SEARCH · PubMed Health

Results for “Persistent Vegetative State”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 523 records · Page 29Linked to original sources

PubMedDate not supplied

Electrical treatment of reduced consciousness: experience with coma and Alzheimer's disease.

The right median nerve can be stimulated electrically to help arouse the central nervous system for persons with reduced levels of consciousness. The mechanisms of central action include increased cerebral blood flow and raised levels of dopamine. There is 11 years of experience in the USA of using nerve stimulation for acute coma after traumatic brain injury. There is a much longer period of experience by neurosurgeons in Japan with implanted electrodes on the cervical spinal cord for persons in the persistent vegetative state (PVS). But the use of right median nerve electrical stimulation (RMNS) for patients in the subacute and chronic phases of coma is relatively new. Surface electrical stimulation to treat anoxic brain injury as well as traumatic brain injury is evolving. Novel applications of electrical stimulation in Amsterdam have produced cognitive behavioural effects in persons with early and mid-stage Alzheimer's disease employing transcutaneous electrical nerve stimulation (TENS). Improvements in short-term memory and speech fluency have also been noted. Regardless of the aetiology of the coma or reduced level of awareness, electrical stimulation may serve as a catalyst to enhance central nervous system functions. It remains for the standard treatments and modalities to retrain the injured brain emerging from reduced levels of consciousness.

Acute Disease↗

PubMed1999

Long term results after multiple injuries including severe head injury.

OBJECTIVE: To describe the long term results in patients with multiple injuries including severe head injury. DESIGN: Retrospective and prospective clinical study. SETTING: Level I trauma centre, Germany. PATIENTS: Patients aged 16-60 years who had been injured more than 2 years before, whose Injury Severity Score was over 20 and whose cranial Abbreviated Injury Score (AIS) was over 3. MAIN OUTCOME MEASURES: Glasgow Outcome Scale (GOS), functional, neuropsychological, vocational and social outcomes. RESULTS: 58 patients, median age 24 (range 16-53, interquartile range (IQR) 21-32) years were investigated 5 (3-9; IQR 4-7) years after their injury. Median ISS was 34 (21-57; IQR 26-41) and GCS 6 (3-8; IQR 4-7). Duration of coma was 10 (2-51; IQR 7-22) days and neurological rehabilitation lasted 169 (10-830; IQR 80-300) days. Movements of the elbow and ankle was most impaired by injury. All psychometric tests showed deficits, particularly in speed of processing, concentration, recent memory, and learning performance. The social environment had been changed in half and vocational rehabilitation was dependent on age. 24 (42%) returned to their former profession, 18 (31%) were retrained to another profession, 16 (27%) were unemployed or retired on a pension. 31 (53%) made a good recovery with moderate disability, 19 (33%) had severe disability, and 8 (14%) remained in a persistent vegetative state assessed by the GOS. CONCLUSION: Early and concentrated rehabilitation facilitates functional, social, and neuropsychological reintegration.

Adolescent↗

PubMed1995

Impact acceleration-induced severe diffuse axonal injury in rats: characterization of phosphate metabolism and neurologic outcome.

Diffuse axonal injury (DAI) occurs in over half of all severe cases of traumatic brain injury and has been associated with the development of a persistent vegetative state. Although a number of studies have examined the biochemical and physiological events following brain trauma, none of these has concentrated on events associated with the occurrence of severe DAI. The present study has used phosphorus magnetic resonance spectroscopy (MRS) and the rotarod motor test to characterize metabolic and neurologic consequences of severe diffuse axonal injury in rats induced by impact acceleration. Traumatic brain injury was induced in male rats by dropping a 450-g brass weight a distance of 2 m onto a 10-mm stainless-steel disc (3 mm wide) attached to the closed skull. Changes in brain intracellular pH, free magnesium concentration, cytosolic phosphorylation ratio, and mitochondrial oxidative metabolism after injury were monitored by phosphorus MRS while neurologic motor outcome over 1 week was assessed using the rotarod test. Impact acceleration-induced injury resulted in a highly significant decline in free magnesium concentration, cytosolic phosphorylation ratio, and an increased rate of mitochondrial oxidative phosphorylation, but no significant change in pH. These changes were associated with the occurrence of a significant neurologic deficit over 1 week postinjury. The similarity in metabolic events associated with production of neurologic deficits in this and other models of traumatic brain injury suggests that these bioenergetic changes may be common to all models of brain trauma.

