Decrease In Consciousness Research Articles

Predictors of malignant swelling in space-occupying cerebellar infarction

BackgroundMalignant swelling is a fatal complication that can occur abruptly in space-occupying cerebellar infarction. We aimed to establish markers that predict malignant swelling in cerebellar infarction.MethodsWe retrospectively analysed data of...

People living with HIV presenting with hemiparesis: what are the possible causes?

People living with HIV (PLWH) are commonly associated with opportunistic infections, particularly with low CD4 count, less than 200 cells/μL. Neurological manifestation can be occurred 70% in PLWH and the most symptoms is hemiparesis, seizure, headache, behavioural changes, decrease of consciousness, and cognitive impairment but depends on the localization of the brain lesions. We present a case of 53-year-old man with initial presentation of right hemiparesis and was on highly active antiretroviral therapy (HAART). With laboratory and CT-scan result, the patient diagnosed with stroke ischemic and occurred at the same time with toxoplasma encephalitis (TE) as an opportunistic infection. In PLWH, many possible causes involve central nervous system-caused hemiparesis. The initial differential diagnosis should be considered to prevent delayed treatment and potential of severe complications.

Good health literacy leads to better quality of life and medication adherence among hemodialysis patients

Introduction: The research aimed to investigate the correlation between health literacy levels, medication adherence, and quality of life among hemodialysis patients with chronic kidney disease. Methods: The research employed a cross-sectional design. A random sample of 164 hemodialysis patients from two hemodialysis facilities in Padang, Indonesia, was collected between May and June 2023. Inclusion criteria were patients undergoing hemodialysis twice a week and aged over 18 years. Patients who experienced a decrease in consciousness and memory disorders such as dementia were excluded from this study. The questionnaires used to measure variables in this study were the demographic data questionnaire, the HLS-EU-Q16 health literacy questionnaire, the MMAS-8 medication adherence questionnaire, and the KDQOL-36 quality of life questionnaire for chronic kidney disease patients. Results: The high health literacy group (N = 73) exhibited a markedly superior quality of life compared to those in the mid-level (N = 48) and low-level (N = 43) health literacy groups. Multiple regression analysis revealed that, of the three components of health literacy, health promotion has the greatest influence on patients' quality of life, contributing 25.1%, while the aspect of healthcare has the greatest influence on medication adherence, contributing 43.3%. Conclusions: Health literacy is essential in improving medication adherence and the patient's quality of life in a more optimal direction. Healthcare professionals should create plans for tailored and customized health information with the goal of providing patients with the knowledge about critical components they need to manage chronic kidney disease.

Lymphadenitis and meningoencephalitis resulting from Cryptococcus neoformans infection in HIV patients

Background: Lymphadenopathy can occur at any stage of HIV infection, with multiple aetiologies including reactive, infectious and malignant. An accurate and timely diagnosis has obvious implications for treatment. Case Description: We report cryptococcal lymphadenitis as the presenting manifestation of HIV infection. Clinical symptoms observed in the patient included headaches, fever, non-productive cough, nausea, vomiting, white patches on the tongue, nodules in the right and left jaw area, a weight loss of 10 kilograms within a month, and a decrease in consciousness in the middle of treatment. The diagnosis was eventually confirmed with a lymph node fine needle aspiration biopsy. Fine needle aspiration biopsy (FNAB) indicated chronic granulomatous inflammation with a fungal (yeast) infection, suggestive of Cryptococcus. Conclusion: Cryptococcosis is a major invasive fungal infection capable of causing widespread disease outbreaks in immunocompromised hosts, and even in seemingly immunocompetent individuals. Cryptococcal infection should be a diagnostic consideration for lymphadenopathy in every patient, regardless of known HIV infection.

