Structure and nature of hypertensive intracerebral hemorrhages of supratentorial localization

Objective ‒ to analyze data of patients with hypertensive supratentorial hemorrhages who were hospitalized in Kyiv Emergency Hospital in 2019‒2020.Materials and methods. We analyzed data of 232 patients who were treated for hypertensive intracerebral hemorrhage at the Kyiv Emergency Hospital in 2019‒2020. Patients were included regardless of admission status and chosen treatment tactics (surgical, medical). The study did not include patients with subtentorial hemorrhage, patients with tumor hemorrhage, arteriovenous malformations, aneurysms, angiomas, ischemic and mixed strokes.Results. Among patients males are predominated (149 (64 %)). The average age of patients was 60 years (group of men ‒ 56 years, group of women ‒ 69 years). 77 (33 %) patients were delivered in a comatose state (GCS ≤8 points), 36 (16 %) were in a coma (GCS 9‒12 points), 81 patients were in a state of stupor (GCS 13‒14 points), in a clear mind ‒ 31 (13 %). In 7 (3 %) cases it is impossible to determine the level of consciousness (in patients with seizures or after the introduction of sedative drugs before admission to hospital). 85 patients were operated (surgical activity ‒37 %), who underwent 97 surgical interventions. The overall mortality was 42 %, postoperative mortality ‒ 43 %. Patients who had a compression-dislocation syndrome were operated on. Mortality in the group of patients admitted in a coma mortality was 85 % regardless of the method of treatment.Conclusions. Hemorrhagic strokes predominate in men, due to lifestyle and uncontrolled hypertension in patients. The results of treatment of patients with hypertensive intracerebral hemorrhage indicate the need for early hospitalization, early CT, differentiated approache to surgical removal of hematomas (lobar, lateral with dislocation syndrome), intensive care in patients in a comatose state, even with massive hemorrhages. The results of hypertensive intracerebral hemorrhage depend on the location of the hemorrhage, the severity of the patient’s condition, the timing of hospitalization in specialized stroke departments, the dynamics of cerebrovascular disorders (completed stroke and stroke in development).

A-59 Psychosis and Coma in COVID-19: A Case Report

Objective The objective of this case is to spotlight the potential neurological andneuropsychiatric symptoms associated with COVID-19. Method A 55-year-old African American male with a history of schizophrenia, bipolar disorder, obesity, tobacco use, and hypertension voluntarily presented to the local hospital with auditoryhallucinations and delusions. During an inpatient stay, the patient developed symptomsconsistent with COVID-19 and subsequently tested positive for the virus. Thirty-nine days after the initial positive COVID-19 test result, he remained in a coma with retained brainstem responses. An EEG demonstrated encephalopathy and MRI showed multiple, well-circumscribed white matter lesions consistent with acute demyelination (Figure 1). After three days of high-dose steroids and over a month in a coma, the patient began following simple commands. Unfortunately, on hospital day 66, the patient developed sudden hypotension and worsening respiratory status. Results While psychotic episodes in relation to COVID-19 are not widely reported, psychotic episodes are shown in three COVID-19 cases. Other reports have found significant changes in consciousness in COVID-19 patients with delayed awakening from a comatose state. Pre-existing inflammatory responses in those with psychiatric disease may be accelerated by the immune response due to COVID-19. Conclusion Mental status changes in those with psychiatric illness who have COVID-19 are worth exploring. It is unclear whether a history of COVID-19 may accelerate a neuropsychiatric process or other central nervous system diseases. Future research may want to examine the possible interrelationship between pre-existing neurological vulnerabilities and COVID-19. The possibility of high-dose steroid treatment for COVID-19 neuroinflammatory complications should be considered.

