Periodic complexes, absence-like status and suppression-burst pattern in coma following cardiorespiratory arrest.
A 75-year-old man suffered a cardiac arrest and severe anoxic encephalopathy. A serial study of electroencephalograms during 4 days showed sequential changes from periodic approximately 2 Hz spike activity to absence-like status (ALS) and then into a suppression-burst pattern. Intravenous administration of phenytoin had no effect on ALS. A small dose of intravenous diazepam reduced a suppression-burst pattern. We speculate that the ALS originates in the midline structures, spreading bilaterally and synchronously to the "dysfunctional" cortex; the sustained discharges were a manifestation of associated reticular lesions, and we believe that intravenous diazepam suppressed the spread of ALS to the "dysfunctional cortex," leading to the appearance of the suppression-burst pattern. The only limitation for definitive conclusions may be a lack of postmortem verification. Autopsy findings, however, could not have confirmed the dynamic changes that occurred during the 5 days before the patients death.
Ganji
S S
SS
EEG Lab and Evoked Potential Labs, Terrebonne General Medical Center, Houma, LA, USA.
Palliyath
S
S
Chemmale
J
J
Devrajan
V N
VN
McDonald
L
L
D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use; D001921:Brain / Q000503:physiopathology*; D003128:Coma / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D003975:Diazepam / Q000627:therapeutic use; D004569:Electroencephalography; D004832:Epilepsy, Absence / Q000175:diagnosis / Q000503:physiopathology; D006323:Heart Arrest / Q000150:complications*; D006801:Humans; D002534:Hypoxia, Brain / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D010672:Phenytoin / Q000627:therapeutic use; D013997:Time Factors
D000927:Anticonvulsants; D010672:Phenytoin; D003975:Diazepam