Evaluation of the Comatose Patient

Abstract

Brain death criteria: No spontaneous breathing when the arterial pC02 pressure is above 45 mm Hg. The pupils are unresponsive to light and atropine drops. The oculovestibular responses are completely negative. There are no motor responses including brainstem motor responses.

Keywords

• brain death
• atropin
• Pupiller

Komadaki Hastanın Değerlendirilmesi

Abstract

Beyin ölümü kriterleri : Arteriel pC02 basıncı 45 mm Hg üzerinde iken spontan solunum olmaması.Pupillerin Işığa ve damlatılan atropine karşı cevapsız olmaları Okulovestibüler cevapların tam negatif olmaları. Beyin sapı motor cevapları dahil hiçbir motor cevap olmaması.

Keywords

• beyin ölümü
• atropin
• Pupiller

References

1. I. Bennet DR Hughes JR, Korein J et al Atlas of Electroenceplıalography in Coma and Cerebral Death, Raven Press New York, 1976 p : 3, 2, Boles R : Facial, auditory and vestibular nerve injuries associated with basilar skull fractures. İn Youmans Jr (ed) Neurological Surgery PhiladelphiEL : YV.B. Saunders Company, 1973 vol 2 pp : 1013-1014. 3. Brickmann R, Von Gramon D, and Shultz H : The Munich coma scale. J. Neurol. Neurosurg. Psychiatry 39 788-793, 1976.
2. 4. Brown I-IW, and Plum F, • The neurologic basis of Cheyne-St.okes respiration. Am.J. Med. 30 : 849-860, 1961,
3. 5. Caronna J, Leigh J, Shaw D et al : The outcome of medical coma : Prediction by bedside assesment of physical signs. Trans Am. Neurol As soc. 1975, pp 25-29.
4. 6. Daroff RB, and Trost BT. : Supranuclear disorders of eye movements. In : Glaser JS (ed) : Neuro-opthalmology. Gagerstown : Harper and Row Rublishers. 1978, 1978, pp : 201-218.
5. 7. Davis KR, Taveras JM, New PFJ et al : Cerebral infarction diagnosis by computerized tomography. Am. J, Roentgenol, 124 : 643-660, 1975.
6. 8. DeGovin EL, and DeGovin RL : Bedside Diagnostic Examination. New York The MacMillan Company, 1969, pp : 142.
7. 9. Edholm OG The relationship of hearth rate to intracranial pressure. J. Phvsiol. 98 : 442-445, 1940.
8. 10. Earnest MP, Yarne)l PR, Knapp G et al : Long term survival and neurological status following resuscitation from out-of-hospital cardiac arrest. Neurology 30 : 443,1980.

