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Neurological Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
The level of consciousness is assessed using the Glasgow Coma Scale. Where coma was preceded by focal neurological symptoms (e.g. focal seizures, hemiparesis), there is usually a focal cause (e.g. subdural haematoma), but hypoglycaemia can cause focal disturbances which resolve when the blood glucose is normalized. A focal cause is also more likely where there are asymmetrical pupils or conjugate deviation of the eyes, or asymmetry of the oculocephalic reflex, the caloric responses, the limb response to pain or the plantar response. Common ‘medical’ causes of coma include drugs and alcohol intoxication and diabetic hypoglycaemia.
Injuries in Children
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
A rapid assessment of the neurological status should be made using either the AVPU (alert, voice, pain, unresponsive) method or the GCS. In older children, the conventional adult Glasgow Coma Scale can be used (see page 183). A version of the GCS with a modified verbal response component is used in children under the age of 5 years (Table 22.4). The response to pain is best determined by squeezing one ear lobe hard and observing the best response to that stimulus. Also, importantly, the pupillary reflexes and posture of the child should be observed. It is vital to be certain at this point that abnormal responses are not due to hypoglycaemia, and the child’s blood glucose must be checked.
Traumatic Brain Injury and Neurocognitive Disorders
Published in Gail S. Anderson, Biological Influences on Criminal Behavior, 2019
Assessing the severity of a TBI often involves determining whether the person suffered a loss of consciousness (LOC) and if so, for how long. The Glasgow Coma Scale is often used to assess severity.2 It is used to asses a number of responses, including verbal, motor, and eye-opening, with scores ranging from 15 (best) down to below 8 (indicating coma) and 3 or less (unresponsive). Alternatively, the length of time that a person was unable to process new memories may also be used to rank severity.2
Immediate effect of standing and sit-to-stand training on postural vertical for backward disequilibrium following stroke: a case report
Published in Physiotherapy Theory and Practice, 2023
Kazuhiro Fukata, Kazu Amimoto, Masahide Inoue, Daisuke Sekine, Yuji Fujino, Shigeru Makita, Hidetoshi Takahashi
Assessment prior to the intervention outlined below was performed on the 10th day post stroke. His demographics and neurological functions are shown in Table 1. Neurological findings included the Glasgow Coma Scale scores: eye opening = 4; verbal response = 5; and motor response = 6. Motor assessment was performed using the stroke impairment assessment set (SIAS) (Tsuji et al., 2000). The participant presented no motor paralysis in either the upper or lower limbs. The SIAS-motor scores of the upper arm and forearm of both the left and right upper limbs and the hip, knee, and foot of the left and right lower limbs was 5, but mild to moderate sensory deficits on both the upper and lower limbs were observed. The SIAS-sensory scores of the left upper and lower limbs for touch and position was 1. The SIAS-sensory scores of the right upper limb and the hip, knee, and foot of the right lower limb for touch and position was 2. The participant had sensory ataxia in both upper and lower limbs. The muscle tone of the triceps surae and tibialis anterior muscle was assessed using the modified Ashworth scale; no abnormal muscle tone was observed at rest in the supine position.
Role of cerebrospinal fluid tau protein levels as a biomarker of brain injury in pediatric status epilepticus
Published in International Journal of Neuroscience, 2023
Shivanjali Sood, Chandrika Azad, Jasbinder Kaur, Pankaj Kumar, Vishal Guglani, Seema Singla
All potential cases and controls were screened for eligibility (Figure 1). The patients were enrolled consecutively from pediatric emergency ward and intensive care unit. The demographic and clinical data like age, sex, presenting complaints, duration of CSE, previous episodes of CSE if any, treatment taken from outside, family history of seizures, neuro-development history, findings of physical examination, investigations, treatment details, response to antiepileptic drugs (AEDs) and critical care needs were noted on a pretested proforma by the study investigator. The detailed neurological examination was done at the time of admission and discharge. Assessment of consciousness level was done by Glasgow coma scale (GCS) in older children and modified Glasgow coma scale in younger children. For classifying protein energy malnutrition, standard WHO charts were used [13]. The investigations for determining the etiology were done as per standard protocol. Other investigations to determine the etiology such as Computed Tomography (CT), Magnetic Resonance Imaging (MRI), Electroencephalogram (EEG), laboratory tests to determine infections, tandem mass spectrometry (TMS) etc. were done accordingly.
Middle meningeal artery embolisation for chronic subdural haematomas: the first prospective UK study
Published in British Journal of Neurosurgery, 2022
Saffwan Mohamed, Alvaro Villabona, Oliver Kennion, Rajeev Padmananbhan, Aslam Siddiqui, Shahid Khan, Manjunath Prasad, Nitin Mukerji
Approval was formally sought from the hospital Clinical Techniques, Policies and Procedures Approval Group and was granted on 20 October 2020 (REF. MC/JF/CTP&PAG02). All adult patients with chronic or sub-acute subdural haematoma were identified from the emergency neurosurgery referral system over a period of 14 months; From October 2020 to December 2021, those that did not require urgent decompression surgery were considered for MMA embolisation. Patients had to be symptomatic with Glasgow Coma Scale (GCS) of ≥ 13. Patients with midline shift of >10 mm were excluded and offered decompression surgery. Patients were evaluated in neurovascular MDT and all eligible patients were offered embolisation or conventional treatment with either conservative or burr-hole evacuation of the subdural haematoma. Patients and/or next of kin were counselled on the procedure and given the study’s Patient Information Sheet. Patients with capacity provided written informed consent.