Transient Coma Research Articles

Repeat-dose toxicity study of human umbilical cord mesenchymal stem cells in cynomolgus monkeys by intravenous and subcutaneous injection.

Human umbilical cord mesenchymal stem cells (hUC-MSCs) are proposed for the treatment of acute lung injury and atopic dermatitis. To advance hUC-MSC entry into clinical trials, the effects of hUC-MSCs on the general toxicity, immune perturbation and toxicokinetic study of hUC-MSCs in cynomolgus monkeys were assessed. hUC-MSCs were administered to cynomolgus monkeys by intravenous infusion of 3.0 × 106 or 3.0 × 107cells/kg or by subcutaneous injection of 3.0 × 107cells/kg twice a week for 3weeks followed by withdrawal and observation for 6weeks. Toxicity was assessed by clinical observation, clinical pathology, ophthalmology, immunotoxicology and histopathology. Moreover, toxicokinetic study was performed using a validated qPCR method after the first and last dose. After 3rd or 4th dosing, one or three the monkeys in the intravenous high-dose group exhibited transient coma, which was eliminated by slow-speed infusion after 5th or 6th dosing. In all dose groups, hUC-MSCs significantly increased NEUT levels and decreased LYMPH and CD3+ levels, which are related to the immunosuppressive effect of hUC-MSCs. Subcutaneous nodules and granulomatous foci were found at the site of administration in all monkeys in the subcutaneous injection group. Other than above abnormalities, no obvious systemic toxicity was observed in any group. The hUC-MSCs was detectable in blood only within 1h after intravenous and subcutaneous administration. The present study declared the preliminary safety of hUC-MSCs, but close monitoring of hUC-MSCs for adverse effects, such as coma induced by intravenous infusion, is warranted in future clinical trials.

Reversible Splenial Lesion Syndrome (RESLES) in Sickle Cell Crisis Mimicking Marchiafava-Bignami Disease (P10-7.001)

<h3>Objective:</h3> N/A <h3>Background:</h3> Reversible Splenial Lesion Syndrome (RESLES) is characterized by the presence of transient lesion involving the splenium of corpus callosum in patients with encephalopathies of various cytotoxic etiologies. One of which is Marchiafava-Bignami Disease(MBD), which could manifest with sudden stupor or coma in alcohol use disorder (AUD) or malnutrition with severe demyelination of splenium. Here we report a case of MBD-like presentation in a patient with vaso-occlusive sickle-cell crises. <h3>Design/Methods:</h3> NA <h3>Results:</h3> A 46-year-old male with sickle-cell disease and no history of AUD presented with acute chest syndrome with pain crisis. He was treated with blood transfusion and analgesics. Two days later, he became acutely unresponsive with right-sided hemiparesis, requiring intubation. MRI brain showed numerous punctate infarcts in the watershed areas bilaterally, along with symmetric diffusion restriction in the splenium of corpus callosum, respecting its anatomic boundary. Exchange transfusion was initiated and maintained his hemoglobin &gt;10 g/dL and Hb-SS &lt; 30%, but he remained comatose (GCS 6). Electroencephalogram showed diffuse cerebral dysfunction without epileptogenicity. His extensive infectious workup was unremarkable. Other laboratory tests including electrolytes, liver function tests, ammonia, thyroid function tests, vitamin B12, B6, folic acid, and thiamine levels were normal. He was empirically treated with intravenous thiamine. One week later, his mental status improved to following commands. MRI brain two weeks after showed a near-complete resolution of the callosal lesion. The patient’s acute stupor/coma and MRI findings were attributed to hypoxic watershed infarcts and RESLES due to hypoxic stress from vaso-occlusive sickle cell crisis, leading to a transient coma, mimicking MBD. <h3>Conclusions:</h3> RESLES is a distinct syndrome with characteristic radiographic finding of diffusion restriction in the splenium of corpus callosum due to cytotoxic edema of various etiologies. MBD is one such example, presenting with stupor/coma. This case emphasizes the importance of identifying reversible metabolic stressors, including sickle cell crisis. <b>Disclosure:</b> Dr. Mulatu has nothing to disclose. Dr. Yoon has received personal compensation in the range of $500-$4,999 for serving as a Consultant for ECHAS. Dr. Ramaswamy has nothing to disclose. Dr. Mulatu has nothing to disclose. Cappi C Lay has received publishing royalties from a publication relating to health care.

