ro13-9904 and Coma

A 54-year-old otherwise healthy man presented with altered mental status. On admission, the patient was confused and agitated, with a Glasgow Coma Scale (GCS) score of 11, suggesting moderate brain injury. He was sedated, placed on a ventilator, and started on tobramycin and ceftazidime for presumed bacterial meningitis, but switched to ceftriaxone once cultures returned as Escherichia coli. During his 8-day hospitalization, his mental status fluctuated from confused to nonresponsive, with GCS scores between 6 and 11. Although E. coli meningitis has a high rate of neurological complications and death, this patient recovered completely without any deficits, and recalled an elaborate near-death experience that occurred during his coma. This case highlights the importance of studying near-death experiences occurring during compromised brain function to further our understanding of the brain and consciousness.

Topics: Ceftriaxone; Coma; Humans; Male; Meningitis, Escherichia coli; Middle Aged; Recovery of Function; Treatment Outcome

Topics: Ampicillin; Antibiotic Prophylaxis; Brain Injuries, Traumatic; Ceftriaxone; Cefuroxime; Cohort Studies; Coma; Disease Susceptibility; Forecasting; Humans; Pilot Projects; Pneumonia, Ventilator-Associated; Practice Guidelines as Topic; Randomized Controlled Trials as Topic; Retrospective Studies; Stroke; Sulbactam

We report the case of a 76-year old woman, who presented with signs of a meningoencephalitis. The result of lumbar puncture showed a mononuclear pleocytosis. Empirical antimicrobial treatment was promptly initiated. Nevertheless a comatose state complicated the clinical course. The diagnosis of neuroborreliosis was made serologically and by molecular biology. Under adequate therapy with intravenous ceftriaxone the patient showed a slow but full recovery. This case illustrates that potentially reversible diseases need very careful decision making regarding therapeutic activities and that neuroborreliosis is a potentially reversible cause of severe neurologic impairment.

Topics: Aged; Anti-Bacterial Agents; Ceftriaxone; Coma; Diagnosis, Differential; Female; Humans; Infusions, Intravenous; Lyme Neuroborreliosis; Lymphocytosis; Meningitis; Tomography, X-Ray Computed

We report a case of a 5-year-old boy with acute disseminated encephalomyelitis as the initial presentation of neuroborreliosis. Parents report an upper-airway infection a few days before the development of acute encephalopathy, mild facial palsy, and seizures. The patient needed mechanical ventilation for 10 days, and after extubation, he presented hypotonia, ataxia, dysarthria, as well as weak gag and cough reflexes. Brain magnetic resonance imaging showed hyperintense lesions on T2- and fluid-attenuated inversion recovery sequences on the right subcortical occipital and parietal region, left posterior arm of the internal capsule, and in the medulla oblongata. Borrelia burgdorferi was identified in the plasma and cerebrospinal fluid by polymerase chain reaction and in the plasma by Western blotting. He was treated with ceftriaxone, methylprednisolone, and human immunoglobulin. Recovery was partial.

Topics: Brain Damage, Chronic; Cefotaxime; Ceftriaxone; Child, Preschool; Coma; Diazepam; Encephalomyelitis, Acute Disseminated; Facial Paralysis; Humans; Immunoglobulins, Intravenous; Lyme Neuroborreliosis; Magnetic Resonance Imaging; Male; Mastoiditis; Methylprednisolone; Portugal; Respiration, Artificial; Respiratory Insufficiency; Respiratory Tract Infections; Seizures; Sinusitis; Vancomycin

Typhoid fever may be difficult to distinguish from malaria. Septic shock, encephalopathy and leukopenia are common features of both diseases.. A 20-year-old South Korean woman was admitted to the intensive care unit with coma and shock. Vomiting and abdominal pain were followed by headache, prostration, fever and diarrhea. Leukocytopenia, lymphocytopenia, thrombocytopenia, rhabdomyolysis and hepatitis were present. Clotting tests were normal. The thick peripheral blood film was negative. Salmonella typhi was isolated from 6 blood cultures. Treatment associated ceftriaxone 4 g per day for 5 days, colloid and crystalloid fluids and dopamine. The patient was discharged 2 weeks later.. Typhoid fever should be considered as a diagnosis in patients with sepsis who come from endemic zones. Abdominal symptoms, prolonged fever, coma and delayed headache are particularly contributive signs. Specific treatment should be instituted.

Topics: Adult; Ceftriaxone; Coma; Critical Care; Diagnosis, Differential; Dopamine; Female; Fluid Therapy; Humans; Korea; Salmonella typhi; Shock, Septic; Typhoid Fever