Clinical grading diagnosis of disorder of consciousness (DOC) patients relies on behavioral assessment, which has certain limitations. Combining multi-modal technologies and brain-computer interface (BCI) paradigms can assist in identifying patients with minimally conscious state (MCS) and vegetative state (VS). This study collected electroencephalogram (EEG) and functional near-infrared spectroscopy (fNIRS) signals under motor BCI paradigms from 14 DOC patients, who were divided into two groups based on clinical scores: 7 in the MCS group and 7 in the VS group. We calculated event-related desynchronization (ERD) and motor decoding accuracy to analyze the effectiveness of motor BCI paradigms in detecting consciousness states. The results showed that the classification accuracies for left-hand and right-hand movement tasks using EEG were 93.28% and 76.19% for the MCS and VS groups, respectively; the classification precisions using fNIRS were 53.72% and 49.11% for these groups. When combining EEG and fNIRS features, the classification accuracies for left-hand and right-hand movement tasks in the MCS and VS groups were 95.56% and 87.38%, respectively. Although there was no statistically significant difference in motor decoding accuracy between the two groups, significant differences in ERD were observed between different consciousness states during left-hand movement tasks ( P < 0.001). This study demonstrates that motor BCI paradigms can assist in assessing the level of consciousness, with EEG being more sensitive for evaluating residual motor intention intensity. Moreover, the ERD feature of motor intention intensity is more sensitive than BCI classification accuracy.
Humans ; Brain-Computer Interfaces ; Spectroscopy, Near-Infrared/methods* ; Electroencephalography/methods* ; Consciousness Disorders/diagnosis* ; Male ; Movement ; Adult ; Female ; Intention ; Persistent Vegetative State/diagnosis*

Extravasation injury refers to leakage of corrosive liquids from veins, resulting in tissue damage. The authors report on a case of extravasation injury to the left hand after administration of fluid to the antecubital area in a patient with brain damage. In order to minimize the effects of extravasation injury, rapid diagnosis and management are needed. In patients with stiffness, pressure sores can develop requiring more careful management by the medical staff.
Brain* ; Diagnosis ; Extravasation of Diagnostic and Therapeutic Materials ; Extremities* ; Hand ; Humans ; Medical Staff ; Persistent Vegetative State ; Pressure Ulcer* ; Vancomycin ; Veins

Japanese encephalitis is one of the leading causes of acute encephalitis in Asia. But in Korea, the number of Japanese encephalitis cases has dropped considerably due to mass vaccination and vector control. Especially, there were no case reports under the age of 9 years during the last ten years. We will describe a case of a previously healthy 7-month old boy who presented with fever and seizure. The patient was diagnosed with Japanese encephalitis, based on the cerebrospinal fluid and serum antibody analyses for the Japanese encephalitis virus. Typical brain magnetic resonance image findings of Japanese encephalitis were observed. The patient received extensive conservative treatment including high dose intravenous corticosteroid treatment and immunoglobulin. In spite of severe hemodynamic instability, the patient survived, and he is currently in a vegetative state with respiratory assist by a home ventilator. Although the incidence of Japanese encephalitis dropped dramatically in Korea, pediatricians should always consider the diagnosis as one of the possibilities for patients with encephalitis, especially if the patient is not immunized for JEV. Since there is no specific treatment for JEV, timely and comprehensive conservative care is critical to reduce the mortality and morbidity.
Asia ; Asian Continental Ancestry Group* ; Brain ; Cerebrospinal Fluid ; Diagnosis ; Encephalitis ; Encephalitis Virus, Japanese ; Encephalitis, Japanese* ; Fever* ; Hemodynamics ; Humans ; Immunoglobulins ; Incidence ; Infant* ; Korea ; Male ; Mass Vaccination ; Mortality ; Persistent Vegetative State ; Seizures* ; Ventilators, Mechanical

Rarely, rupture of a cerebral aneurysm causes an acute subdural hematoma(SDH) in addition to subarachnoid hemorrhage(SAH). We report clinical and radiological characteristics of five cases, as well as potential pitfalls in the diagnosis and the treatment of this life-threatening condition. The patients ranged in age from 42 to 76 years. The Hunt-Hess grade on admission was gradeIII in one patient, gradeIV in two, and grade V in two. All five patients underwent one-stage operation (both SDH evacuation and clipping of the aneurysm). The outcome was good recovery in two patients, persistent vegetative state in two, and death in one. Patients with a good outcome had a better Hunt-Hess grade on admission, with less amount of SDH.
Aneurysm* ; Diagnosis* ; Hematoma, Subdural, Acute* ; Humans ; Intracranial Aneurysm* ; Persistent Vegetative State ; Rupture

Subacute sclerosing panencephalitis (SSPE) is a progressive inflammatory disease of the central nervous system (CNS) caused by a persistent, aberrant measles virus infection. The outcome is usually fatal. After a latent period of 6 to 7 years, there is subtle and slow cognitive decline and visuospatial disorientation develops followed by myoclonic jerks, extrapyramidal symptoms, ataxia, and seizures, progressing to coma or vegetative state. The diagnosis is based on at least three of the following criteria 1) clinical manifestations 2) abnormal EEG 3) hyperglobulinorrachia, elevated serum or spinal fluid measles antibody 4) histologic features. No therapeutic maneuver has been proven conclusively to be of value. We have diagnosed and experienced a case of subacute sclerosing panencephalitis (SSPE) in a 5-year-old child with the chief complaint of myoclonic seizure and mental deterioration. We report a case and the brief review of related literature.
Ataxia ; Central Nervous System ; Child ; Child, Preschool ; Coma ; Diagnosis ; Electroencephalography ; Humans ; Measles ; Measles virus ; Myoclonus ; Persistent Vegetative State ; Seizures ; Subacute Sclerosing Panencephalitis*

