Evaluation and Outcome of Impairment of Consciousness and Coma in Pediatric Population.

Ramakrishnan, V (2011) Evaluation and Outcome of Impairment of Consciousness and Coma in Pediatric Population. Masters thesis, Tirunelveli Medical College, Tirunelveli.

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Abstract

INTRODUCTION Coma is a relatively common condition in the paediatric intensive care unit. Epidemiological studies generally divide the causes of coma as traumatic and nontraumatic. The incidence of non traumatic coma was five times greater in children in developed countries. Non traumatic coma is an important source of morbidity and mortality in paediatric age group. Design of appropriate and efficient protocols of investigation for coma require an understanding of the relative frequencies of various potential etiologies. There are no prospective study on the etiology, clinical signs, severity of non traumatic coma in children with a view to define predictors of outcome in south Tamilnadu. Considering the fact that acute non traumatic coma is accounting for 10 to 15% of all hospital admissions, there is a need for more studies so that outcome rather than survival can be improved. Consciousness is a state of normal cerebral function in which the child is aware of both self and surroundings and responds to stimuli, both internal, e.g., hunger and external. Sleep is a normal variation of this state. Impairment in consciousness may range from confusion, drowsiness and stupor to coma and brain death. The ascending reticular activating system (RAS) is a collection of neurons located in the brainstem and medial thalamus, having connections with all parts of the cerebral hemispheres. This system maintains the brain in wakeful consciousness. Impairment of consciousness and coma occurs due to lesions that damage the RAS or its projections, disruption of large portions of both cerebral hemispheres, suppression of reticulo-cerebral functions by drugs, toxins, inflammation, or metabolic derangement etc. Most cases of acute impairment of consciousness and coma are due to potentially treatable conditions and respond well to treatment. In certain conditions prognosis depends more on the causative illness rather than the severity of the illness. Outcome also depends on the speed and quality of the treatment given. Residual neurological deficit might improve over time with proper physiotherapy and rehabilitation. Cognitive functions may improve over time. Behavioral problems are common during recovery which may also improve in due course. 72 CONCLUSION: 1. CNS infection is the commonest etiology and epilepsy is the second common etiology in all age groups and both sexes. 2. Low age groups are more susceptible for occurrence of impairment of consciousness and coma. Hypoxic – ischemic encephalopathy is the common etiology in 01 month to 3 year age group. 3. Gender had no role in etiological diagnosis and outcome. 4. Meningeal and focal signs are viable and valid factors to facilitate the diagnosis of etiology. 5. Severity of coma, duration of coma and meningeal and focal signs are the influencing factors upon the nature of outcome. 6. Secondary symptomatic seizures are more common in CNS infections than in other non epileptic etiologies. Presence of secondary symptomatic seizures in non-epileptic group had adverse impact on the outcome. 7. CT Brain with positive findings is an objective collateral evidence to diagnose etiology. Presence and absence of findings in CT brain is not significant in determining the outcome in this study. Further larger studies are needed. 8. Epilepsy had better outcome than other etiology. 9. Hypoxic ischemic, Metabolic, toxic and other etiological group had variable outcome due to heterogenous nature of multiple etiologies. In pediatric population, impairment of consciousness is an urgency and coma is an emergency. Proper history taking, focussed clinical examination and relevant laboratory investigations are essential to find out etiology. The present study shows that clinical variables such as age specificity, severity of coma, duration of coma, meningeal and focal signs and disease related seizures are important factors that can influence the outcome of non traumatic coma in paediatric population.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Evaluation and Outcome ; Impairment of Consciousness ; Coma ; Pediatric Population.
Subjects: MEDICAL > Neurology
Depositing User: Kambaraman B
Date Deposited: 03 Jul 2017 08:39
Last Modified: 03 Jul 2017 08:39
URI: http://repository-tnmgrmu.ac.in/id/eprint/807

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