9. 11 Finklestein S, and Ropper A. : The diagnosis of coma : Its pitfalls and limitations. Heart Lung 8 : 1059-1064, 1979.
10. 12. Fisher CM. : Some neuro-ophthalmological observations. J. Neurol. Neurosurg. Psychiatry 30 á83-392, 1967.
11. 13, Fisher CM. : The neurological examination of the comatose patient. Acta Ne urol. Scand. 45 (suppl 36) 1-56, 1969.
12. 14. Fluur E, and Eriksson L, : Nystagmographic recording of vertical eye move ments. Acta Otolaryngol. 53 486-492, 1961.
13. 15. Fog M, and Hein-Sorenson O. Mesencephalic syndromes. In Vinken PJ and Bruyn GW. (eds) : Handbook of Clinical Neurology. Amsterdam, North holland Publishing Company, 1969, pp : 281-283.
14. 16. Forbes GS, Sheedy PF, Piepgras DG et al : Computed tomography in the eva luation of subdural hematoma. Radiology 126 • 143-148, 1978,
15. 17. Gilner LI and Avin B. A reversible ocular manifestation of thalamic hemorrhage. Arch. Neurol. 34 715-716, 1977.
16. 18. Gröschel D, Gerstein AR, and Rosenbaum JM. : Skin lesions as a diagnostic aid in barbiturate poisoning. N. Engl. J. Med. 283 : 409-410, 1970.
17. 19. Ingvar DH, and Brun A. : Das komplette appalische syndrom. Arch. Psychiatr. Nervenkr. 215 : 219-239, 1972.
18. 20. Jennet B, and Plum F. : Persistent vegetativ eat,age aflor brain damage. Lancet • 734-727, 1972.
19. 21. Jennet B. and reasdale C. Aspect; cf coma aftet scvere head iniury. Lancet 1 87d-881, 1977,
20. 22. Jennet B, Teasdale G, Galbaith S, et al : Severe head injury in three countries.J. Neurol. Neurosurg. Psychiatry 40 : 291-297, 1977.
21. 23. Keane JR Contralateral gaze deviation with supratentorial hemorrhage. Arch, Neurol. 32 : 119-122, 1975.
22. 24. Keane JR Ocular skew deviation. Arch. Neurol.. 32 • 185-190, 1975
23. 25. Keane JR : Retinal hemorrhages. Arch. Neurol. 36 : 691-694, 1979,
24. 26. Koeppen AH, Daniels JC and Barron KD : Subnormal body temperatures in Wernickes encephaolpathy. Arch. Neuro). 21 : 493-498, 1969.
25. 27. Nathanson M. In Bender MB (ed) : The Oculornotor System. New York : Harper and Row Publishers, 1969, pp : 48+488,
26. 28. Pagan LF : The rapid appermce of papilledema. J. Neurosurg. 30 : 247-249, 1969.
27. 29. Pagni CA, Giovanelli M, Tomei G. et al : Lon term results in 62 cases of postraumatic complete aphalic syndrome. Acta Neurochir. 36 : 37-45, 1977.
28. 30. Pazza.klia P, Frank G, Frank F. et al : Clinical course and prognosis of acut post-traumatic coma. J. Neurol Neurosurg, Psychiatry 38 149-154, 1975.
29. 31. Pinkus NB : Skin eruptions in drug induced coma. Med. J. Aust 2 : 866-888, 1971.
30. 32. Plum F. And Swanson AG : Central neurogenic hyperventilation in man. Arch.Neurol. Psychiatry 81 : 535„549, 1959,
31. 33, Plum F : Hyperpnea, hyperventilation and brain dysfunction. Annb Intern. Med. 76 : 382, 1972.
32. 34. Plum F, and Posner JB Diagnosis of Stupor and Coma. Philadelphia : F.A. Davis Company, 1972, pp : 1-286.
33. 35. Plum F. : Examination of the unconscious patient. Br, Med. J. 1 : 49, 1972.
34. 36. Plum F, and Levy D ; Predicting prognosis in coma. Am. J. Med. 65 224-226, 1978.
35. 37. Posner JB : The comatose JAMA 233 : 1313-1314, 1975.
36. 38. Rosin AJ, and Exton-Smith An : Clinical features of accidental hypotermia with some observation on thyroid function. Br. Med, J. 1 16-19, 1694. 39. Schafer JA, and Caronna JJ : Duration of apnea needed to confirm brain death. Neurology 28 : 661-666, 1978.
37. 40. Schwertz BA and Vendrely E. : One of the problems posed by the diagnosis of irreversible coma ; The flat EEG and pupil diameter. Electroenceph. Clin. Neurophysiol. 28 : 648, 1976.
38. 41. Shibolet S, Coll R, Gilat T. et al Heatstroke : Its clinical picture and mechanism in 36 cases. Q. J. Med. 36 • 525-548, 1967.
39. 42. Silverman D. : Retrospective study of EEG in coma. Electroencephalogr. Clint Neurophysiol. 15 : 486-503, 1963.
40. 43. Simon PR. : Forced downward ocular deviation. Arch, Neurol. 35 ; 456, 1978.
41. 44. Susac JO, Hoyt WF, Daroff RB. et al Clinical spectrum of ocular bobbing. J. Neurol. Neurosurg. Psychiatry 33 : 771-775, 1970.
42. 45. Snyder BD, Ramirez? lassepas M and Lippert DM : Neurologic status and prognosis after cardiopulmonary arrest. Neurology 27 : 807-811, 1977.
43. 46. Teasdale G, and Jennet B. : Assesment of coma and impaired consciousness. Lancet 2 ; 81-83, 1974.
44. 47. Thompson HS, and Pilley SFJ : Unequal pupils : A flow chart for sorting out the anisocorias, Surv. Opthalmol. 21 : 45-48, 1976.
45. 48. Vidal BE, Dergal EB, Cesarman E* et al : Cardiac arrhythymias associated with subarachnoid hemorrhage : Prospective study. Neurosurgery 5 : 675-680, 1979.
46. 49. Werternburg R. The signs of Brudinsky and Kermg. J. Pediatr. 37 : 679-684,1950,
47. 50, Weinstein JD, Langfitt TW, and Kassel NF. : Vasopressor response to increased intracranial pressure Neurology 14 : 1118-1131, 1964.
48. 51. Yarnel PR. : Neurologic autcome of prolonged coma survivors of out-of-hospital cardiac arrest. Stroke 7 : 279-282, 1976.