Journal article
Neurological Prognostication After Hypoglycemic Coma: Role of Clinical and EEG Findings
Neurocritical care, Vol.37(1), pp.273-280
04/18/2022
DOI: 10.1007/s12028-022-01495-2
PMID: 35437670
Abstract
Background
Hypoglycemic coma (HC) is an uncommon but severe clinical condition associated with poor neurological outcome. There is a dearth of robust neurological prognostic factors after HC. On the other hand, there is an increasing body of literature on reliable prognostic markers in the postanoxic coma, a similar—albeit not identical—situation. The objective of this study was thus to investigate the use and predictive value of these markers in HC.
Methods
We conducted a retrospective, multicenter, cohort study within five centers of the Critical Care EEG Monitoring Research Consortium. We queried our electroencephalography (EEG) databases to identify all patients undergoing continuous EEG monitoring after admission to an intensive care unit with HC (defined as Glasgow Coma Scale < 8 on admission and a first blood glucose level < 50 mg/dL or not documented but in an obvious clinical context) between 01/01/2010 and 12/31/2020. We studied the association of findings at neurological examination (Glasgow Coma Scale motor subscale, pupillary light and corneal reflexes) and at continuous EEG monitoring(highly malignant patterns, reactivity, periodic discharges, seizures) with best neurological outcome within 3 months after hospital discharge, defined by the Cerebral Performance Category as favorable (1–3: recovery of consciousness) versus unfavorable (4–5: lack of recovery of consciousness).
Results
We identified 60 patients (30 [50%] women; age 62 [51–72] years). Thirty-one and 29 patients had a favorable and unfavorable outcome, respectively. The presence of pupillary reflexes (24 [100%] vs. 17 [81%];
p
value 0.04) and a motor subscore > 2 (22 [92%] vs. 12 [63%];
p
value 0.03) at 48–72 h were associated with a favorable outcome. A highly malignant EEG pattern was observed in 7 of 29 (24%) patients with unfavorable outcome versus 0 of 31 (0%) with favorable outcome, whereas the presence of EEG reactivity was observed in 28 of 31 (90%) patients with favorable outcome versus 13 of 29 (45%) with unfavorable outcome (
p
< 0.001 for comparison of all background categories).
Conclusions
This preliminary study suggests that highly malignant EEG patterns might be reliable prognostic markers of unfavorable outcome after HC. Other EEG findings, including lack of EEG reactivity and seizures and clinical findings appear less accurate. These findings should be replicated in a larger multicenter prospective study.
Details
- Title: Subtitle
- Neurological Prognostication After Hypoglycemic Coma: Role of Clinical and EEG Findings
- Creators
- Douaae Bouyaknouden - Université Libre de BruxellesTeja N. Peddada - University of Pittsburgh Medical CenterNidhi Ravishankar - Yale UniversitySafoora Fatima - University of WisconsinJoanna Fong-Isariyawongse - University of Pittsburgh Medical CenterEmily J. Gilmore - Yale UniversityJong Woo Lee - Brigham and Women's HospitalAaron F. Struck - University of WisconsinNicolas Gaspard - Université Libre de BruxellesCritical Care EEG Monitoring Research Consortium (CCEMRC)
- Contributors
- Rup K Sainju (Contributor) - University of Iowa, Neurology
- Resource Type
- Journal article
- Publication Details
- Neurocritical care, Vol.37(1), pp.273-280
- Publisher
- Springer US
- DOI
- 10.1007/s12028-022-01495-2
- PMID
- 35437670
- ISSN
- 1541-6933
- eISSN
- 1556-0961
- Language
- English
- Date published
- 04/18/2022
- Academic Unit
- Neurology
- Record Identifier
- 9984302208702771
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