Animals↗

PubMed1999

Cerebral hemodynamic effects of pentobarbital coma in head-injured patients.

The purpose of this study was to examine the changes in cerebral hemodynamics of head-injured patients undergoing barbiturate treatment of refractory intracranial hypertension. Cerebral blood flow (CBF) and metabolism variables were measured in 67 severely head-injured patients at the following times: before the loading dose of pentobarbital; after the loading dose of pentobarbital (average pentobarbital level 28.1+/-8.3 microg/mL); and 3 days later, when the peak pentobarbital level averaged 42.5+/-17.2 microg/mL. Intracranial pressure (ICP) and mean arterial blood pressure (MAP) were decreased by the loading dose of pentobarbital by an average of 12 and 9 mm Hg, respectively. Cerebral perfusion pressure (CPP) was unchanged when the entire group was analyzed together. CBF, cerebral oxygen consumption (CMR(O)2), and arteriovenous oxygen difference (AVD(O)2) were significantly decreased after the loading dose of pentobarbital, by 20%, 31%, and 11%, respectively. The average cerebrovascular resistance (CVR) was increased by 20%. The change in CMR(O)2 with the loading dose of pentobarbital was closely related to the pretreatment value (n = 67, r2 = 0.65, p < .001). Thirty (45%) of the patients had a "good ICP response," with a reduction in ICP from 34+/-9 to 15+/-5 mm Hg after the initial loading dose of pentobarbital. Twenty-seven (40%) of the patients had a "partial ICP response," with ICP decreasing but still remaining above 20 mm Hg after the loading dose of pentobarbital. In the remaining 10 patients, ICP did not change or even increased after pentobarbital. In the 30 patients with a good ICP response, pretreatment CMR(O)2 and AVD(O)2 were greater before administration of pentobarbital, and CMR(O)2 and AVD(O)2 decreased more with the loading dose of pentobarbital, than in the patients with partial or no ICP response. The outcome was significantly better in the patients with a good or partial ICP response to pentobarbital, with 21% of these patients having a good recovery or moderate disability at 3 months after injury, compared with 100% persistent vegetative state or death in the nonresponders. In summary, barbiturate coma can be a useful treatment modality for acutely reducing ICP in selected patients. Patients with overwhelmingly severe injuries are not likely to benefit, partly because their CMR(O)2 is already markedly reduced by the injury and partly because their outcome is already predetermined by the injury. Patients with systemic hypotension are not likely to have a good response because hypotension limits the amount of barbiturates that can be given.

Adult↗

PubMed1977

Diffuse brain damage of immediate impact type. Its relationship to 'primary brain-stem damage' in head injury.

In a neuropathological analysis of 151 fatal non-missile head injuries, there were 19 cases with focal lesions in the dorsolateral quadrant of the brain-stem in the corpus callosum, and histological evidence of diffuse damage to white matter. Eight of these cases had not experienced a high intracranial pressure during life. All 19 cases had been rendered unconscious at the moment of impact and had remained so or in the persistent vegetative state until death. It is therefore concluded that diffuse damage to white matter may occur as a primary event at the moment of impact, that is, it is one type of immediate impact damage to the brain. It is also concluded that this type of damage is the pathological basis of 'primary brain-stem injury' since in no patient thought clinically to have sustained 'primary brain-stem injury' were abnormalities confined to the brain-stem. Since no patient with this type of brain damage recovered consciousness after injury, it is probable that diffuse damage to white matter is the most important single factor governing the outcome in a patient who sustains a non-missile head injury.

Adolescent↗

PubMed1988

Justice and the severely demented elderly.

In this paper I address the relation between just claims to health care and severe cognitive impairment from dementia. Two general approaches to justice in allocation of health care are distinguished--prudential allocation and interpersonal distribution. First, I analyze why a patient who has died has no further claims to health care. Second, I show why prudential allocators would not provide for health care treatment should they be in a persistent vegetative state. Third, I argue that the destruction of personal identity from severe dementia implies that only claims to palliative, but not life-sustaining, health care remain. Finally, I argue that the prudential allocator approach is indeterminate regarding life-sustaining care for the moderately demented and that social policy should not deny that care to patients.

Aged↗

PubMed2003

Use of somatosensory-evoked potentials and cognitive event-related potentials in predicting outcomes of patients with severe traumatic brain injury.

