Examination of the Comatose Patient

2019 ◽  
pp. 43-92
Author(s):  
Jerome B. Posner ◽  
Clifford B. Saper ◽  
Nicholas D. Schiff ◽  
Jan Claassen
Keyword(s):  
Surgical Treatment ◽  
Diagnostic Approach ◽  
Medical Emergency ◽  
Neurologic Examination ◽  
Comatose Patient ◽  
Alteration Of Consciousness ◽  
Physical Findings

Chapter 2 defines a brief but informative neurologic examination that is necessary to determine if reduced consciousness has a structural cause (and therefore may require immediate imaging and perhaps surgical treatment) or a metabolic cause (in which case the diagnostic approach can be more lengthy and extensive). The authors stress that a coma or any alteration of consciousness is a medical emergency, and, as such, the physician must begin examination and treatment simultaneously. The examination must be thorough, but brief. The chapter also describes some of the physical findings that distinguish structural from nonstructural causes of stupor and coma.

MANAGEMENT OF MULTIPLE TRAUMATIC INTRACRANIAL HEMATOMAS

2020 ◽  
Vol 3 (1) ◽  
pp. 70-74
Author(s):  
Rustam Hazratkulov ◽  
Keyword(s):  
Traumatic Brain Injury ◽  
Surgical Treatment ◽  
Brain Injury ◽  
Hospital Stay ◽  
Treatment Outcomes ◽  
Brain Injuries ◽  
Traumatic Brain Injuries ◽  
Diagnostic Approach ◽  
Early Activation ◽  
Intracranial Hematomas

Multiple traumatic hematomas (MG) account for 0.74% of all traumatic brain injuries. A comprehensive diagnostic approach to multiple traumatic intracranial hematomas allows to establish a diagnosis in the early stages of traumatic brain injury and to determine treatment tactics. A differentiated approach to the choice of surgical treatment of multiple hematomas allows to achieve satisfactory results and treatment outcomes, which accordingly contributes to the early activation of the patient, a reduction in hospital stay, a decrease in mortality and disabilityin patients with traumatic brain injury

Dural arteriovenous malformations

1974 ◽  
Vol 40 (3) ◽  
pp. 322-329 ◽  
Author(s):  
Edward J. Kosnik ◽  
William E. Hunt ◽  
Carole A. Miller
Keyword(s):  
Surgical Treatment ◽  
Arteriovenous Malformations ◽  
Content Type ◽  
Venous Sinuses ◽  
Feeding Vessels ◽  
Physical Findings ◽  
Fine Print

✓ The history, physical findings, and treatment of dural arteriovenous malformations are reviewed. The importance of completely identifying and obliterating the fistula, even at the expense of obliterating major venous sinuses, is emphasized. Failure of surgical treatment usually is the result of mistaking the more obvious dilated feeding vessels for the lesion itself.

Coma

2018 ◽  
Author(s):  
David Sprigings
Keyword(s):  
Haemorrhagic Stroke ◽  
Medical Emergency ◽  
Clinical Approach ◽  
Pathological State ◽  
Comatose Patient ◽  
Secondary Effects ◽  
Thalamic Projections ◽  
Reticular System ◽  
Diffuse Injury ◽  
Underlying Disorder

Coma is a pathological state of unconsciousness from which a patient cannot be roused to wakefulness by stimuli, and reflects dysfunction of the brainstem reticular system and its thalamic projections (the neuronal basis of wakefulness), or diffuse injury of both cerebral hemispheres. A unilateral lesion of a cerebral hemisphere (e.g. haemorrhagic stroke) will not cause coma unless there is secondary compression of the contralateral hemisphere or brainstem. Coma is a medical emergency, because a comatose patient is at high risk of permanent brain injury or death, caused either by the underlying disorder or the secondary effects of coma. Stabilization of the airway, breathing, and circulation, and exclusion of hypoglycaemia are the first priorities, before diagnosis is explored further. Clinical assessment together with neuroimaging will usually identify the likely cause or causes. The clinical approach to diagnosis and management of the comatose patient is described in this chapter.