Spontaneous retrovesical bleeding on COVID-19 patient: A rare case

Introduction: COVID-19 does not merely cause respiratory distress as a clinical manifestation but also can develop into other systemic conditions such as cardiovascular, neurologic, hematopoietic, coagulopathy, and immunity disorders, and finally, multiple organ failure. This case aims to report a rare case of spontaneous retrovesical bleeding as one of the complications of COVID-19 Case Description: The patient was a female 66 years old with COVID-19 who complained of abdominal mass, followed by abdominal pain, decrease of consciousness, and unstable hemodynamics. During exploratory laparotomy, we found hematoma and diffuse bleeding from the retrovesical space. During the treatment of COVID-19, the patient was also administered enoxaparin to prevent venous thromboembolism. Conclusion: Coagulopathies in patients with COVID-19, aggravated with the administration of enoxaparin, induce spontaneous retrovesical bleeding. Moreover, the clinical manifestation of spontaneous retrovesical bleeding was atypical, making it challenging to recognize and diagnose early.

Case report: 82-year old patient with chronic subdural hematoma (SDH)

Background: Chronic Subdural Hematoma (CSDH) is commonly found on elderly and appears to be increasing within the last decades. Not only associated with substantial morbidity and mortality, CSDH also increases financial burden, thus appropriate treatment is required for better outcomes. Case Presentation: 82-year-old patient is admitted with the chief complaint of decrease in consciousness since 12 hours before admission. The family also complained an untreated left hemiparesis since one week prior to the admission. Patient also complained pain when straightening the right leg before losing consciousness. Summary: CSDH is a common neurosurgical case amongst elderly. Burr-hole drainage is the preferred technique to treat the condition. Follow up after the treatment is recommended as recurrence is quite common.

Nutrition Therapy for a 58-year-old man with Intracerebral Hemorrhage and Post Craniotomy: A Case Report

The nutritional status of individuals plays a crucial role during the subacute and recovery phases following a cerebrovascular event. Moreover, poor nutrition correlates with worsened disease severity, higher mortality rates, increased risk of infections, difficulty in swallowing, and limited improvement in daily activities even risk of malnutrition. A- 58 years old man was brought to emergency room with decrease of consciousness. Patient had history of hypertension and needed to undergo craniotomy with diagnose of Stroke Hemorrhage (ICH +IVH). Patient received 2100 kcal/day of total energy with 120 grams protein, fat 60 grams, carbohydrate 270 gr. Patient body weight when admitted was 100kg with height 178cm, Body Mass Index (BMI) 31.56 kg/m2 (Obesity type 2). After 21 days being admitted, nutrition intake reached the target and his clinical condition improved.

Severe Traumatic Brain Injury Induced Coagulopathy in Pediatric: An Important Lesson with Literature Review

Children with coagulopathy had a greater mortality rate after moderate to severe traumatic brain injury (TBI). The purpose of the current study was to examine the most recent relevant literature in relation to the therapy of TIC in pediatric isolated severe TBI patients. A 5 years old boy presented to emergency department with decrease of consciousness after hit by a motorcycle. He was referred from the district hospital without proper stabilization within 3 hours after the injury. From the blood examination, hemoglobin level was 8.1 g/dl, base deficit -9.9mEq/L with PTT and aPTT no coagulation suggesting coagulopathy. Emergency non-contrast head computed tomography was performed and showed anterior skull base fracture with discontinuity in left squamous suture suggesting a diastases fracture with an air hypodensity lesion in left frontal area suggesting a pneumocephalus. There was also a hyperdense lesion with crescent shape in frontal and interhemispheric region suggesting subdural hematoma. Delayed operation for almost 6 hours was advocated due to transfusion of whole blood and fresh frozen plasma to correct coagulopathy. The operation was successful, the patient was survived but upon 2 years follow up, the patient still wasn’t able to perform normal daily activity. Localized injury at the brain manifesting in systemic coagulopathy requires special care. Several steps need to be evaluated before surgery but it should not delay the attempt of controlling the source of coagulopathy by it means lesion in the brain. Our case demonstrates the important of recognizing and managing coagulopathy in severe traumatic brain injury.

Brain abscess as a complication of Salmonella meningitis in an infant: What can we learn from this case?