OBJECTIVE: This study was performed to evaluate the usefulness of somatosensory-evoked potentials (SEPs) and cognitive event-related potentials (ERPs) in predicting functional outcomes of severe traumatic brain injury patients. DESIGN: Prospective study of 22 patients with severe traumatic brain injury. Demographic information, Glasgow Coma Scale, and electrophysiologic measurements were recorded. Functional outcomes, as quantified by the Glasgow Outcome Scale-Extended, were obtained. RESULTS: Bilateral absence of median nerve SEP was strongly predictive of the worst functional outcome. The specificity and positive predictive value of absent SEP for predicting death or persistent vegetative state at 6 mo after traumatic brain injury were as high as 100%. If the definition of unfavorable outcome was expanded to include Glasgow Outcome Scale-Extended 1-4, absence of ERP was equivalent to the absence of SEP in specificity and positive predictive value. On the other hand, normal ERPs showed higher sensitivity and negative predictive value for prognosticating the best outcomes compared with normal SEPs. If the definition of favorable outcome was expanded to include Glasgow Outcome Scale-Extended 5-8, ERP was still superior to SEP for prognosticating good outcome. Interestingly, the highest sensitivity and negative predictive value for favorable outcomes were associated with the presence of any discernible waveform. CONCLUSIONS: Although median nerve SEP continues to make reliable prediction of ominous outcome in severe traumatic brain injury, the addition of the speech-evoked ERPs may be helpful in predicting favorable outcomes. The strength of the latter test seems to complement the weakness of the former.

Adolescent↗

PubMed1985

Intracranial pressure and cerebral perfusion pressure in near-drowning.

Intracranial pressure (ICP) and cerebral perfusion pressure (CPP) were strictly controlled in 11 pediatric victims of near-drowning. Three outcome groups were defined: complete recovery, persistent vegetative state, and death. In the early postimmersion phase (first 72 h), CPP was consistently above 50 mm Hg in all patients. There were occasional, nonrepetitive, and easily controllable ICP spikes above 15 mm Hg in three patients from each group. Repeated ICP spikes above 15 mm Hg were observed in some patients with adverse outcome only after 72 h. Successful control of ICP and CPP did not ensure intact survival, and sustained late intracranial hypertension is more likely a sign of profound neurologic insult rather than its cause.

Brain↗

PubMed1990

Early prediction of outcome from cerebral trauma by somatosensory evoked potentials.

The prognostic value of short-latency somatosensory evoked potentials (SEP) during the first 4 days after severe head injury was studied in a group of 100 ICU patients. There was a strong association between the presence of bilateral cortical potentials and a good recovery or moderate disability 6 months after injury. In contrast, the bilateral or unilateral absence of cortical potential was associated with severe disability, persistent vegetative state, or death in a high percentage of patients. A reliable prediction of outcomes was obtained from SEP recorded within 24 h of head injury. Predictive accuracy was not influenced by the time of recording or cumulative analysis of consecutive daily SEP over the first 4 days after injury. Short-latency SEP can provide a reliable and accurate prognosis for sedated and curarized patients, and can have an important role in the management and triage of patients with severe head injury who are undergoing intensive therapy.

Adolescent↗

PubMed1992

Patients' preferences for intensive care.

OBJECTIVES: To determine patients' preferences for intensive care and to evaluate the influence of a recent ICU experience on preferences for future ICU treatment. DESIGN: Survey of nonrandomized patient sample using structured interviews. SETTING: Large, urban, tertiary academic medical center. PATIENTS: Eighty-four adult inpatients discharged from the medical ICU between June and August 1990. MEASUREMENTS: Agreement with life-supportive care under each of four potential outcome scenarios was assessed on a 5-point scale. An overall preference score was created by summing scores for the four items. Patients were also asked about their recent experiences in the ICU. RESULTS: Patients identified sources of stress associated with their ICU stay, yet most (76%) rated their ICU experience positively. Preferences for future intensive care varied with perceived outcome, and were strongest for health restoration and weakest for persistent vegetative states. No significant relationships were found between ICU preferences and any demographic or clinical variable except race. CONCLUSIONS: Patients tolerate intensive care well and desire it to restore health. Most patients modify their desire for intensive care if less favorable outcomes are likely. Patients' preferences for intensive care cannot be predicted from demographic features or previous ICU experiences.

Academic Medical Centers↗

PubMed1996

Prediction of outcome in patients with anoxic coma: a clinical and electrophysiologic study.

