Predictors of awakening from postanoxic status epilepticus after therapeutic hypothermia.

BACKGROUND: Postanoxic status epilepticus (PSE) is considered a predictor of fatal outcome and therefore not intensively treated; however, some patients have had favorable outcomes. The aim of this study was to identify favorable predictors for awakening beyond vegetative state in PSE. METHODS: We studied six subjects treated with hypothermia improving beyond vegetative state after cerebral anoxia, despite PSE. They were among a cohort of patients treated for anoxic encephalopathy with therapeutic hypothermia in our institution between October 1999 and May 2006 (retrospectively, 3/107 patients) and June 2006 and May 2008 (prospectively, 3/74 patients). PSE was defined by clinical and EEG criteria. Outcome was assessed according to the Glasgow-Pittsburgh Cerebral Performance Categories (CPC). RESULTS: All improving patients had preserved brainstem reflexes, cortical somatosensory evoked potentials, and reactive EEG background during PSE. Half of them had myoclonic PSE, while three had nonconvulsive PSE. In the prospective arm, 3/28 patients with PSE showed this clinical-electrophysiologic profile; all awoke. Treatments consisted of benzodiazepines, various antiepileptic drugs, and propofol. One subject died of pneumonia in a minimally conscious state, one patient returned to baseline (CPC1), three had moderate impairment (CPC2), and one remained dependent (CPC3). Patients with nonconvulsive PSE showed a better prognosis than subjects with myoclonic PSE (p = 0.042). CONCLUSION: Patients with postanoxic status epilepticus and preserved brainstem reactions, somatosensory evoked potentials, and EEG reactivity may have a favorable outcome if their condition is treated as status epilepticus.

Election de M. Asquith député de Paisley : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 58255

Le roi d'Angleterre [avec lord Ashfield] reçoit à Buckingham Palace des conducteurs d'autobus [de] retour de la guerre : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 58158

Equipe du Pays de Galles [de rugby affrontant la France], Colombes, 17/2/20 : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 58042

Severe traumatic brain injury in a high-income country: an epidemiological study.

This adult cohort determined the incidence and patients' short-term outcomes of severe traumatic brain injury (sTBI) in Switzerland and age-related differences. A prospective cohort study with a follow-up at 14 days was performed. Patients ≥16 years of age sustaining sTBI and admitted to 1 of 11 trauma centers were included. sTBI was defined by an Abbreviated Injury Scale of the head (HAIS) score >3. The centers participated from 6 months to 3 years. The results are presented as percentages, medians, and interquartile ranges (IQRs). Subgroup analyses were performed for patients ≤65 years (younger) and >65 (elderly). sTBI was observed in 921 patients (median age, 55 years; IQR, 33-71); 683 (74.2%) were male. Females were older (median age, 67 years; IQR, 42-80) than males (52; IQR, 31-67; p<0.00001). The estimated incidence was 10.58 per 100,000 inhabitants per year. Blunt trauma was observed in 879 patients (95.4%) and multiple trauma in 283 (30.7%). Median Glasgow Coma Score (GCS) on the scene was 9 (IQR 4-14; 8 in younger, 12 in elderly) and in emergency departments 5 (IQR, 3-14; 3 in younger, 8 in elderly). Trauma mechanisms included the following: 484 patients with falls (52.6%; younger, 242 patients [50.0%]; elderly, 242 [50.0%]), 291 with road traffic accidents (31.6%; younger, 237 patients [81.4%]; elderly, 54 [18.6%]), and 146 with others (15.8%). Mortality was 30.2% (24.5% in younger, 40.9% in elderly). Median GCS at 14 days was 15 (IQR, 14-15) without differences among subgroups. Estimated incidence of sTBI in Switzerland was low, age was high, and mortality considerable. The elderly had higher initial GCS and a higher death rate, but high GCS at 14 days.

Le Père Noël distribuant des jouets aux enfants d'un hôpital de Londres : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 57333

Comparação entre instrumentos de mensuração das consequências do trauma crânio-encefálico

O trauma crânio-encefálico (TCE) é considerado a causa mais importante de incapacidades entre jovens e a mais freqüente causa neurológica de morbidade. Em conseqüência, há um crescente interesse em instrumentos para monitorizar a recuperação após sua ocorrência. Nesse contexto, a Escala de Resultados de Glasgow (ERG) e a Disability Rating Scale (DRS) são instrumentos bastante utilizados. A atual investigação tem como objetivo comparar os resultados observados com o uso da DRS, ERG original e ampliada. Para atingir esse propósito, foram avaliadas as conseqüências pós-trauma de 63 vítimas de TCE contuso, com idade entre 12 e 65 anos, em seguimento ambulatorial em um centro de trauma da cidade de São Paulo, entre seis meses e três anos após TCE. A comparação dos resultados permitiu concluir que, embora as três escalas fossem fortemente correlacionadas, a ERG ampliada destacou-se pela sua maior sensibilidade para detectar alterações nas vítimas com melhores condições pós-traumáticas.

1/1/20, Parc des Princes, équipe d'Écosse [de rugby] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 57438

1/1/20, Parc des Princes, équipe d'Écosse [de rugby] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 57437

Colombes, 17/2/20, équipe du Pays de Galles [de rugby affrontant la France] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 58041

Colombes, 17/2/20, match France contre Pays de Galles [rugby, cérémonie d'avant-match, hommage rendu par les Gallois aux joueurs morts pendant la guerre] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 58075

Colombes, 17/2/20, match France contre Pays de Galles [rugby, cérémonie d'avant-match, hommage rendu par les Gallois aux joueurs morts pendant la guerre] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 58074

Première réunion de la ligue des nations à Londres, Albert Thomas et M. [Léon] Bourgeois au Palais St James : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 57999

Conférence des alliés à Downing street, résidence de M. Lloyd George, le maréchal Foch et le général Weygand quittant Downing street : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 57998

Election de M. Asquith député de Paisley : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 58254