Idiopathic recurrent stupor mimicking status epilepticus.
(1/5)
Stupor is defined as a deep sleep or behaviourally similar unresponsiveness from which the subject can be aroused only by vigorous repeated stimuli. Causes of stupor may be related to brain damage, toxic or metabolic encephalopathies. Idiopathic recurring stupor is a stupurous condition of unknown aetiology, unrelated to structural, toxic or metabolic disturbance. This condition responds to flumazenil, a benzodiazepine antagonist. We describe a 60-year-old man presenting with abnormal jerky movements of the body and who was wrongly treated as status epilepticus. He responded to flumazenil which confirmed the diagnosis. (+info)
Endorsement of the FOUR score for consciousness assessment in neurosurgical patients.
(2/5)
The Full Outline of UnResponsiveness (FOUR) score was previously developed for neurological assessment, but has not been validated in neurosurgical patients, so was compared to the Glasgow Coma Scale (GCS) in practice. Four groups of raters, expert clinicians, novice clinicians, experienced nurses, and inexperienced nurses, assessed 64 patients in awake, drowsy, stuporous, and comatose conditions to investigate rater reliability. Then, 36 patients were evaluated by 1 expert clinician and 1 from the other groups randomly to test the difference. Spearman's correlation was used to find the correlation between both scores from 68 patients. The estimation of FOUR score cut points was validated by weighted kappa compared with the GCS to establish the risk prognosis. Score feasibility was analyzed by nonparametric test. Intraclass correlation in each group was over 0.9, with no difference between expert and inexperienced raters (p > 0.05). The correlation was 0.78. Low, intermediate, and high risk prognosis were associated with 0-7, 8-14, and 15-16 FOUR scores with kappa of 0.92. The feasibility of the FOUR score was lower than that of the GCS (p < 0.01). The FOUR score is reliable and valid for consciousness evaluation with some consequences for practicability. Extensive implementation would increase familiarity. (+info)
Retrospective and observational study to assess the efficacy of citicoline in elderly patients suffering from stupor related to complex geriatric syndrome.
(3/5)