COVID-19-related diffuse leukoencephalopathy with microbleeds and persistent coma: a case report with good clinical outcome

A 60-year-old patient presented with respiratory distress, after recently being tested COVID-19 positive and was mechanically ventilated for 15 days. After cessation of sedation, he remained in deep comatose state, without any reaction on pain stimuli (Glasgow Coma Score 3). MRI of the brain showed diffuse leukoencephalopathy and multiple (>50) microbleeds. Diffuse COVID-19-associated leukoencephalopathy with microhaemorrhages is associated with a poor prognosis. However, 3 months later, our patient showed a remarkable recovery and was able to walk independently. This case report shows COVID-related leukoencephalopathy and intracerebral microbleeds, even with persistent comatose state, may have a favourable clinical outcome and prolonged treatment should be considered in individual cases.

Prolonged Unconsciousness Following Severe COVID-19

Objective:We report a case series of patients with prolonged but reversible unconsciousness following COVID-19 related severe respiratory failure.Methods:A case series of patients who were admitted to the ICU due to COVID-19 related acute respiratory failure is described.Results:After cessation of sedatives the described cases all showed a prolonged comatose state. Diagnostic neurological work-up did not show signs of devastating brain injury. The clinical pattern of awakening started with early eye opening without obeying commands and persistent flaccid weakness in all cases. Time between cessation of sedatives to the first moment of being fully responsive with obeying commands ranged from 8 to 31 days.Conclusion:Prolonged unconsciousness in patients with severe respiratory failure due to COVID-19 can be fully reversible warranting a cautious approach for prognostication based on a prolonged state of unconsciousness.

Acute methadone poisoning in infants

Acute poisoning in children is one of the most frequent reasons for seeking medical care and hospitalization in intensive care units, but it is extremely rare in children of the first year of life. On the example of the clinical case, the peculiarities of the course of acute severe methadone poisoning in a two-month-old child against the background of natural feeding are considered. The main data of history and clinical-laboratory examination are reflected, which allowed to suspect acute poisoning in a timely manner and to carry out reasonable intensive therapy, against the background of which the maximum rapid improvement of the child s condition is achieved. The algorithm of differential diagnosis of comatose state in children is presented, which can be used in all cases of sudden suppression of consciousness of unclear genesis. Special attention is paid to the need for maximum early recognition of exogenous poisoning and targeted pathogenetic treatment aimed at elimination of toxicant metabolites. A distinctive feature of this case was the severe course of acute methadone poisoning in the infant with the development of coma and respiratory distress, which regressed against the background of the treatment carried out with the full recovery of the patient.

MON-370 Treatment of Parathyroid Storm in a Patient with Traumatic Brain Injury: A Reversible Comatose State

Background: Parathyroid storm, also known as parathyroid crisis, is a rare and under-recognized endocrine emergency due to severe hypercalcemia in patients with primary hyperparathyroidism. It is characterized by significantly elevated parathyroid hormone (PTH) levels even up to 20 times above the normal limit along with calcium levels >15 mg/dl, leading to multiorgan dysfunction, notably altered mental status and acute kidney injury. Risk of mortality is high without urgent parathyroidectomy. We describe a case of a patient with acute traumatic brain injury and parathyroid storm with PTH >1700 pg/ml (11-51) and Ca 15.4 mg/dl (8.6-10.4) in whom resection of a parathyroid adenoma reversed the comatose state. Clinical Case: Our patient is a 68 year-old male with no significant past medical history who sustained a fall off a 12-foot ladder complicated by right intracranial bleed s/p hemicraniectomy and multiple fractures, including left clavicle fracture with possible subclavian artery injury, left rib fractures, and right hip fracture s/p ORIF. The patient had a brief, partial improvement of mental status, followed by comatose state in the setting of rapidly rising calcium levels and acute kidney injury. In the setting of blood transfusions, the patient had an initial Ca of 8.8 mg/dl (8.6-10.4) on admission. The calcium levels rose over a week to 15.4 mg/dl with albumin of 2.4 g/dl (3.9-5.0), PTH levels from 953 pg/ml to >1700 pg/ml (11-51) after tracheostomy, and creatinine from 0.69 mg/dl to peak of 2.0 mg/dl (0.60-1.30). In spite of IV hydration, calcitonin, cinacalcet up to 90mg twice daily, pamidronate 60mg IV, and several sessions of hemodialysis, the patient’s calcium did not normalize, and the patient remained comatose. Other labs showed phosphorus nadir of 1.4 mg/dl (2.3-4.4), 25-OH VitD 13 ng/ml (20-50), 1,25-OH VitD 9.8 pg/ml (19.9-79.3), VitA 0.6 mg/L (0.3-0.9), PTHrP <2.0 pmol/L (0.0-2.3), normal SPEP/UPEP, and peak CK of 569 U/L (63-474). Sestamibi scan showed intense tracer uptake within a nodule near the suprasternal notch, and parathyroid 4D-CT showed a left 17mm pretracheal lesion with cystic degeneration along the superior margin of the manubrium. The patient subsequently underwent parathyroidectomy of an ectopic cystic mass with normalization of calcium and PTH levels. Pathology revealed a 0.8 gram, 1.5 x 1.0 x 0.3 cm enlarged, hypercellular parathyroid. The patient woke up from his comatose state immediately after surgery with progressive improvement in mental status back to baseline, other than left-sided weakness. Conclusion: Our case highlights the importance of surgical management as an effective cure for parathyroid crisis and underscores the associated critical and significant rise in calcium and PTH levels, which was resistant to medical treatment.