OBJECTIVE: To evaluate and compare the predictive powers of clinical examination, electroencephalography (EEG), and studies of short-latency somatosensory evoked potentials in determining the prognosis in anoxic coma. DESIGN: Prospective case series of patients in anoxic coma, whose prognoses were uncertain based on previously established clinical criteria. The clinical features, EEG, and somatosensory evoked potentials results were correlated with outcome. SETTING: A 40-bed intensive care unit in a university teaching hospital. PATIENTS: Thirty-four consecutive patients admitted over a 2-yr period with anoxic coma as the principal diagnosis. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Twenty-seven (79%) patients never recovered consciousness and seven (21%) patients made a good recovery. One of six patients whose pupillary reflexes were present but whose other cranial nerve reflexes were absent on day 1 recovered, but none of the seven patients with these features still present on day 3 survived. None of the patients with motor responses of extension to painful stimuli or worse on days 1 or 3 recovered. The EEGs were classified into benign, uncertain, and malignant categories. The results of both EEG and somatosensory evoked potentials studies were strongly associated with outcome. With malignant EEG, the sensitivity was 74%, the specificity was 71%, and the positive predictive value was 90% [corrected] for the prediction of no recovery (death or persistent vegetative state). However, two patients with an initially malignant EEG eventually made a good recovery. The sensitivity for low amplitude or absent somatosensory evoked potentials for prediction of no recovery was 66%. There were no falsely pessimistic predictions with somatosensory evoked potentials, as all 18 patients with absent or low-amplitude responses had no recovery (specificity and positive predictive value were 100%). EEG and somatosensory evoked potentials studies were complementary to clinical examination in the determination of prognosis. Using a combined clinical and electrophysiologic approach, 63% of patients who had no recovery could be identified by day 3. Repeat EEG and somatosensory evoked potentials studies were of value in patients whose prognoses were uncertain, as their evolution invariably correlated with outcome. CONCLUSIONS: Based on the present data and a literature review, we propose that clinical examination combined with the results of EEG and somatosensory evoked potentials can be used to establish an early, definitive prognosis in a significant proportion of patients in anoxic coma. On day 3 or thereafter, patients with motor response of extension to pain or worse and malignant EEG, or those patients with flexor posturing or worse and bilaterally absent cortical somatosensory evoked potentials invariably have poor outcome. However, some patients with initially malignant EEG and normal somatosensory evoked potentials may recover and should be supported until their prognoses become more definitive.

Adolescent↗

PubMed2001

Therapy of malignant intracranial hypertension by controlled lumbar cerebrospinal fluid drainage.

OBJECTIVES: To evaluate the effect of controlled lumbar cerebrospinal fluid drainage in adult patients with refractory intracranial hypertension. DESIGN: Prospective, pre- vs. postintervention study. SETTING: Surgical intensive care unit of a university hospital. PATIENTS: Twenty-three patients with severe traumatic brain injury or delayed ischemia after subarachnoid hemorrhage with intracranial hypertension refractory to aggressive treatment, including repeated applications of tromethamine, hypertonic saline solution, barbiturate coma, and decompressive craniectomy. Patients were considered for controlled lumbar cerebrospinal fluid drainage if basal cisterns on computerized tomography scan were discernible. INTERVENTIONS: After institution of a lumbar drain, cerebrospinal fluid was gradually aspirated, and then, continuous cerebrospinal fluid drainage was maintained under control of intracranial pressure (ICP) and pupillary status. MEASUREMENTS AND MAIN RESULTS: ICP and cerebral perfusion pressure before and after initiation of lumbar cerebrospinal fluid drainage and related complications were documented. The neurologic outcome of the patients was assessed according to the Glasgow Outcome Scale 6 months after injury. As a result of lumbar cerebrospinal fluid drainage, all patients demonstrated an immediate and lasting decrease of ICP and a concomitant increase of cerebral perfusion pressure. Two patients temporarily showed a unilateral fixed and dilated pupil 6 and 8 hrs after onset of lumbar cerebrospinal fluid drainage, respectively. Ten patients showed a favorable outcome, four patients survived with a severe permanent neurologic deficit, one patient remained in a persistent vegetative state, and eight patients died. CONCLUSIONS: Controlled lumbar cerebrospinal fluid drainage significantly reduces refractory intracranial hypertension. The danger of transtentorial or tonsillar herniation is minimized by considering lumbar drainage in the presence of discernible basilar cisterns only.

Adolescent↗

PubMed1991

Five years' follow-up of severely injured ICU patients.

