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Fatal Pressure Over Neck by Hanging
Published in Sudhir K. Gupta, Forensic Pathology of Asphyxial Deaths, 2022
During the convulsive stage, the person usually suffers multiple injuries due to contact with rough surfaces in the vicinity. The author himself has come across several cases with injuries over the body parts in contact with the ground or wall at the scene of occurrence. One such case has been illustrated, wherein a middle-aged man was found in a partially hung position inside his house and had injuries over dorsum of foot and toes in addition to the ligature mark. This was confirmed with crime scene photos (Figures 4.4 and 4.5). These injuries may be misinterpreted as injuries of criminal involvement and can cause doubts in the minds of relatives, investigating officers and even the autopsy surgeons. In case of doubt, scene of occurrence examination has to be done to get clarity about such injuries.
Assessing and responding to sudden deterioration in the adult
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
Monitoring using the ABCDE approach must continue, with recording of vital signs and consideration of possible causes of the seizure. After convulsions have ceased, move the individual into the recovery position to protect their airway (see www.resus.org.uk for further details of this position). Sometimes, incontinence occurs during a seizure, so be sensitive and promote dignity.
Gestational hypertension and pre-eclampsia
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Pre-eclampsia is defined as new-onset hypertension in the second half of pregnancy with new-onset proteinuria. In order to diagnose proteinuria, greater than 300 mg must be present on a 24-hour sample or 0.1 g/L in at least two random urine samples more than 4 hours apart. Often evidence of end-organ dysfunction is present. Development of convulsions or coma in patients with signs and symptoms or pre-eclampsia in the absence of other causes of convulsions is diagnostic of eclampsia.
Motor-evoked potentials after focal electrical stimulation predict drug-induced convulsion potentials in rats
Published in Toxicology Mechanisms and Methods, 2023
Kazuhiro Kuga, Harushige Ozaki, Minoru Fujiki
Convulsions are one of the most common drug-induced adverse effects. Though convulsions cause distress or increase the risk of mortality, there are no biomarkers that are able to predict them (Engel and Pitkänen 2020). Accordingly, this can lead to the discontinuation of the development of a drug. Thus, it is necessary to assess the baseline risk of drug-induced convulsions to determine the safe dose for conducting clinical studies. Even if a drug candidate is discontinued, it is necessary to investigate the mechanism underlying the occurrence of convulsions to develop drugs that target alternate pathways. Many drug-induced convulsions are caused in response to a decrease in gamma-aminobutyric acid type A (GABAA) levels and an increase in glutamate levels (Chen et al. 2016). GABA receptors are expressed in inhibitory neurons and act by suppressing the propagation of excitatory pulses, whereas glutamate receptors are expressed in excitatory neurons and function by inducing the propagation of excitatory pulses. When the balance between excitatory and inhibitory neurons is disrupted, neurons become highly stimulated, and this results in seizures. Although these mechanisms have occasionally been investigated in the field of molecular biology (Enna and McCarson 2013), it is challenging to confirm the effects of drugs on GABAA and glutamate receptors in vivo.
Updated review of rescue treatments for seizure clusters and prolonged seizures
Published in Expert Review of Neurotherapeutics, 2022
Benjamin N Blond, Lawrence J Hirsch
Rescue medications are often prescribed to treat prolonged seizures. While this is a common practice, the use of at-home rescue medications for this indication has not been specifically studied outside of the setting of status epilepticus (SE) and is off-label (we support use in this manner as discussed further below). Indeed, convulsive seizures lasting longer than 5 min, which is a commonly used threshold in rescue medication prescriptions, meet the operational definition of convulsive status epilepticus [24]. This definition is based on evidence that seizures which reach this duration are significantly less likely to spontaneously terminate and the need for a timeframe in which intervention can take place prior to developing long-term adverse consequences as a result of the ongoing seizure activity. A detailed discussion of the initial treatment of SE is beyond the scope of this review, but there are several important points from this literature, which inform the appropriate use of rescue medication.
Fatal serotonin syndrome: a systematic review of 56 cases in the literature
Published in Clinical Toxicology, 2021
Sanjay Prakash, Chaturbhuj Rathore, Kaushik Rana, Anurag Prakash
Seizure is not reported as a common manifestation in most of the reviews on SS. The prevalence of seizures varies from 2 to 5% in different reviews [53, 61]. In this review, convulsions were observed in 20 patients (36%), and it was the second most common symptom, again indicating that it may be a poor prognostic factor. The muscle rigidity is considered less common and less severe with SS compared to NMS [56]. Sternbach’s criteria did not include rigidity as a clinical feature. Although rigidity/hypertonicity is a part of the Hunter criteria, it was not a very common and prominent symptom in their database. They considered the presence of rigidity in severe and life-threatening SS [5]. Rigidity was noted in about 27% of our cases, and it was severe in many cases, leading to trismus, hyperextended spine and legs, opisthotonus, and inelicitable deep tendon reflex/clonus. Identification of trismus is very important as these patients may need an urgent tracheostomy. Our observation indicates that severe rigidity can occur in patients with severe SS and is again a poor prognostic factor. This can also cause diagnostic confusion with NMS.