Ground-based observability of Dimorphos DART impact ejecta: photometric predictions

ABSTRACT The Double Asteroid Redirection Test (DART) is a NASA mission intended to crash a projectile on Dimorphos, the secondary component of the binary (65803) Didymos system, to study its orbit deflection. As a consequence of the impact, a dust cloud will be be ejected from the body, potentially forming a transient coma- or comet-like tail on the hours or days following the impact, which might be observed using ground-based instrumentation. Based on the mass and speed of the impactor, and using known scaling laws, the total mass ejected can be roughly estimated. Then, with the aim to provide approximate expected brightness levels of the coma and tail extent and morphology, we have propagated the orbits of the particles ejected by integrating their equation of motion, and have used a Monte Carlo approach to study the evolution of the coma and tail brightness. For typical power-law particle size distribution of index –3.5, with radii rrmin = 1 μm and rmax = 1 cm, and ejection speeds near 10 times the escape velocity of Dimorphos, we predict an increase of brightness of ∼3 magnitudes right after the impact, and a decay to pre-impact levels some 10 d after. That would be the case if the prevailing ejection mechanism comes from the impact-induced seismic wave. However, if most of the ejecta is released at speeds of the order of ≳100 m s−1, the observability of the event would reduce to a very short time span, of the order of 1 d or shorter.

Clinical profile of designer drug “Strox” intoxicated cases presented to Poison control center Ain Shams University, Egypt from first of January 2017 to end of January 2018

Introduction: Drug addiction is considered one of the serious problems. Clinical profile of drug dependence is continuously changing taking new shape, new drugs and routes. From 2004, illicit drug manufacturers began to produce herbal smoking substances under a wide range of brand names. Recently over the past two to three years, the drug abuse market in Egypt was invaded by a new herbal preparation, called “Strox” that gained favor among abusers and rapidly spread. Aim of Study: to evaluate the strox toxicity cases including; the presenting symptoms and signs, the lines of treatment and highlight the outcomes secondary to strox exposure, also correlate the presenting clinical pictures with strox structure. Methodology: A cross sectional observational study carried out at Poison Control Center Ain Shams University (PCC-ASU). The study included all strox intoxicated patients presented to PCC-ASU from the first of Jan. 2017 to the end of Jan. 2018, and the obtained seized Strox packages screened by Gas Chromatography (GC). Results: there were 84 patients. The mean age was 25±9.8 year. The median of delay time was 2-4 hours. Disturbed conscious level observed in 45% of patients, chest pain (37%), shortness of breathing (32%). Hypoxemia was evident in 65% of cases, associated with Hypercapnia and respiratory acidosis in 50 % of cases. No observed changes regarding serum electrolytes, renal function or random blood sugar. ST segment depression and T wave inversion were reported in 6% of cases. All patients were admitted and received supportive treatment. Gas chromatographic analysis of some Strox packages revealed the presence of xylene, methylene dioxy methamphetamine, and trihexyphenidyl. Conclusion: Patients with Strox smoking presented with transient coma, hallucinations, impaired ventilation, and chest pain. The displayed picture was attributed to a mixture of xylene, MDMA, and the central anti-cholinergic trihexiphenidyl. The picture was confirmed by gas chromatography analysis of seized strox package.

Transient coma as Percheron’s artery stroke

The artery of Percheron is a rare anatomic variation in the brain vascularization, in which a single arterial trunk arises from the posterior cerebral artery to supply both sides of brain structures, i.e., the thalamus and midbrain. Occlusion of this uncommon vessel results in a characteristic pattern of bilateral paramedian thalamic infarcts with or without mesencephalic infarctions. We report the case of a Caucasian woman who completely recovers after transient coma due to Percheron artery infarction.

Pediatric non-diabetic ketoacidosis: a case-series report

BackgroundThis study is to explore the clinical characteristics, laboratory diagnosis, and treatment outcomes in pediatric patients with non-diabetic ketoacidosis.MethodsRetrospective patient chart review was performed between March 2009 to March 2015. Cases were included if they met the selection criteria for non-diabetic ketoacidosis, which were: 1) Age ≤ 18 years; 2) urine ketone positive ++ or >8.0 mmol/L; 3) blood ketone >3.1 mmol/L; 4) acidosis (pH < 7.3) and/or HCO3 < 15 mmol/L; 5) random blood glucose level < 11.1 mmol/L. Patients who met the criteria 1, 4, 5, plus either 2 or 3, were defined as non-diabetic ketoacidosis and were included in the report.ResultsFive patients with 7 episodes of non-diabetic ketoacidosis were identified. They all presented with dehydration, poor appetite, and Kussmaul breathing. Patients treated with insulin plus glucose supplementation had a quicker recovery from acidosis, in comparison to those treated with bicarbonate infusion and continuous renal replacement therapy. Two patients treated with bicarbonate infusion developed transient coma and seizures during the treatment.ConclusionDespite normal or low blood glucose levels, patients with non-diabetic ketoacidosis should receive insulin administration with glucose supplementation to correct ketoacidosis.

