[Differential diagnosis in patients with suspected anoxic-ischaemic coma].
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.
van der Jagt
M
M
Afd. Intensive Care, Onze Lieve Vrouwe Gasthuis, Amsterdam. m.vanderjagt@erasmusmc.nl
Bosman
R J
RJ
van Schaik
I N
IN
van der Bilt
I A C
IA
Dekker
L R
LR
Zandstra
D F
DF
D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001921:Brain; D003937:Diagnosis, Differential; D004562:Electrocardiography; D004827:Epilepsy / Q000175:diagnosis / Q000188:drug therapy; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000150:complications / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis*; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D016896:Treatment Outcome
D000925:Anticoagulants