Background: Salmonella species (sp.) is a rare yet challenging causative organism of meningitis in the pediatric population. Salmonella meningitis has been reported to present with a more severe clinical course, poorer outcome, and higher degree of complications and relapses. Case Illustration: An 8-month-old male infant was admitted to our hospital with a history of focal tonic-clonic seizure, fever, projectile vomiting, and a decrease in consciousness. A head CT scan revealed a brain abscess in the frontal-temporoparietal region. The patient was administered a triple combination of intravenous antibiotics as the empirical treatment, followed by craniotomy for abscess evacuation. The abscess specimen culture isolated the growth of Salmonella sp. Improvement was observed during the hospital stay; however, the patient developed focal epilepsy, communicating hydrocephalus, and subsequent cerebral palsy as sequelae. The infant had a prior admission to the hospital at 6 months old when he was diagnosed with bacterial meningitis caused by Salmonella sp., treated with intravenous antibiotics for 21 days. Although the last cerebrospinal fluid (CSF) culture evaluation was sterile, slight pleocytosis and low glucose on CSF analysis persisted. Conclusion: Longer antibiotic administration, up to 4-6 weeks, might be considered for treating Salmonella meningitis. Evaluation of CSF culture, along with CSF analysis and neuroimaging studies, should be carefully considered to determine the appropriate duration of treatment.

Correlation of Neutrophil-Lymphocyte Ratio with the Evidence of Stroke Haemorrhagic at Tertiary Hospitals

Stroke is the leading cause of death, disability, and morbidity in the world. Hemorrhagic stroke (HS) prevalence accounts for 10–20% of all strokes, whereas ischemic stroke accounts for 85 percent. Clinical manifestation and numerous biomarkers such as ferritin level, cholesterol level, and lately neutrophil-to-lymphocyte ratio have been suggested as a sign of HS prognosis. It’s also used as a modality for differentiating ischemia from hemorrhagic. The purpose of this study is to assess if there is a link between NLR and HS evidence. A retrospective cross-sectional study was conducted among the medical reports of patients treated with stroke at Sanjiwani Hospital Bali through 2018–2020. The inclusion criteria were complete medical reports in adults≥ 18 years old. Data obtained from the medical record include demographic data, including age, gender, chief complaint, stroke diagnoses based on clinical manifestations, data of leucocytes, neutrophils, lymphocytes, NLR, and results of computed-tomography scanning of the head. Data were analyzed with the Chi-Square test for nominal data and Spearman Correlation test to evaluate the correlation of the leucocyte, neutrophil, lymphocyte, NLR, with the diagnoses. Ninety-six patients’ medical records were evaluated in the current study. Age ≥ 50 years old (85.4%) with the oldest age was 91 years old. The top three chief complaints are hemiparesis (78.1%), a decrease of consciousness (7.3%), and facial palsy (5.2%). We also analyzed the correlation of inflammation parameters using the Spearman correlation test. There is a positive weak correlation between leucocyte count (r: 0.351; p<0.001) and NLR with evidence of HS (r = 0.371; p<0.001). The correlation between neutrophil counts and evidence of HS is a positive moderate correlation (r = 0.408, p<0.001). Lymphocyte count has a strong positive correlation with HS (r: 1.000, p = 0.017). The leucocyte, neutrophil, lymphocyte, and NLR are able to predict the evidence of hemorrhagic disease in resource-limited countries.

Multi-territorial posterior circulation ischemic stroke after cocaine intoxication.

A 35-year-old man presented to the emergency department with altered mental status and bilateral tonicclonic seizures. Due to a progressive decrease in consciousness, he was intubated for airway protection. The patient’s relatives reported that he had used cocaine, leading to an initial suspicion of acute cocaine intoxication. However, a head CT scan without contrast revealed a hyperdense basilar artery sign without other signs of infarction (figure 1).

Risk factors of death in children with bacterial meningitis: a systematic review and meta-analysis

