BMC Neurology最新文献

Objective: This retrospective cohort study aims to provide comprehensive data on the disease trajectory and end-of-life care in patients dying from ALS.

Methods: The study presents detailed information on a cohort dying from ALS in the area served by Akershus University Hospital from 2011 to 2022. Data was obtained from the patient medical records.

Results: 118 patients were included. 65 patients (55%) were referred to the Department of Palliative medicine for specialist palliative care, with a median duration from referral to death of two months and one third of patients not being able to communicate verbally at the time of referral. The most common life-sustaining treatment was non-invasive ventilation and percutaneous endoscopic gastrostomy, whereas most prevalent limitation of life-sustaining treatment was withholding of tracheostomy with invasive ventilation. Hospital was the most common place of death with 54 (46%) of all deaths. For in-hospital-deaths, the most common place of death was the palliative care ward, with 21 patients (39%), but a substantial proportion (17%) died at intensive or intermediate care units. Overall, 37% of in-hospital deaths had been admitted to either intensive or intermediate care units during their last week of life, which may suggest these patients deteriorated rapidly without having documented advanced care planning and therefore received resource demanding and futile treatment during the last week of life.

Conclusion: Many patients lived in their own homes until admitted to their last hospital stay in life. However, these last hospital stays were frequently characterized by insufficient advanced care planning, leading to futile overtreatment.

Trial registration: Retrospectively registered.

Background: Carbon monoxide (CO) intoxication can lead to various brain lesions, with the globus pallidus being the most common site of injury. Herein, we report a rare case of CO poisoning with acute bilateral hippocampal lesions and delayed midbrain involvement of the substantia nigra.

Case presentation: A woman in her twenties who attempted suicide by burning charcoal briquettes presented with a Glasgow Coma Scale score of 3/15. Initial head computed tomography revealed low-density areas in the bilateral globus pallidus and hippocampi. Magnetic resonance imaging (MRI) on day 3 showed high signal intensity in the same regions on diffusion-weighted imaging (DWI), with a corresponding low signal on the apparent diffusion coefficient map and high signal intensity on fluid-attenuated inversion recovery imaging. The patient underwent hyperbaric oxygen therapy (HBOT) and gradually regained consciousness. However, the patient experienced persistent short-term memory loss. Follow-up MRI on day 23 showed improvement in the hippocampal and globus pallidus lesions but revealed new bilateral high-signal lesions in the substantia nigra on DWI. Despite these findings, the patient did not exhibit any extrapyramidal signs. Subsequent HBOT sessions led to further improvements in her cognitive function, as evidenced by an increase in her Mini-Mental State Examination score from 13/30 to 27/30.

Conclusions: This case highlights the importance of serial neuroimaging in CO poisoning, as delayed midbrain lesions may occur more frequently than previously thought, even in the absence of overt neurological symptoms. The patient's cognitive recovery and lack of parkinsonism suggests that early intervention with HBOT may help mitigate the long-term consequences of CO-induced brain injury.