Neurology
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Case Reports
Clinical reasoning: a 76-year-old man remaining comatose after cardiopulmonary resuscitation.
A 76-year-old man was admitted to the hospital after having a "cardiac arrest" while riding his bicycle and subsequently falling into a canal. Thirty minutes after the accident, he was resuscitated by an ambulance crew. They detected a ventricular tachycardia, which responded to defibrillation. ⋯ Neurologic examination during hypothermia and under sedation showed a deeply comatose patient with intact pupillary reaction to light bilaterally and present oculocephalic reflex. He had multifocal random twitching movements involving the face, arms, and legs. These shock-like movements were found to increase by external stimuli.
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Multicenter Study
Cardiac dysfunction after aneurysmal subarachnoid hemorrhage: relationship with outcome.
To assess whether cardiac abnormalities after aneurysmal subarachnoid hemorrhage (aSAH) are associated with delayed cerebral ischemia (DCI) and clinical outcome, independent from known clinical risk factors for these outcomes. ⋯ WMAs are independent risk factors for clinical outcome after aSAH. This relation is partly explained by a higher risk of DCI. Further study should aim at treatment strategies for these aSAH-related cardiac abnormalities to improve clinical outcome.
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Comparative Study
High-dose midazolam infusion for refractory status epilepticus.
This study compares 2 treatment protocols allowing low vs high continuous IV midazolam (cIV-MDZ) doses. ⋯ This study provides Class III evidence that midazolam at higher infusion rates is associated with a reduction in seizure recurrence within 48 hours after discontinuation and may be associated with lower mortality.
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Stroke and TIA are recognized complications of acute herpes zoster (HZ). In this study, we evaluated HZ as a risk factor for cerebrovascular disease (stroke and TIA) and myocardial infarction (MI) in a UK population cohort. ⋯ HZ is an independent risk factor for vascular disease in the UK population, particularly for stroke, TIA, and MI in subjects affected before the age of 40 years. In older subjects, better ascertainment of vascular risk factors and earlier intervention may explain the reduction in risk of stroke after the occurrence of HZ.