Clinical correlates and prognosis in early spindle coma

Objective: To determine the prognostic significance of spindle coma (SC) ac cording to etiology and EEG reactivity. Methods: We reviewed 15 patients with SC due to various causes within 8 day s of coma Co determine the prognostic significance of this EEC pattern. Results: The outcome among survivors was favorable: among 13 survivors, 9 w ere independent in all activities of daily living (ADLs) at 6 months; 3 wer e dependent in all ADLs; and one remained in coma. EEG reactivity to noxiou s stimuli best predicted outcome: All patients (whatever the coma etiology) with EEG reactivity survived; conversely, not all patients without EEG rea ctivity died. Conclusion: In our patients, EEG reactivity independent of etiology predict ed survival, neurological examination did not predict outcome. Most SC surv ivors had a meaningful recovery achieving all ADLs. From the literature, th e cause of SC was predictive of outcome: encephalopathy, seizures and traum a had the best prognosis while hypoxia, CRA and structural lesions carried the worst. Literature review, revealed that 23% of patients [56/242] died o r remained in a persistent vegetative state (PVS). Best outcomes occurred w hen SC was due to drugs, encephalopathy or seizures: (0/14 died or were in a PVS). With trauma 15% [25/169] died or were in a PVS). Intermediate outco mes occurred with hypoxia and cardio-respiratory arrest (CRA): 33% [7/21] d ied or were in a PVS. The gravest outcomes occurred with brainstem and cere bral infarctions, and tumors: 73% [22/30] died or were in a PVS. (C) 2000 E lsevier Science Ireland Led. All rights reserved.