Abstract Details

Title Eye opening and blinking in post anoxic coma

Topic Neuro Trauma and Critical Care

Presentation(s) P1 - Poster Session 1 (9:00 AM-5:00 PM)

Poster/Presentation
Number 358

Objective To report a case of a comatose patient with anoxic brain injury who had eye opening and blinking in response to physical stimulation, hence questioning the current existing definition of coma.

Background Coma is defined as a state of deep unresponsiveness with eyes closed from which the patient cannot be aroused to respond appropriately to any kind of vigorous stimulation. However, rare cases of coma patients with either blinking or eye opening have been reported in literature. The mechanisms remain unclear.

Design/Methods

Case Report

Results A 72 year old woman with hypertension, CKD and history of coronary artery disease presented as out of hospital PEA arrest with a downtime of 10 minutes. She arrested again en route to the hospital and ROSC was achieved for a second time after 6 minutes. She had multifocal myoclonic jerking after reaching the ICU and was placed under hypothermia protocol with continuous video-EEG monitoring. Her initial EEG recording showed evidence of burst suppression. Multiple eyelid and whole body positive and negative myoclonic jerks were recorded. By day 4, the EEG had evolved into generalized background suppression and patient remained in coma off sedation. On exam, she had bilateral extensor posturing to noxious stimulation with no verbal response. She did, however, have intermittent eye opening and eye blinking only with noxious stimulation. Brainstem reflexes were intact. MRI brain showed diffuse cortical and subcortical anoxic injury.

Conclusions Periodic eye opening has been described previously in patients with burst suppression; the eye opening being time locked with the bursts. More recently, eyes open coma has been described as a unique coma phenotype independent of the cause. Our case adds to the existing sparse literature of eye opening in coma patients. The mechanism in our case is unclear.

Authors/Disclosures
Neel Fotedar, MD (University Hospitals Cleveland Medical Center) PRESENTER	Dr. Fotedar has received research support from NINDS.
Hemani Ticku, MD	Dr. Ticku has nothing to disclose.

��ɫ��

��ɫ��