Sinusitus with Subdural Empyema

2019 ◽  
pp. 267-273
Author(s):  
Christina Sayama
Keyword(s):  
Infectious Disease ◽  
Decision Making ◽  
Surgical Treatment ◽  
Intracranial Pressure ◽  
Broad Spectrum ◽  
Clinical Care ◽  
Subdural Empyema ◽  
Neurologic Examination ◽  
Infectious Disease Specialists

Subdural empyema is considered a neurosurgical emergency and, if found on neuroimaging, should prompt craniotomy for evacuation followed by broad spectrum antibiotics. In the setting of a patient with severe parenchymal swelling, a craniectomy may be indicated, as well as other modalities to lower intracranial pressure. Clinical care and decision making occurs with a multidisciplinary team of pediatric intensivists, infectious disease specialists, otolaryngologists, and neurosurgeons. Detection of recurrent subdural empyema is critical to prevent further morbidity and mortality, and surveillance of fever, neurologic examination, and follow-up imaging is critical. Timely surgical treatment of these infections can lead to good clinical outcomes.

scholarly journals Predicting the outcome of a comatose patient at the bedside

2019 ◽  
pp. practneurol-2019-002359 ◽  
Author(s):  
Eelco F M Wijdicks
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Surgical Treatment ◽  
Brain Death ◽  
Drug Interactions ◽  
Neurological Deficits ◽  
Temperature Management ◽  
Lower Probability ◽  
Comatose Patient ◽  
Critical Factors

The call to the bedside and the prognostication of a comatose patient—telling family members what to expect—commonly falls to neurologists. The assessment is often confounded by the treatment paradigms of modern intensive care (ie, drugs, drug interactions and targeted temperature management). Patients may be too unstable to leave the intensive care unit for neuroimaging; thus, repeated clinical examinations are decisive. Despite diverse causes, certain principles do apply: (1) Many patients can improve, although with significant abnormalities; (2) Neuroimaging and electrodiagnostic tests can help but are rarely definitive; (3) Secondary involvement of the upper brainstem marks a tipping point with much lower probability for an independent outcome; (4) We rarely predict mortality or diagnose brain death; usually the major concern is anticipated neurological deficits; and (5) Prior comorbidity and permanent organ dysfunction are critical factors in making decisions about de-escalation or escalation of care. This review provides a practical approach to evaluating outcome of a comatose patient. Prognostication is difficult, and we should only attempt it when the diagnosis is confirmed and appropriate (often aggressive) medical or surgical treatment has been tried.

scholarly journals Amyand’s Hernia: an Up-to-Date Review of the Literature

2017 ◽  
Vol 60 (3) ◽  
pp. 131-134 ◽  
Author(s):  
Dimitrios Patoulias ◽  
Maria Kalogirou ◽  
Ioannis Patoulias
Keyword(s):  
Inguinal Hernia ◽  
Surgical Treatment ◽  
Relevant Literature ◽  
Rare Condition ◽  
Diagnostic Approach ◽  
Amyand’S Hernia ◽  
Review Of The Literature ◽  
Hernia Sac ◽  
Comprehensive Review ◽  
Review Study

Amyand’s hernia is defined as an inguinal hernia, containing the appendix within the hernia sac. Incidence of this rare condition rises up to 1% (0.19–1.7%) of all inguinal hernia cases. Inflammation of the appendix within the inguinal sac is even rarer, as it corresponds to 0.1% (0.07–0.13%) of all Amyand’s hernia cases. After a comprehensive review of the limited relevant literature, we aim through this review study to describe the pathophysiology of inflammation of the appendix – contained in the hernia sac – and present the latest data about the diagnostic approach and surgical treatment of Amyand’s hernia.

Selection for Early Treatment in Myelomeningocele: A Retrospective Analysis of Various Selection Procedures

PEDIATRICS ◽  
1974 ◽  
Vol 54 (5) ◽  
pp. 553-557
Author(s):  
Sherman C. Stein ◽  
Luis Schut ◽  
Mary D. Ames
Keyword(s):  
Surgical Treatment ◽  
Selection Criteria ◽  
Selection Procedures ◽  
X Ray ◽  
Predicting Outcome ◽  
Selection Protocol ◽  
Selection For ◽  
Skull Deformity ◽  
Physical Findings ◽  
Early Surgical Treatment

The results of early surgical treatment in 163 children with open myelomeningocele 1963-1968 were reviewed. Based upon this review, a selection protocol is proposed. Lacunar skull deformity (LSD, lückenschädel), a common x-ray finding in newborns with myelomeningocele, is quite strongly associated with eventual mental retardation. Early surgery is not recommended for children having both LSD and multiple adverse physical findings or those with associated gross congenital anomalies. The proposed protocol is shown to be of considerably greater reliability in predicting outcome among our cases than existing selection criteria.

Sign in / Sign up

Export Citation Format

Share Document