on the clinical assessment of patients suffering from disorders of consciousness (DOC) is unknown or underestimated and may mask the presence of conscious behavior. In a group of DOC patients (n = 11; time post-injury range: 5–252 months), we investigated the main neural functional and structural underpinnings of linguistic processing, and their relationship with the behavioral measures of the auditory function using the Coma Recovery Scale-Revised (CRS-R). We assessed the integrity of the brainstem auditory pathways, of the left superior temporal gyrus and arcuate fasciculus, the neural activity elicited by passive listening of an auditory language task, and the mean hemispheric glucose metabolism. Our results support the hypothesis of a relationship between the level of preservation of the investigated structures/functions and the CRS-R auditory subscale scores. Moreover, our findings indicate that patients in minimally conscious state minus (MCS−): (1) when presenting the auditory startle (at the CRS-R auditory subscale) might be aphasic in the receptive domain, being severely impaired in the core language structures/functions; (2) when presenting the localization to sound might retain language processing, being almost intact or intact in the core language structures/functions. Despite the small group of investigated patients, our findings provide a grounding of the clinical measures of the CRS-R auditory subscale in the integrity of the underlying auditory structures/functions. Future studies are needed to confirm our results that might have important consequences for the clinical practice.

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