IRON AND STEEL INDUSTRIES; A STRATEGIC SECTOR FOR TECHNO-ECONOMIC DEVELOPMENT AND NERVE CENTER FOR INDUSTRILIZATION IN NIGERIA

The Nigerian iron and steel industry established as a basis for industrialization has remained unproductive even as the year 2020 targeted for the country to become one of the world's top 20 economies is barely a few months away. Despite, the boom in the oil sector, the value-added sector is low while the inter-sectoral linkages are weak. This implies a boom in one activity rarely affects another in the sector, but will rather impact on the foreign economy from where imports were sourced. Nigeria relies mainly on crude oil to the neglect of the iron and steel sector which is a major determinant for the industrialization of any nation. Lack of industrialization and unemployment in Nigeria today which engenders insecurity could be linked to the comatose state of the Nigerian iron and steel industry. Thus, this paper discussed the iron and steel sector as a strategic sector for rapid development and nerve center for industrialization in Nigeria.

Death from Neglected Pituitary Adenoma: A Case Report

We present a case of a patient who presented with pituitary macroadenoma complicated with hydochephalus. He presented late to the referral hospital in a comatose state and died a few hours later. He was a 33-year-old, male who gave a history of highly accelerated symptoms lasting 1 week. Neurosurgical consultation as well as investigations with CT scan or MRI were not availed the patient,which could have been life saving. Autopsy findings were of a pituitary macroadenoma and signs of hydrocephalus and raised intracranial pressure which proved fatal.

Minimally Conscious State and Persistent Vegetative State

Advances in critical care medicine have allowed for more patients to survive catastrophic brain injuries. However, the degree of recovery from serious neurologic injury is highly variable. An acute, severe neurologic insult can cause a state of pathologic unconsciousness referred to as a coma. Common causes of brain injuries leading to a comatose state include cardiac arrest, a severe vascular event, a profound metabolic disturbance (eg, hypoglycemia), carbon monoxide or other poisoning, intoxications, or overdoses. The duration of a comatose state is rarely longer than days to weeks.

Successful Surgical Treatment of Severe Perforating Diametric Craniocerebral Gunshot Wound Sustained during Combat: A Case Report

Many researchers classify perforating diametric craniocerebral gunshot wounds as fatal because mortality exceeds 96% and the majority of patients with such injuries die before hospitalization. A 23-year-old Ukrainian male soldier was admitted to a regional hospital with a severe perforating craniocerebral wound in a comatose state (Glasgow Coma Scale score, 5). Following brain helical computed tomography, the patient underwent primary treatment of the cerebral wound with primary duraplasty and inflow/outflow drainage. After 18 days of treatment in the intensive care unit, he was transferred to a military hospital for further rehabilitation. This report details our unusual case of successful treatment of a perforating diametric craniocerebral gunshot wound.