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Query: UMLS:C0036572 (seizures)
 80,221 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Clinically evident epileptic seizures were observed in 145 patients during the first week of traumatic coma. They frequently occurred during the first day in young subjects in reactive coma, and were often isolated attacks. When ssen at a later stage they are more common in adults with non-reactive coma. The partial or generalised nature of the seizures, the depth of the coma, and the chronological order in which the seizures appear have no bearing on the etiology; the only positive finding was that recurrent seizures were more frequent in patients with intracranial hematoma (18,6% of the patients). The early appearance of seizures does not worsen the prognosis of reactive coma or non-reactive coma in young people. Critical discharges without clinical manifestations were present in 37 patients with traumatic coma during the first week. The average age of these injured patients was higher, and the prognosis for non-reactive coma worse in this group. The comatous state does not modify the clinical aspects or the etiological significance of these early post-traumatic discharges.
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PMID:[Significance of epileptic seizures occurring during the first week of traumatic coma (author's transl)]. 11 88

One hundred and four children suffering from non-traumatic coma were referred to the Pediatric Neurology Service, Children's Hospital, Winnipeg, between February 1976 and December 1978. Stepwise discriminant analysis was used to obtain a classification function of outcome, based on clinical variables determined at two separate time-periods of examination: (1) the time of admission and (2) about 24 hours after onset of coma. 12 clinical variables were included in the stepwise procedure. Seven of these: coma severity, extra-ocular movements, pupils, motor patterns, blood pressure, temperature and seizure type, entered the classification function for the first time-period, data being available for 102 children. 75 per cent of these cases were correctly classified into one of five outcome groups and 8 per cent were seriously misclassified. Similarly, 67 per cent of the 66 children evaluated in the second time-period were correctly classified and 3 per cent seriously misclassified. The variables that entered the classification function in this second time-period were age, coma severity, motor patterns, blood pressure and seizure type. The data suggest that the analysis of clinical variables recorded early in the comatose state can provide predictive information, and stepwise discriminant analysis may be one method of determining the most likely outcome for individual cases.
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PMID:Non-traumatic coma in childhood: clinical variables in prediction of outcome. 661 27

The aim of this study is to review indications for emergency EEG in case of brain trauma. The authors emphasize the indication of emergency EEG for the diagnosis of either cerebral death or early post traumatic seizures, and for the monitoring of intensive neurological treatments. Emergency EEG and diagnosis of cerebral death has been reviewed in another issue of this journal. Diagnosis of early post-traumatic seizures may be difficult in case of cranial trauma in either the presence or the absence of coma. Emergency EEG help guide the diagnosis of electrical signs of seizures, thus indicating that treatment with antiepileptic drugs is advisable. Severe post-traumatic coma requires barbiturate impregnation and moderate hypothermia. In this last case, emergency EEG is essential for the monitoring of pharmacological treatments. The authors conclude that continuous EEG monitoring could in the future substitute for standard EEG recorded in emergency.
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PMID:[Emergency EEG and brain injuries]. 962 4

Altered mental status is a common occurrence in children with acute critical illness. The causes of non-traumatic coma are diverse ranging from neurological to systemic causes. Early appropriate supportive care is essential to avoid preventable secondary insults and optimize the neurological outcome. Evaluation and stabilization of the patient's airway, breathing and circulation (ABCs) must proceed simultaneously with assessments of the depth of coma and the presence of raised intracranial pressure (ICP). Any rapidly correctable cause of coma must be immediately corrected. Most patients with non-traumatic encephalopathies have raised ICP, although papilledema may be absent and the CT scan may be normal if ICP elevation occurs acutely. The most important early treatment for raised ICP is controlled intubation and ventilation followed by osmotherapy. Early control of seizures, including non-convulsive seizures is important. Urgent imaging is indicated in most cases particularly in the presence of afebrile coma, focal signs or papilledema. Following stabilization, isotonic fluids are administered, aiming for euvolemia and euglycaemia. Ventilation should aim for the lower end of eucapnia to avoid causing cerebral ischemia. Surgical options should be explored and, in refractory intracranial hypertension, barbiturates and mild hypothermia may have a role.
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PMID:Emergency and intensive care management of a comatose patient with intracranial hypertension, current concepts. 1673 62

Coma and other states of impaired consciousness represent a medical emergency. The potential causes are numerous, and the critical window for diagnosis and effective intervention is often short. The common causes of non-traumatic coma include central nervous system infections, metabolic encephalopathy (hepatic, uremic, diabetic ketoacidosis etc.), intracranial bleed, stroke and status epilepticus. The basic principles of management include 1) Rapid assessment and stabilization, 2) Focussed clinical evaluation to assess depth of coma, localization of lesion in the central nervous system and possible clues to etiology, and 3) Treatment including general and specific measures. Commonly associated problems such as raised intracranial pressure and seizures must be recognized and managed to prevent secondary neurologic injury.
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PMID:Approach to the child with coma. 2140 16

Non traumatic coma in childhood is an important emergency. It can result from wide range of etiologies. CNS infections are the most common cause of non traumatic coma in children. However, multiple interrelated factors may be present in one patient. Management of a comatose child goes hand in hand with clinical evaluation. It is an emergency that requires simultaneous institution of immediate life support, identification of the cause and institution of definite therapy. The primary goal is to establish airway, breathing and circulation and to identify and treat raised intracranial pressure and seizures.
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PMID:Non-traumatic coma and altered mental status. 2187 Jan 45

Because coma has many causes, physicians must develop a structured, algorithmic approach to diagnose and treat reversible causes rapidly. The three main mechanisms of coma are structural brain lesions, diffuse neuronal dysfunction, and, rarely, psychiatric causes. The first priority is to stabilise the patient by treatment of life-threatening conditions, then to use the history, physical examination, and laboratory findings to identify structural causes and diagnose treatable disorders. Some patients have a clear diagnosis. In those who do not, the first decision is whether brain imaging is needed. Imaging should be done in post-traumatic coma or when structural brain lesions are probable or possible causes. Patients who do not undergo imaging should be reassessed regularly. If CT is non-diagnostic, a checklist should be used use to indicate whether advanced imaging is needed or evidence is present of a treatable poisoning or infection, seizures including non-convulsive status epilepticus, endocrinopathy, or thiamine deficiency.
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PMID:Diagnosis of reversible causes of coma. 2584 89