Zolpidem-Induced Narcolepsy, Faint, Seizure or Coma? A Case Report

Zolpidem, as an imidazopyridine agent, is a widely prescribed drug among practitioners for short-term treatment of insomnia. Nevertheless, there have been a number of cases associated with the adverse effects of the stated drug recently. Many cases of serious complications induced by high dose of zolpidem have been reported. Further to the existing reports of adverse reactions to zolpidem, throughout the current manuscript, another case of zolpidem-induced loss of consciousness is going to be presented. The case had taken 100 mg of zolpidem and afterwards, went into an unknown status of narcolepsy, faint, seizure or transient coma. Overdosing zolpidem and being affected by its central effects, he performed risky actions such as cooking by a gas oven and eating meal while intoxicated. The current case suggests that zolpidem overdose might contribute to loss of consciousness and exhibition of high-risk behaviors.

Hepatocellular carcinoma with inferior vena caval and right atrial tumor thrombi and massive pulmonary artery embolism: A case report.

The aim of the present study was to report the case of a 55-year-old female patient with a sizeable (7.1×6.2 cm) hepatocellular carcinoma (HCC), who succumbed to massive pulmonary artery embolism. The main symptoms included sudden thoracodynia, dyspnea and transient coma. The initial diagnosis was HCC according to the typical abdominal ultrasound and triple-phase abdominal computed tomography (CT) findings, chronic hepatitis B infection and elevated α-fetoprotein levels (1,036 µg/l; normal, 0-20 µg/l). Two days following admission, the patient developed recurrent chest pain and shortness of breath. The electrocardiogram and myocardial enzyme levels were normal, but the D-dimer level was elevated to 7,210 µg/l (normal, 0-550 µg/l). Magnetic resonance angiography and a contrast-enhanced chest CT confirmed that the inferior vena cava and right atrium were invaded by tumor thrombi; the bilateral pulmonary embolism was also suspected to be formed by tumor thrombi. The final diagnosis was HCC with inferior vena caval and right atrial tumor thrombi, as well as massive pulmonary embolism. Anticoagulation therapy with low-molecular weight heparin calcium was administered; however, the patient succumbed to pulmonary embolism in <2 months.

Cortical connectivity modulation induced by cerebellar oscillatory transcranial direct current stimulation in patients with chronic disorders of consciousness: A marker of covert cognition?

ObjectiveAlthough some patients suffering from unresponsive wakefulness syndrome (UWS) may retain some capacity for covert cognition, it is difficult to directly demonstrate this property by means of tasks needing patient active cooperation and preserved top-down attention processes. Instead, specific passive paradigms may allow identifying a residual θ and γ band functional connectivity within fronto-parietal networks (FPN), which may sustain covert cognitive processes. MethodsWe attempted to highlight such networks in a sample of minimally conscious state (MCS) and UWS patients by means of a cerebellar 5Hz oscillatory transcranial direct current stimulation (otDCS), in order to modulate the FPN functional connectivity. ResultsWe found a FPN θ and γ power modulation and coherence increase, which were paralleled by a transient coma recovery scale-revised score amelioration, only in MCS individuals. ConclusionsOur data show a functional link between the FPN coherent θ and γ oscillations and the cerebellar-cerebral output. Moreover, our data highlighted a residual FPN functional connectivity, which is a fundamental prerequisite for objectifying every aware processes and the potential to cognitive processes (covert cognition). SignificanceOur otDCS cerebellar-cerebral connectivity modulation may be a useful approach in improving chronic disorders of consciousness differential diagnosis and ameliorating the level of consciousness.

Susceptibility weighted imaging in the evaluation of hemorrhagic diffuse axonal injury.

Diffuse axonal injury (DAI) is axonal and small vessel injury produced by a sudden acceleration of the head by an external force, and is a major cause of death and severe disability (Paterakis et al., 2000). Prognosis is poorer in patients with apparent hemorrhage than in those without (Paterakis et al., 2000). Therefore, it is important to identify the presence and precise position of hemorrhagic foci for a more accurate diagnosis. CT and magnetic resonance imaging (MRI) have long been applied in the diagnosis of DAI, but they are not sensitive enough for the detection of small hemorrhagic foci, and cannot meet the requirements for early diagnosis. A major advance in MRI has been the development of susceptibility weighted imaging (SWI), which has greatly increased the ability to detect small hemorrhagic foci after DAI (Ashwal et al., 2006). In this study, we retrospectively analyzed MRI data for 25 patients with hemorrhagic DAI verified by clinical imaging, and we explored whether SWI was sufficiently sensitive to evaluate hemorrhagic DAI and help accurately assess the severity of the disease.

