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Coma and brain death

Coma and brain death
Coma and brain death

Coma must persist for at least 1 hour to distinguish it from transient unconsciousness. Traumatic and nontraumatic coma are common problems in pediatric practice with high mortality and morbidity. Emergency neuroimaging is worthwhile even when etiology is known, as treatable complications, such as venous sinus thrombosis, as well as extradural and intracerebral hemorrhage, are commonly diagnosed. There is a wide range of possible etiologies in the previously well child, most of which may be diagnosed from neuroimaging and laboratory testing available as an emergency, or can be treated presumptively, e.g., with antimicrobials for infections. The modified Child's Glasgow Coma Scale (CGCS) for recording depth of consciousness in children is widely used and should be supplemented by examination for the signs of reversible central and uncal brainstem herniation due to acute intracranial hypertension. An evidence-based guideline for the investigation and management of decreased level of consciousness in children, written by an expert panel using the DELPHI principles, is available. Monitoring and rehabilitation should also be part of the management plan. Etiology, depth and duration of coma, and serial neurophysiology and imaging are predictors of outcome in survivors but must be interpreted cautiously. There are no reports of children meeting adult brain death criteria making good neurological recovery.

0072-9752
43-61
Kirkham, Fenella J.
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58
Ashwal, Stephen
de7fd882-3962-4b8a-8593-9272df3131ee
Kirkham, Fenella J.
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58
Ashwal, Stephen
de7fd882-3962-4b8a-8593-9272df3131ee

Kirkham, Fenella J. and Ashwal, Stephen (2013) Coma and brain death. Handbook of Clinical Neurology, 111, 43-61. (doi:10.1016/B978-0-444-52891-9.00005-1).

Record type: Article

Abstract

Coma must persist for at least 1 hour to distinguish it from transient unconsciousness. Traumatic and nontraumatic coma are common problems in pediatric practice with high mortality and morbidity. Emergency neuroimaging is worthwhile even when etiology is known, as treatable complications, such as venous sinus thrombosis, as well as extradural and intracerebral hemorrhage, are commonly diagnosed. There is a wide range of possible etiologies in the previously well child, most of which may be diagnosed from neuroimaging and laboratory testing available as an emergency, or can be treated presumptively, e.g., with antimicrobials for infections. The modified Child's Glasgow Coma Scale (CGCS) for recording depth of consciousness in children is widely used and should be supplemented by examination for the signs of reversible central and uncal brainstem herniation due to acute intracranial hypertension. An evidence-based guideline for the investigation and management of decreased level of consciousness in children, written by an expert panel using the DELPHI principles, is available. Monitoring and rehabilitation should also be part of the management plan. Etiology, depth and duration of coma, and serial neurophysiology and imaging are predictors of outcome in survivors but must be interpreted cautiously. There are no reports of children meeting adult brain death criteria making good neurological recovery.

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e-pub ahead of print date: 25 April 2013
Published date: 2013

Identifiers

Local EPrints ID: 424266
URI: http://eprints.soton.ac.uk/id/eprint/424266
ISSN: 0072-9752
PURE UUID: 54a63bcf-0e86-4fb8-849e-c4ae86f6f1f3
ORCID for Fenella J. Kirkham: ORCID iD orcid.org/0000-0002-2443-7958

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Date deposited: 05 Oct 2018 11:35
Last modified: 16 Mar 2024 03:22

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Author: Stephen Ashwal

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