Background and objectives. To identify the risk factors that cause death in children with bacterial meningitis. Materials and methods. Articles were obtained through a journal literature search of observational studies using electronic databases: PubMed, Scopus, ProQuest, Science Direct, and Web of Science. The articles were systematically selected using international guidelines from the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols. Results. A literature search identified 8746 articles. After screening, 19 studies were found that met the requirements for meta-analysis. There was a total of 6997 patients aged 1 month to 18 years who were included in the study. Factors that significantly influence the risk of death in children with bacterial meningitis in this meta-analysis are: age less than five years (pooled OR = 3,19; 95% CI, 1,03-9,89; p = 0.04), age less than three years (pooled OR = 18,77; 95% CI, 2,10-167,83; p = 0.009), decreased of consciousness (pooled OR = 4,85; 95% CI, 1,25-18,86; p = 0.02), seizure (pooled OR = 2,97; 95% CI, 1,09-8,07; p = 0,03), and bacteria Streptococcus pneumoniae compared to Haemophilus influenzae from culture of cerebrospinal fluid (pooled OR = 12,52; 95% CI, 8,95-17,52; p <0,00001). Conclusions. Risk factors for death in children with bacterial meningitis were age less than five years old, age less than three years, decrease of consciousness, seizure, and cerebrospinal fluid culture result of bacteria Streptococcus pneumoniae compared to bacteria Haemophilus influenzae.

Bilateral Blindness as an Initial Finding of Occipital Lobes Meningioma Metastated from Lung Cancer

Introduction: Meningioma may increase intracranial pressure (ICP) and cause papilledema, which results bilateral blindness. Since elevated ICP is thought to be caused by an underlying condition, immediate neuroimaging is required to look into the possibility of papilledema. Patients with intracranial tumour sometimes being consulted to ophthalmologist with ocular problems as their complaint. The purpose of this report is to describe a case of papilledema as an initial finding of occipital lobes intracranial tumor metastated from lung cancer. Case presentation: A female, 50-year-old patient being consulted from the ward with chief complaint bilateral visual loss gradually worsening in the last three months. Further history taking revealed other symptoms including relapsing headache since a year ago. Patient also came to the ophthalmologist a year ago and get examinated because of the headache and the examination result is only refraction disorder. Patient had decrease of consciousness and started coughing with massive sputum production since a week ago before she is admitted to the hospital. Patient was undergone Lung CT scan, a large mass was found in left lung, then she is diagnosed with lung cancer. Before that she never have any complaints about shortness of breath and chronic cough. The visual acuity on both eyes were already no light perception at the initial visit. Anterior segment was calm but the pupil was mid dilatation with no light reflexes. Fundus examination revealed papilledema, the optic nerve heads edges was blurred. Intraocular pressures were 12 mmHg. A MRI was performed 3 months before the patient got admitted to the hospital and revealed a massive solid mass in the left occipital lobe (approx AP 4 x LL 5 x CC 5.5 cm). Radiological reading suggested a meningioma. The patient was immediately referred to pulmonologist, neurologist, together with surgical neurology unit. Conclusion: A patient with slow growing intracranial tumour may come quite late to seek medical attention since the symptoms are very mild and bearable. When being consulted, the visual acuity is already no light perception. Ophthalmologist must be aware and consider the metastases of lung cancer into intracranial tumour as a cause of visual loss and therefore not to delay its management.

Acute pancreatitis during valproic acid administration in a patient with vascular dementia, epileptic seizures, and psychiatric symptoms: a case report

BackgroundValproic acid (VPA) is a relatively safe drug widely used for the treatment of epileptic seizures and mania in bipolar disorder, as well as the prevention of migraine headaches. Here, we present a case of VPA-induced pancreatitis in a patient with vascular dementia, epileptic seizures, and psychiatric symptoms. He had no distinctive abdominal symptoms.Case presentationA 66-year-old Japanese man was treated with VPA for agitation and violent behavior due to vascular dementia, epileptic seizures, and psychiatric symptoms. During admission, he experienced a sudden decrease in consciousness and blood pressure. Abdominal findings were unremarkable; however, blood tests showed an inflammatory response and elevated amylase levels. Contrast-enhanced abdominal computed tomography showed diffuse pancreatic enlargement and inflammation extending to the subrenal pole. VPA-induced acute pancreatitis was diagnosed, VPA was discontinued, and high-dose infusions were administered. Acute pancreatitis resolved after treatment initiation.ConclusionsClinicians should be aware of this relatively rare side effect of VPA. Diagnosis may be challenging in elderly people and patients with dementia as they may present with non-specific symptoms. Clinicians should consider the risk of acute pancreatitis when using VPA in patients who cannot report spontaneous symptoms. Blood amylase and other parameters should be measured accordingly.