Rotation-stimulated structures in the CN and C3comae of comet 103P/Hartley 2 close to the EPOXI encounter

In late 2010 a Jupiter Family comet 103P/Hartley 2 was a subject of an intensive world-wide investigation. On UT October 20.7 the comet approached the Earth within only 0.12 AU, and on UT November 4.6 it was visited by NASA's EPOXI spacecraft. We joined this international effort and organized an observing campaign. The images of the comet were obtained through narrowband filters using the 2-m telescope of the Rozhen National Astronomical Observatory. They were taken during 4 nights around the moment of the EPOXI encounter. Image processing methods and periodicity analysis techniques were used to reveal transient coma structures and investigate their repeatability and kinematics. We observe shells, arc-, jet- and spiral-like patterns, very similar for the CN and C3 comae. The CN features expanded outwards with the sky-plane projected velocities between 0.1 to 0.3 km/s. A corkscrew structure, observed on November 6, evolved with a much higher velocity of 0.66 km/s. Photometry of the inner coma of CN shows variability with a period of 18.32+/-0.30 h (valid for the middle moment of our run, UT 2010 Nov. 5.0835), which we attribute to the nucleus rotation. This result is fully consistent with independent determinations around the same time by other teams. The pattern of repeatability is, however, not perfect, which is understendable given the suggested excitation of the rotation state, and the variability detected in CN correlates well with the cyclic changes in HCN, but only in the active phases. The revealed coma structures, along with the snapshot of the nucleus orientation obtained by EPOXI, let us estimate the spin axis orientation. We obtained RA=122 deg, Dec=+16 deg (epoch J2000.0), neglecting at this point the rotational excitation.

Life at the Frontier

Life at the Frontier

Transient Sunitinib-Induced Coma in a Patient With Fibromyxoid Sarcoma

Transient Sunitinib-Induced Coma in a Patient With Fibromyxoid Sarcoma

Rapid Recovery from Coma with Multifocal PLEDs in a Patient with Severe Dementia and Transient Hypoxemia

We report a patient with severe dementia who acutely developed transient coma following possible acute anoxic encephalopathy, and presented multifocal periodic lateralized epileptiform discharges (PLEDs) on EEG, who had a good recovery from the acute state. Two EEGs were recorded from this patient. In the first EEG taken immediately after admission, multifocal PLEDs were prominent, and the background activity consisted of low voltage, continuous and irregular theta activity (4-6 Hz). The patient recovered from coma (GCS-3) to the conscious state (GCS-15) within 14 hours and was not associated with newly developed focal or global neurological deficits except for stable severe dementia which had developed in the previous several years. Another EEG taken 5 days later showed disappearance of multifocal PLEDs. Transient appearance of multifocal PLEDs might represent at least the transient, vulnerability associated with underlying dementia in this particular patient. We concluded that multifocal PLEDs do not always indicate a poor outcome in patients with possible acute anoxic encephalopathy, and rapid diagnosis and appropriate treatment should be done even if the initial EEG shows multifocal PLEDs.

Miller–Fisher syndrome mimicking intracranial hypertension following head trauma

Miller-Fisher syndrome (MFS) is a polyneuropathy with benign outcome characterized by ophthalmoplegia, limb ataxia and tendon areflexia. Impaired consciousness level and intracranial hypertension are very rare symptoms in MFS. We describe the case of a 5-year-old girl who showed intracranial hypertension, transient coma and respiratory failure after mild head injury; moreover the patient showed mild ataxia, areflexia, ophthalmoplegia and autonomic disturbances. These symptoms were suggestive of MFS. Electrophysiologic studies and laboratory tests confirmed the diagnosis and immunoglobulins and steroids were given. The child showed a progressive clinical improvement and the final outcome was good. This case, initially managed as trauma injury due to the presence of suggestive signs and clinical history, maskered an atypical presentation of Miller-Fisher syndrome, a rare disorder of central nervous system.