We conducted a 5-year follow-up study of a group of 461 consecutive trauma patients treated in our Intensive Care Unit from 1980 to 1983. The entry criteria (initial survival and severe injury: ISS greater than or equal to 18) were fulfilled by 233 patients with a mean ISS of 29.3 and mean age of 35.6 years. Data on prehospital care, type and timing of surgery, and hospital and ICU stay were recorded during hospital discharge. The protocol strictly asked for a personal interview and a physical examination. Mailed questionnaires or phone interviews were not allowed. The areas of medical sequelae, aftercare, missed injuries, occupation, insurance, social integration, economics, legal aspects, and traffic involvement were covered. We were able to gather final information from 223 (95.6%) of the 233 cases. Forty-three patients (18.4%) died in the hospital, 13 patients (5.6%) died later, and 167 (76.5%) were eventually seen. Only 10 patients (4.4%) were lost to follow-up. Outcome was judged using the Glasgow Outcome Scale (GOS), which was compared with a GOS value given prospectively at the time of hospital discharge. Eighty-nine percent of the survivors were healthy or slightly disabled (GOS 5 and 4), 9% were severely disabled, and only 2% were in a persistent vegetative state. Outcome after 5 years was better than tentatively prognosed at the time of hospital discharge. Ninety-one patients with severe head injuries (AIS 4-5) were additionally tested using the Mini Mental State instrument. This test revealed normal mental functions in 77% and dementia, mostly of a minor degree, in 23% of the head-injured patients. Almost all the early deaths and two thirds of the late deaths were related to severe head injury. Seventy-nine percent of the survivors were working after 5 years. During the post-trauma period, patients experienced reduced social well-being and also changed professional and recreational activities. There appears to be extensive room for improvement in the posthospital recovery phase. We conclude that survivors of critical trauma have a very good chance, after 5 years, of regaining a high quality of life. All efforts at improving trauma survival and quality of trauma care are therefore worthwhile and deserve high priority.

Adolescent↗

PubMed1991

Should survivors with an injury severity score less than 10 be entered in a statewide trauma registry?

The necessity of including survivors with minor (ISS less than 10) injuries in a statewide trauma registry with a quality assurance focus was evaluated. During a 3-month period, data for 3,594 admissions to 28 trauma centers were entered into the registry. Of these admissions 1,696 patients (50.8% of patients studied) had an ISS less than 10. Of those, 10 (0.6%) were nonsurvivors and 67 (3.9%) had severe disability (66) or were in a persistent vegetative state (PVS) (1) at hospital discharge. Five nonsurvivors were 65 years of age or older. Four were injured in falls and one was an injured pedestrian. The disabled subset included a high percentage of older patients (61.2% greater than or equal to 55). Minor falls, including those from a bed or chair or from the same level accounted for nearly one half (46.2%) of the disabling injuries. Fifty-one disabled patients had isolated extremity or pelvic fractures. Their hospital stays ranged from 1 to 42 days and averaged 13.0 days. The proportion of elderly in the United States is increasing substantially. Because of the significant risk of death or serious disability to elderly patients, even with minor injuries, we conclude it is appropriate to include data for elderly patients with an ISS less than 10 who meet other registry inclusion criteria. We also recommend the entry of data for patients with an ISS less than 10 and significant disability at discharge who qualify by other criteria. Exclusion of remaining patients with an ISS less than 10 would reduce qualifying cases by 38%.

Adolescent↗

PubMed1996

Surgical cricothyroidotomy in trauma patients: analysis of its use by paramedics in the field.

OBJECTIVE: To analyze the indications for and the success rate, complications, and neurologic outcomes of surgical cricothyroidotomy when performed in the field by ambulance paramedics. METHODS: The ambulance and hospital records of all trauma patients on whom a surgical cricothyroidotomy was attempted in the field by ambulance paramedics over a 5-year period were reviewed. A telephone survey of survivors was used to assess long-term complications and neurologic outcome. RESULTS: Surgical cricothyroidotomy was attempted on 50 patients, or 9.8% of those requiring definitive airway control. The most common indications were clenched teeth, blood or vomit obscuring visualization of the upper airway, severe maxillofacial injuries, and inaccessibility because the patient was trapped. Airway establishment was successful in 47 patients (94%). Major complications occurred in 2 patients (4%), where inadvertent dislodgement of the tube developed, requiring replacement. No patient developed significant subglottic stenosis. Nineteen patients (38%) survived and no patient died because of an inadequate airway. Evaluation of neurologic outcome revealed 12 patients (63%) with no significant deficits, 3 (16%) with moderate disability, 2 (10%) with severe disability, and only 2 in a persistent vegetative state. CONCLUSIONS: Surgical cricothyroidotomy can be performed on the critically injured patient in the field by ambulance paramedics with a high success rate and a low complication rate. The use of surgical cricothyroidotomy should be included in airway protocols for well-trained, ambulance Advanced Life Support paramedics.