Neurologic Manifestation in Children with Coronavirus Disease 2019 at Prof. Dr. I.G.N.G Ngoerah Tertiary Hospital

AIM: The objective of the study is to describe neurologic manifestation in children with coronavirus disease-2019 (COVID-19) at Prof. Dr. I.G.N.G Ngoerah Hospital. METHODS: This was a retrospective descriptive study using the medical record with a total sampling of children with confirmed COVID-19 that manifests neurologic symptoms. Exclusion criteria were pre-existing neurologic comorbidities and incomplete medical records. RESULTS: From March 2020 to December 2021, from 308 children with confirmed cases of COVID-19, 106 had neurologic symptoms, 17 were excluded (16 pre-existing comorbidities, and 1 incomplete medical record), and total samples were 89 (28.8%) from inpatient and outpatient. Most children were male (57.3%) with a median age of 13 years. Most symptoms found were anosmia (73%), followed by a decrease in consciousness (19.1%) and seizure (10.1%). Children with anosmia median age were 14 years. There were 84 (94.3%) children with specific neurological symptoms (encephalopathy, seizures, and anosmia) and 5 (5.7%) with non-specific neurological symptoms (headache). CONCLUSION: There were 28.8% confirmed cases of COVID-19 with a neurologic manifestation, and most symptoms found were anosmia (73%).

Pulmonary and central nervous system nocardiosis: Alcoholism as an immunocompromising factor

Nocardiosis is a disease with worldwide distribution. It is usually found in tropical areas and mainly affects immunocompromised patients, however, there are also cases where its infection has been reported in immunocompetent patients. This pathology is caused by bacteria known as Nocardia spp., which are gram-positive microorganisms and environmental saprophytes, and although exposure to Nocardia spp. is almost universal, only a small fraction of exposed people develops the disease. We present the case of a 47-year-old man, with no evidence of immunosuppression, from a rural area of Boyacá, who was admitted due to intense and intermittent headache accompanied by paresthesia and, finally, a decrease in consciousness. A brain magnetic resonance was performed and evidenced a fronto-temporo- occipital space-occupying lesion in the cortico-subcortical region with a compressive effect and displacement of the ventricular system cavities. It was suspected at first a neoplastic lesion or a brain abscess. The lesion was surgically resected, and its culture showed Nocardia africana/nova. In later studies a possible primary pulmonary focus was evidenced. Alcoholism was the only risk factor documented. The patient completed 6 weeks of hospital antibiotic treatment with favorable clinical and radiological evolution and was discharged with a 1-year plan of outpatient antibiotic therapy. Although Nocardia spp. mainly affects immunocompromised patients, evidence shows that this microorganism can also be a threat to individuals without traditional immunosuppression risk factors.

Ependymal lined paraventricular neuroglial cyst: an outcome of endoscopic cystoventriculostomy concomitant ventriculoperitoneal shunt procedures: a case report

Neuroglial cysts are one of the problems that might develop in the neuroaxis region. We present the case of a 79-year-old male with an acute decrease in consciousness, dysphagia, and seizure with a past medical history of a cystic mass in the frontal lobe since 5 years ago. A cystic lesion with a calcification component was found in the regio left frontal after the patient received a head CT without contrast. The periventricular white matter is where the lesion is found. Subsequent brain MRI with and without contrast showed hypointense T1 weighted image (T1W1), hyperintense T2-weighted imaging (T2W1), hypointense fluid-attenuated inversion recovery (FLAIR), and non-restricted diffusion-weighted imaging (DW1). A non-enhancing intra-axial lesion measuring 5.1 cm (AP) x 3.1 cm (LL) x 3.6 cm (CC). Following a discussion of the benefits and risks with his family, the decision was eventually made to proceed with Endoscopic Cystoventriculotomy (Cyst Fenestratum) and concurrent ventriculoperitoneal (VP)-shunting. This method produced positive results. The preferred method is endoscopic fenestration since it carries fewer risks and consequences than open craniotomies and fenestration.

