[Differential diagnosis in patients with suspected anoxic-ischaemic coma]

Ned Tijdschr Geneeskd. 2008 Feb 9;152(6):297-301.
[Article in Dutch]

Abstract

Three case studies illustrate that suspected anoxic-ischaemic coma often requires careful differential diagnosis to detect treatable conditions. A 47-year-old man underwent cardiopulmonary resuscitation for ventricular fibrillation caused by myocardial ischaemia. He exhibited rhythmic eyelid movements while in a coma. Epilepsy was suspected, and the patient regained consciousness after being treated with antiepileptic drugs. A 34-year-old man underwent cardiopulmonary resuscitation for multiple episodes of ventricular fibrillation. Treatment was directed toward myocardial ischaemia and included anticoagulants. The patient had bilateral, fixed dilated pupils. A CT of the brain showed traumatic contrecoup haemorrhage in the left temporal lobe with signs of transtentorial herniation. The patient died. A 74-year-old woman was found unconscious at home. An ECG performed by the paramedics showed ST segment elevation in the precordial leads. Anoxic-ischaemic coma following cardiac arrest was suspected. However, a coronary angiogram was normal and a CT of the brain revealed subarachnoid haemorrhage caused by a ruptured intracranial aneurysm. She recovered after cranial surgery.

Publication types

  • Case Reports
  • Comment
  • English Abstract

MeSH terms

  • Adult
  • Aged
  • Anticoagulants / therapeutic use
  • Brain
  • Diagnosis, Differential
  • Electrocardiography
  • Epilepsy / diagnosis
  • Epilepsy / drug therapy
  • Fatal Outcome
  • Female
  • Humans
  • Hypoxia-Ischemia, Brain / complications
  • Hypoxia-Ischemia, Brain / diagnosis*
  • Male
  • Middle Aged
  • Myocardial Infarction / complications
  • Myocardial Infarction / diagnosis*
  • Subarachnoid Hemorrhage / complications
  • Subarachnoid Hemorrhage / diagnosis*
  • Subarachnoid Hemorrhage / surgery
  • Treatment Outcome

Substances

  • Anticoagulants