Adolescent↗

PubMed2000

Similarities between civilian gunshot wounds to the head and nongunshot head injuries.

BACKGROUND: This investigation compared the cerebral pathophysiologic status of gunshot wounds to the head (GSWH) with that of severe head injury of other causes (non-GSWH). METHODS: Data were collected prospectively from 71 GSWH and 541 non-GSWH patients. The two groups had similar demographic characteristics and injury severities. Cerebral metabolic parameters for each patient were averaged for the entire period of monitoring. These per-patient averages were compared between GSWH and non-GSWH groups. RESULTS: Median intracranial pressure was 21.4 mm Hg in GSWH patients vs. 16.7 mm Hg in non-GSWH patients (p < 0.001). Mean arterial pressures were similar, but the higher intracranial pressure in GSWH patients produced a lower median cerebral perfusion pressure. Cerebral blood flow, cerebrovascular resistance, cerebral metabolic rate of oxygen, average jugular venous oxygen saturation, and number of jugular venous desaturations did not differ significantly between the groups. Three-month outcome was death in 43% of GSWH patients and 32% of non-GSWH patients, persistent vegetative state or severe disability in 33% and 32%, respectively, and moderate disability or good recovery in 24% and 36%, respectively. These outcomes were not significantly different (p = 0.11). CONCLUSION: GSWH patients suffer global cerebral metabolic disturbances that are at least as severe as those seen in non-GSWH patients with injuries of comparable severity. This selected population of GSWH patients may enjoy outcomes comparable to those of non-GSWH patients if they are treated by the same aggressive protocols.

Adult↗

PubMed1999

Postoperative brainstem high intensity is correlated with poor outcomes for patients with spontaneous cerebellar hemorrhage.

OBJECTIVE: The outcomes for patients with cerebellar hemorrhage are thought to be influenced by anatomic damage to the brainstem. In this study, we investigated the magnetic resonance imaging findings in the brainstem, to examine the relationship between the degree of brainstem damage and the outcomes for patients with spontaneous cerebellar hemorrhage who are in poor-grade condition. METHODS: The results for 31 patients with spontaneous cerebellar hemorrhage, with Glasgow Coma Scale scores of 8 or less at admission, who underwent magnetic resonance imaging examinations were reviewed. All patients underwent surgical intervention. The patients were divided into two groups according to their Glasgow Outcome Scale scores at the time of discharge, i.e., patients who experienced good recoveries or exhibited moderate disabilities (Group I, n = 8) and patients who exhibited severe disabilities, were in a persistent vegetative state, or had died (Group II, n = 23). We investigated obliteration of the fourth ventricle and the perimesencephalic cistern and the presence of hydrocephalus in initial computed tomographic scans and the presence of areas of high signal intensity in the brainstem in T2-weighted images. RESULTS: Eight patients experienced good outcomes, and 23 patients experienced poor outcomes. The overall mortality rate was 32.3%. There were no significant differences between groups with respect to computed tomographic findings such as hematoma size, but the incidence of high signal intensities in the pons and midbrain in T2-weighted images for Group II was significantly higher than that for Group I (P < 0.01). CONCLUSION: Magnetic resonance imaging clearly demonstrated brainstem damage, and high signal intensity in the brainstem was a significant prognostic factor for determining outcomes for patients with spontaneous cerebellar hemorrhage who were in poor-grade condition.

Aged↗

PubMed2000

Irreversible maternal brain injury during pregnancy: a case report and review of the literature.

Maternal brain death or massive injury leading to persistent vegetative state during pregnancy is a rare event. Since 1979, 11 cases, including the current one, of irreversible maternal brain damage in pregnancy have been reported. In all but one, the pregnancies were prolonged with a goal of achieving delivery of a viable infant. Current advances in medicine and critical care enable today's physician to offer prolonged life-support to maximize the chances for survival in the neonate whose mother is technically brain dead. We present a case at our institution and review all previously published cases in the English literature for comparison as well as make management recommendations.

Adult↗