Anoxic-ischemic alpha coma: prognostic significance of the incomplete variant

Suspected cerebrovascular air embolism during endoscopic esophageal varices ligation under sedation with fatal outcome: A case report

BACKGROUND

Air embolism is a very rare, yet serious and potentially fatal complication of digestive endoscopic treatment. Air embolism is the result of air directly entering the arteries or veins. However, to recognize neurological dysfunction under sedation can be difficult. Therefore, it is extremely important to identify high-risk groups and take preventive measures.

CASE SUMMARY

Herein, we report a 74-year-old female patient with esophageal varices who suffered from consciousness disturbance after the third endoscopic ligation of esophageal varices under sedation. Combined with the patient’s imaging examination results and medical history, we highly suspected that the patient had developed paradoxical cerebral air embolism during endoscopic ligation. We learned that the patient died at a later follow-up. In order to be able to identify and prevent the occurrence of air embolism early, we summarize and analyze the risk factors, pathogenesis, clinical manifestations, prevention and treatment options of gastrointestinal endoscopy complicated by cerebral air embolism.

CONCLUSION

Electroencephalographic monitoring helps to recognize the occurrence of air embolism in time and increase the patient's chance of survival.

Postanoxic alpha, theta or alpha-theta coma: Clinical setting and neurological outcome

AIM

The aim of this study was to determine the prognosis of 26 consecutive adults with alpha coma (AC), theta coma (TC) or alpha-theta coma (ATC) following CRA and to describe the clinical setting and EEG features of these patients.

METHODS

We retrospective analyzed a prospectively collected cohort of adult patients diagnosed as having AC, TC or ATC after CRA between January 2008 and June 2016. None of patients included in this analysis underwent therapeutic hypothermia (TH). Neurological outcome was expressed as the best score 6 months after CRA using the five-point Glasgow-Pisttsburgh Cerebral Performance Categories (CPC) RESULTS: Twenty-six patients were identified with a diagnosis of postanoxic AC, TC or ATC coma. There were 20 (77%) men and 6 (23%) women. The mean age was 63 ± 16 years. The most frequent EEG pattern was TC (21 patients, 80%), followed by AC (3 patients, 12%) and ATC (2 patients, 8%). The cardiac rhythm as primary origin of the CRA was ventricular fibrillation (VF) in 16 patients (61.5%), asystole in 8 patients (34.6%) and ventricular tachycardia (VT) in one patient (3.8%). The presence of EEG reactivity was present in 8 patients (30%). The mortality rate was 85%. Of the 4 surviving patients, two (3.8%) had moderate disability (CPC 2), one (3.8%) had severe disability (CPC 3) and one (3.8%) reached a good recovery. The age was significantly lower in survivors 46.2 ± 10.8 versus nonsurvivors 63.3 ± 15.5 (p = 0.04). There was increased association of EEG reactivity with survival (p = 0.07).

CONCLUSION

Hypoxic-ischemic AC, TC and ATC are associated with a poor prognosis and a high rate of mortality. In younger patients with AC, TC and ATC and incomplete forms showing reactivity on the EEG, there is a greater probability of clinical recovery.