Advertisement

Woman in a coma

Published:October 16, 2022DOI:https://doi.org/10.1016/j.ejim.2022.10.006
      A 49-year-old woman of unremarkable past health was found comatose in her car. Blood pressure was 130/70 mmHg, pulse 80 beats per minute. There was no circumstantial evidence of drug overdose. Urine toxicology tested negative. Electrocardiography (ECG) showed anterolateral ST-segment elevation (Fig. A). Head computed tomography (CT) of demonstrated no intracranial pathology. Non-sustained ventricular tachycardia developed shortly. Echocardiography revealed left ventricular dysfunction with akinesia of mid-ventricular walls but sparing basal and apical segments (Fig. B, video). Notably, a large kidney cyst was noted (Fig. C). Troponin was elevated at 200 ng/L (normal<14 ng/L). Four hours later, the patient remained comatose. Extensive investigations were unrevealing, including serum ammonia and electroencephalography.
      Fig A:
      Fig. AECG on admission showed anterolateral ST-segment elevation.
      Fig B:
      Fig. BSubcostal view on echocardiography revealed left ventricular dysfunction with akinesia of mid-ventricular walls (arrows) but sparing basal and apical segments.
      Fig C:
      Fig. CA large renal cyst was noted incidentally on subcostal view (*).
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to European Journal of Internal Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      Reference

        • Xu H.W.
        • Yu S.Q.
        • Mei C.L.
        • Li M.H.
        Screening for intracranial aneurysm in 355 patients with autosomal-dominant polycystic kidney disease.
        Stroke. 2011; 42: 204-206