Muhammad Arif Nadeem, Khadija Irfan, Kh A Irfan Waheed, Tariq Waseem, Abdul Hafeez Khan.
Structural CNS Diseases (Non-Traumatic) causing Coma and their prognostic significance
Pak J Neurol Dec 2000;6(1-2):8-12.
Department of Medicine, Mayo Hospital, Lahore
Coma is not a single diagnosis. A broad distinction can be made between structural causes having a localised anatomical lesion in the CNS whether supratentorial or infratentorial, and diffuse cerebral dysfunction, in which a non-localised / global neurological insult is the pathologic lesion. We studied the non-traumatic, structural causes of coma and their outcome presenting in the emergency room and differentiated them from diffuse cerebral lesions. Out of total 116 patients admitted with coma, 30 had structural cause of coma. CVA comprised the bulk of these patients (28 patients, 93%) i.e., haemorrhagic lesions seen in 57% vs 37% infarcts, and one patient each of brain tumour and tuberculoma. Out of 14 patients having diffuse cerebral pathology, half were due to infectious diseases, i.e., pyogenic meningitis in 4 patients, 2 had tuberculous meningitis and one cerebral malaria, 3 heat stroke, 2 patients with post cardiac arrest coma (hypoxic coma) and one patient had status epilepticus. Structural coma had the worst prognosis i.e. 13% patients died (43%) and haemorrhagic CVA having a mortality of 63% and ischaemic one 36%. Among diffuse cerebral disorders 4 patients died i.e., tuberculous meningitis had the worst outcome, 1 post cardiac arrest comatose patient died i.e., tuberculous meningitis had the worst outcome, 1 post cardiac arrest comatose patient died, and 1 patient having pyogenic meningitis died. Structural CNS causes should be diagnosed and treated early because of associated worst prognosis requiring urgent brain imaging and neurosurgical intervention if need arises.
Category: Neurology
Keywords: Structural CNS Diseases. Coma. Meningitis. CVA. Stroke.
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well a nice and relevent article for people workiing in AE
Posted by: drhilal on Aug 2006
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