Skip to main content
SpringerLink
Log in

Persistent but reversible coma in encephalitis

  • Original Article
  • Published:
Neurocritical Care Aims and scope Submit manuscript

Abstract

Introduction: Nontraumatic coma in adults has a poor prognosis, and late recovery of consciousness is unlikely. Functional recovery is usually extremely poor. However, a few nontraumatic comatose patients have shown late recovery of both awareness and function.

Methods: A retrospective survey was conducted by reviewing the medical records of all inpatients to our department during the 1990s. Patients with persistent but reversible nontraumatic coma were identified according to the following criteria: (a) deep coma with a Glasgow Coma Scale (GCS) score of 7 or less on admission; (b) nontraumatic cause; (c) persistence of unconsciousness for longer than 1 month; and (d) subsequent recovery of GCS (total) to normal. The clinical spectrum of patients meeting these criteria was evaluated.

Results: Six patients (ages 16–75 years) met the criteria. Viral encephalitis was diagnosed in five (two with herpes simplex virus, two with cytomegalovirus, and one with Epstein-Barr virus or cytomegalovirus). Two young female patients with encephalitis manifested extremely protracted coma persisting for 3 and 18 months, respectively. Complications included nonconvulsive status epilepticus in two patients and relative overdose of clonazepam in one patient.

Conclusion: Recognition of the clinical spectrum of persistent but reversible nontraumatic coma is important.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Childs NL, Mercer WN. Late improvement in consciousness after post-traumatic vegetative state. N Engl J Med 2003;334:24–25.

    Article  Google Scholar 

  2. The Multi-Society Task Force on PVS. Medical aspects of the persistent vegetative state (second of two parts). N Engl J Med 1994;330:1572–1579.

    Article  Google Scholar 

  3. Jorgensen EO, Malchow-Moller A. Natural history of global and critical brain ischaemia. Part I: EEG and neurological signs during the first year after cardiopulmonary resuscitation in patients subsequently regaining consciousness. Resuscitation 1981;9:133–153.

    Article  PubMed  CAS  Google Scholar 

  4. Jorgensen EO, Malchow-Moller A. Natural history of global and critical brain ischaemia. Part II: EEG and neurological signs in patients remaining unconscious after cardiopulmonary resuscitation. Resuscitation 1981;9:155–174.

    Article  PubMed  CAS  Google Scholar 

  5. Jorgensen EO, Malchow-Moller A. Natural history of global and critical brain ischaemia. Part III: cerebral prognostic signs after cardiopulmonary resuscitation. Cerebral recovery course and rate during the first year after global and critical ischaemia monitored and predicted by EEG and neurological signs. Resuscitation 1981;9:175–188.

    Article  Google Scholar 

  6. Levy DE, Bates D, Caronna JJ, et al. Prognosis in non-traumatic coma. Ann Intern Med 1981;94:293–301.

    PubMed  CAS  Google Scholar 

  7. Levy DE, Caronna JJ, Singer BH, Lapinski RH, Frydman H, Plum F. Predicting outcome from hypoxic-ischemic coma. JAMA 1985;253:1420–1426.

    Article  PubMed  CAS  Google Scholar 

  8. Bates D. Defining prognosis in medical coma. J Neurol Neurosurg Psychiatry 1991;54:569–571.

    PubMed  CAS  Google Scholar 

  9. Young GB. Major syndromes of impaired consciousness. In: Young GB, Ropper AH, Bolton CF, eds. Coma and Impaired Consciousness. New York: McGraw-Hill, 1998, pp. 39–78.

    Google Scholar 

  10. Hamel MB, Phillips R, Teno J, et al. Cost effectiveness of aggressive care for patients with nontraumatic coma. Crit Care Med 2002;30:1191–1196.

    Article  PubMed  Google Scholar 

  11. Bates D, Caronna JJ, Cartlidge NE, et al. A prospective study of nontraumatic coma: methods and results in 310 patients. Ann Neurol 1977;2:211–220.

    Article  PubMed  CAS  Google Scholar 

  12. Shiota H, Kamei S, Takasu T. Clinical analysis of adult patients with herpes simplex virus encephalitis (HSVE)- first report. J Nihon Univ Med Ass 1998;57:484–497.

    Google Scholar 

  13. Towne AR, Waterhouse EJ, Boggs JG, et al. Prevalence of nonconvulsive status epilepticus in comatose patients. Neurology 2000;54:340–345.

    PubMed  CAS  Google Scholar 

  14. Appoloni O, Mavroudakis N, Sadis C, Vincent J-L. Reversible hypoglycemic coma despite bilateral absence of the median nerve N20 evoked potential. Neurology 2003;60:1723–1724.

    PubMed  Google Scholar 

  15. Nokura K, Yamamoto H, Okawara Y, Koga H, Osawa H, Sakai K. Reversible limbic encephalitis caused by ovarian teratoma. Acta Neurol Scand 1997;95:367–373.

    Article  PubMed  CAS  Google Scholar 

  16. Bates D. The prognosis of medical coma. J Neurol Neurosurg Psychiatry. 2001 Suppl 1; i20-i23.

    Google Scholar 

  17. The Multi-Society Task Force on PVS. Medical aspects of the persistent vegetative state (first of two parts). N Engl J Med 1994;330:1499–1508.

    Article  Google Scholar 

  18. Andrews K, Murphy L, Munday R, Littlewood C. Misdiagnosis of the vegetative state: retrospective study in a rehabilitation unit. BMJ 1996;313:13–16.

    PubMed  CAS  Google Scholar 

  19. Childs NL, Mercer WN, Childs HW. Accuracy of diagnosis of persistent vegetative state. Neurology 1993;43:1465–1467.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Critical Care and Emergency Medicine, Tokai University School of Medicine, 259-1193, Kanagawa, Japan

    Masao Nagayama

  2. Department of Neurology, Tokai University School of Medicine, Bohseidai, Isehara, 259-1193, Kanagawa, Japan

    Masao Nagayama, Kazushi Matsushima, Tomiko Nagayama & Yukito Shinohara

Authors
  1. Masao Nagayama
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kazushi Matsushima
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tomiko Nagayama
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yukito Shinohara
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Masao Nagayama.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nagayama, M., Matsushima, K., Nagayama, T. et al. Persistent but reversible coma in encephalitis. Neurocrit Care 2, 252–257 (2005). https://doi.org/10.1385/NCC:2:3:252

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1385/NCC:2:3:252

Key Words

Search

Navigation