Although the life expectancy of posttraumatic persistent vegetative state is obviously expected to be shorter than that of the general population, exact estimates of the length of survival are not available, however. The author, after reviewing literatures on the definition, criteria for diagnosis, and prognosis of the persistent vegetative state, has proposed a table for the estimation of life expectancy of posttraumatic persistent vegetative state. In this proposal, age and sex of the patient as well as the duration of the vegetative state were used as determining factors of lifespan. Although this proposal is not based on the actual data, it still could serve as a helpful reference to estimate the patients life expectancy and minimizing discrepancies among clinicians with different personal experience.
Craniocerebral Trauma ; Diagnosis ; Humans ; Life Expectancy* ; Persistent Vegetative State* ; Prognosis

Patients with overwhelming demage to the cerebral hemispheres commonly pass into a chronic state of unconsciounsness(ie, loss of self awareness) called the vegetative state. When such cognitive loss lasts for more then a few weeks, the condition has been termed a persistent vegetative state. The auther reviewed "Position of the American Academy of Neurology on certain aspects of the care and management of the persistent vegetative state patient" adopted by the Executive Board, American Academy of Neurology, April 21, 1988 and "Current Opinions of the Council on Ethical and Judicial Affairs of the American Medical Association" - 1989. In the U.S.A. they insist :If the patient is competent to act in his own befalf and did not previously indicate his preferences, the family or other surrogate decision maker, in concert with the physician, must act in the best interest of the patient" and "Even if death is not imminent but a patient is beyond doubt permanently unconscious, and there are adequate safeguards to confirm the accuracy of the diagnosis, it is not unethical to discontinue all means of life-prolonging medical treatment." In Korea :brain death" has not been referred to the death of the individual yet socially and legally. The neurosurgeons in our country must consider about how seriously to treat vegetative patients and brain death patients who are unlikly to improve, in the concerns of bio-medical ethice. On the other hand, they recognize that their capacity to achieve a diagnosis and highly probable prognosis represents the indispensable basis for any decision. This article provides criteria for the diagnosis of persistent vegetative state and reviews the available data of my 19 patients. Lastly in our country any considerations or discussions have not yet been made with regard to withdrawal of life support to patients in persistent vegetative states according to the national emotion and morality.
Brain ; Brain Death ; Cerebrum ; Cognition ; Diagnosis ; Diffuse Axonal Injury ; Hand ; Humans ; Korea ; Morals ; Neurology ; Persistent Vegetative State* ; Positron-Emission Tomography ; Prognosis

Accidents cause more than half of all childhood deaths, despite early diagnosis and proper treatment. It has showed still high mortality and morbidity. We analyzed the results of treatment of 50 severely head injured children who were admitted to the department of neurosurgery. Wonkwang University Hospital from January, 1984 to March, 1988 and evaluated prognostic factors affecting the outcome. Our conclusions are as follow: 1) We experienced the high mortality in children no more than five years of age. 2) The Glasgow coma scale on admission was a reliable indicator predicting the outcome in severe head injury. 3) The neurological features such as papillary light reflex, oculocephalic reflex and motor respons were good indicators of outcome. 4) Therer was no significant difference in outcome between diffuse brain injury and intracranial mass lesion. 5) The diffuse brain swelling on brain CT scan worsened the outcome. 6) The mortality rate increased in children associated with viscus rupture in head inujury. 7) The overall outcome showed 38% of good recovery, 20% of moderate disability, 10% of severe disability, 4% of vegetative state, and 28% of death.
Brain ; Brain Edema ; Brain Injuries ; Child* ; Craniocerebral Trauma* ; Early Diagnosis ; Glasgow Coma Scale ; Head* ; Humans ; Mortality ; Neurosurgery ; Persistent Vegetative State ; Reflex ; Rupture ; Tomography, X-Ray Computed

The management of patients with severe head injury continues to present neurosurgeons with a major challenge. Despite of early diagnosis and aggressive treatment, it has showed still high mortality and morbidity. We analyzed the results of treatment of 50 cases with severly head injured-children who were treated during past 2 years for detection of predicting factors of outcome. Our conclusions are as follows ; 1) The Glasgow coma scale(GCS) on admission was an important predicting factor for outcome of severe head injury. In patients with 3, 4 of GCS, outcome was poor. In cases above 5 of GCS, outcome was better than the former. 2) The clinical features on admission(i. e., light reflex of pupils, oculocephalic responses and abnormal motor responses) were also important predicting factor of outcome. 3) There was no significant relation between outcome of severe head injury and age distribution in children. 4) The mass lesion occupied relatively small proportion in the types of lesion which was proved by CT scan(26%). 5) Overall outcome showed 28% of good recovery, 26% of moderately disabled, 12% of severly disabled, 12% of vegetative state and 22% of dead.
Age Distribution ; Child* ; Coma ; Craniocerebral Trauma* ; Early Diagnosis ; Head* ; Humans ; Intracranial Hypertension ; Mortality ; Persistent Vegetative State ; Pupil ; Reflex