Case report of dengue shock syndrome with decrease of consciousness, sepsis, and clinical tuberculosis

Dengue is a disease caused by the dengue virus, which is a classification of the Flavivirus group. The Aedes mosquito group transmits this virus. Dengue infection can provide a diverse clinical spectrum. This is a type of qualitative research with a case study approach. The case was conducted at the K.R.M.T. Wongsonegoro Regional Hospital, Semarang. Retrieval of data used primary data and secondary data. Case management was done following the Standard Operating Procedures set by the hospital. Data analysis was conducted by comparing cases with review literature sourced from articles or other scientific sources. The case study results pointed out that a girl was brought by her parents to the emergency room at R.S.D. K.R.M.T. Wongsonegoro on April 18, 2022, at 13.30 WIB as a referral patient from the Public Health Center with complaints of seizures and shortness of breath. The child's condition was monitored by experiencing changes on the eleventh day in the PICU Room.

PENYULUHAN TENTANG BAHAYA NARKOBA DAN KENAKALAN REMAJA DALAM RANGKA PENINGKATAN PENGETAHUAN SISWA DI SMP 1 ANGKOLA BARAT

ABSTRACT
 Narcotics are natural, synthetic and semi-synthetic substances or drugs which can cause a decrease in consciousness, hallucinations and excitability in humans. According to Law no. 39 of 2009 concerning 
 
 Narcotics states that narcotics are artificial substances or even those derived from plants that have hallucinatory effects, decrease consciousness, and cause addiction. These drugs can be addictive if used excessively. Utilization of these substances is as a painkiller and provide peace. Its misuse can be subject to legal sanctions. Youth is the future asset of a nation. But nowadays a lot is happening to teenagers, such as drugs and juvenile delinquency such as motorcycle gangs. Therefore, knowledge about drugs and juvenile delinquency is very important as a strategy in reducing things that can harm the future of adolescents. This community service aims to increase students' knowledge about drugs and juvenile delinquency. This community service activity was attended by 30 class IX students. This activity was carried out by delivering counseling materials about drugs and juvenile delinquency at SMP Negeri 1 Angkola Barat. This activity was also interspersed with discussions and questions and answers. The results of this community service activity were received enthusiastically by students. All activity participants stated that this community service was very useful because it could add insight into knowledge about drugs and juvenile delinquency which affect habits in everyday life.
 
 Keywords: teens, drugs, delinquency, teenagers

Evaluation of Clinical, Socioeconomic, and Demographic Factors in Different Poisoning Agents in Pediatric Population

Background: Poisoning is a critical global health problem, especially among children. This study aimed to assess the epidemiological features, clinical signs, and risk factors of childhood poisoning in the southeastern region of Iran. Patients and Methods: This cross-sectional study was conducted on 636 children and adolescents admitted to the Emergency Department of Ali Ebne Abitaleb Teaching Hospital in Zahedan, Iran, within 2014 to 2020. The collected data were clinical symptoms at the time of admission, socioeconomic and demographic determinants, poisoning agents, admission to the pediatric intensive care unit (PICU), using antidote, hospital stay in days, discharge status from the hospital, self-poisoning, gender, and place of residency. The data were analyzed using SPSS software (version 18). Mean and standard deviation, Pearson and chi-square were used to assess the association between two specific categorical variables, and the level of significance was considered 0.05. Results: Opium was the most common poisoning agent with the age of 8 years and femalepriority. Among poisoned subjects by chemical agents, the highlighted symptoms were respiratory distress, decreased peripheral oxygen saturation (SPO2), nausea and vomiting, fever, and a decrease in heart rate in the given order. Among poisoned subjects by medicinal agents with a decrease in SPO2, a decrease in consciousness and blood pressure was common. More frequent symptoms in children poisoned by opium were a decrease in SPO2, myosis, a decrease in heart rate, a decrease in respiratory rate, seizures, and nausea and vomiting. The factors, including antidote, gender, place of residency, poisoning by accidental events, admission to PICU, and days stayed in the hospital, were the significant factors in poisoning. Conclusions: Poisoning by opium agents was more common than other agents in Iran in lower age groups. Poisoned children by opium agents had severe symptoms with higher frequency than other agents. Antidote, gender, place of residency, poisoning by accidental events, admission to PICU, and days stayed in the hospital were significant factors in agent poisoning.