Miller Fisher syndrome with transient coma: comparison with Bickerstaff brainstem encephalitis

We herein report a 4-year-old boy with Miller Fisher syndrome (MFS) who presented with transient coma in addition to the typical triad of internal and external ophthalmoplegia, cerebellar ataxia and areflexia after an influenza type B infection. The electroencephalogram findings revealed intermittently generalized slow wave bursts. The cerebrospinal fluid revealed high protein and a lack of any cellular response. The serum anti-GQ1b IgG antibody was elevated in the acute phase and disappeared in the convalescent phase. The transient coma with the triad of MFS in this patient indicated an extended brainstem lesion including a reticular formation, which is also the responsible lesion of Bickerstaff brainstem encephalitis (BBE), but the magnetic resonance imaging repeatedly showed no abnormal finding. Our patient suggested the involvement of central nervous system in addition to the peripheral nerve injury in MFS. He also suggested that MFS and BBE may belong to the same group of disorders as syndrome of ophthalmoplegia, ataxia and areflexia (SOAA).

La RM nelle sequele dei traumi cranici

Given the higher sensitivity of MRI and the recent advances in faster imaging techniques the purpose of the study was to obtain MRI findings in 70 patients who had suffered from a head injury with transient consciousness loss or prolonged coma at least 24 months before entering the study. Multiplanar MRI offers invaluable advantages in the identification of the precise location of the sequelae of cranial traumas. In case of hemorrhagic lesions, the information capacity of CT progressively diminishes in relation to the absorption of the edema and bleeding, whereas MRI increases its sensitivity due to the paramagnetic properties of hemoglobin by-products. MRI allows the identification of a larger amount of small lesions, particularly those located at critical sites, as corpus callosum, temporal and frontal tips cortical surface. Using Fluid Attenuated Inversion Recovery (FLAIR) pulse sequences, a better delineation of cortical and subcortical lesions is permitted, with remarkable improvement of sensitivity when compared with conventional Spin-Echo images. Finally, adopting MRI has important implications from a medico-legal standpoint.

A phase I trial of chlorambucil administered in short pulses in patients with advanced malignancies.

We carried out a phase I trial with chlorambucil. Thirty patients with advanced cancer were entered in six dose levels: 36, 48, 60, 84, 108, and 144 mg/m2. The drug was given in six divided oral doses every 6 hours and the regimen was repeated every 3 weeks. The median age was 62 years (31-84), median Karnofsky performance status (KPS) 60 (40-90). All patients but one had received prior radiation therapy, chemotherapy, or both. Central nervous system toxicity was dose limiting, occurring in 5 of 6 patients at 144 mg/m2. It was characterized by transient seizures, hallucinations, lethargy, stupor, and coma. Metoclopramide was successful in controlling nausea and vomiting, which was severe if the antiemetic was not used. Leukopenia (3 patients) and thrombocytopenia (2 patients) were mild. One patient with colorectal carcinoma had a minor response, and two patients with non-small cell lung cancer had stable disease. A safe dose for phase II trials is 108 mg/m2 in six 6-hourly oral doses.

Aphonia as the only speech disturbance from bilateral paramedian thalamic infarction

We examined a 55-year-old right-handed woman showing transient coma, amnesia, mild right hemiparesis, vertical gaze impairment and aphonia without aphasia. CT-scanning revealed bilateral paramedian thalamic infarction in the territory of the thalamo-subthalamic paramedian arteries. Aphonia may occur as a consequence of thalamic lesions, but until now it has not been described as an isolated speech disturbance.

Multiple personality disorder as perpetrator of child abuse

An eighteen-month-old Alaskan girl suffered transient coma with multiple superficial contusions when injured by her multiple personality disturbed caretaker. The relative disinterest in multiple personality disorder as a psychiatric diagnosis among American trained practitioners is reflected in the great difficulty encountered by child protection workers while seeking psychotherapy for this disturbed family. The public health nurse, pediatrician, and social workers of the child protection team were unsuccessful in attempting to secure psychiatric therapy for this child batterer. Multiple factors, other than psychiatric community disinterest in multiple personality disorders, influenced these unsuccessful attempts. Legal process delays, strongly punitive community attitudes, tired and nearly “burned out” child protection workers, and conflicting psychological and psychiatric consultant opinions are described. A brief review of multiple personality disorder traits is given with emphasis on the common childhood exposure to abuse and violence among reported multiple personality subjects. Despite the obvious hope by the eighteen-month-old child's parents for effective help to reconstitute her family, the multiple factors described show institutional neglect and abuse which has made such recovery impossible to date. A plea is made to all persons involved with child abuse and neglect to more accurately diagnose and treat multiple personality disorders in abusive parents.