Acute hypoglycemia masquerading as head trauma: A report of four cases

Luber, Samuel D.; Brady, William J.; Brand, Asher; Young, Jeffrey S.; Guertler, Andrew T.; Kefer, Mike

doi:10.1016/s0735-6757(96)90094-7

Cited by 25 publications

(3 citation statements)

References 20 publications

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“…4 As Luber et al have highlighted, even simple hypoglycaemia may have a confusing presentation of coma. 19 Our results about likelihood ratios of both light reflex loss and anisocoria now confirm their importance as the strong clinical signs.…”

Section: Discussionsupporting

confidence: 65%

Pupillary evaluation for differential diagnosis of coma

Tokuda

Nakazato

Stein

2003

Postgraduate Medical Journal

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Objectives: To determine the usefulness of bedside evaluation of pupils in determining the aetiology of coma by adopting a probabilistic approach. Patients and methods: One hundred and fifteen consecutive patients presenting with coma were enrolled in this prospective cohort during the 12 month study period in the emergency room of a community teaching hospital. Patients underwent structured clinical examinations and laboratory and imaging tests. Assignment of aetiology of coma was based on strict adherence to predetermined criteria and achieved by consensus of the two physician investigators. One year follow up was obtained in all patients. Results: Aetiology of coma was determined in 98% of the patients. It was metabolic in 69 patients (60%) and structural in 46 patients (40%). Metabolic causes included drug overdose, acute alcohol intoxication, hypoglycaemia, sepsis, and pneumonia. Structural causes included intracerebral haemorrhage, subarachnoid haemorrhage, cerebral infarction, subdural haematoma, and epidural haematoma. Multivariate logistic regression analysis showed light reflex loss (likelihood ratio for positive test result 3.59) and anisocoria (likelihood ratio for positive test result 9.0) as independent predictors of structural origin. Conclusions: In this prospective study of patients presenting to the emergency room of a community based teaching hospital with coma, in about 60% the coma is of metabolic origins and in about 40% of structural origins. Light reflex loss and anisocoria suggest a structural aetiology.

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Section: Discussionsupporting

confidence: 65%

Pupillary evaluation for differential diagnosis of coma

Tokuda

Nakazato

Stein

2003

Postgraduate Medical Journal

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“…In secondary analyses, we considered emergency department visits/hospital admissions for fall related fractures and altered consciousness/mental status, which have been linked to hypoglycemia. 21 22 23…”

Section: Methodsmentioning

confidence: 99%

Association between use of warfarin with common sulfonylureas and serious hypoglycemic events: retrospective cohort analysis

Romley

Gong

Jena

et al. 2015

BMJ

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“…Hypoglycaemia may, however, be the initial cause of TBI through altered sensorium or behaviour, and the reduced GCS found with persisting hypoglycaemia may mimic severe TBI. 86…”

Section: Secondary Insultsmentioning

confidence: 99%

Traumatic brain injury: assessment, resuscitation and early management

Moppett

2007

British Journal of Anaesthesia

246

172

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This review examines the evidence base for the early management of head-injured patients. Traumatic brain injury (TBI) is common, carries a high morbidity and mortality, and has no specific treatment. The pathology of head injury is increasingly well understood. Mechanical forces result in shearing and compression of neuronal and vascular tissue at the time of impact. A series of pathological events may then ensue leading to further brain injury. This secondary injury may be amenable to intervention and is worsened by secondary physiological insults. Various risk factors for poor outcome after TBI have been identified. Most of these are fixed at the time of injury such as age, gender, mechanism of injury, and presenting signs (Glasgow Coma Scale and pupillary signs), but some such as hypotension and hypoxia are potential areas for medical intervention. There is very little evidence positively in favour of any treatments or packages of early care; however, prompt, specialist neurocritical care is associated with improved outcome. Various drugs that target specific pathways in the pathophysiology of brain injury have been the subject of animal and human research, but, to date, none has been proved to be successful in improving outcome.

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Acute hypoglycemia masquerading as head trauma: A report of four cases

Cited by 25 publications

References 20 publications

Pupillary evaluation for differential diagnosis of coma

Pupillary evaluation for differential diagnosis of coma

Association between use of warfarin with common sulfonylureas and serious hypoglycemic events: retrospective cohort analysis

Traumatic brain injury: assessment, resuscitation and early management

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