Anoxic Brain Injury - Glasgow Coma Scale estimation needed

[mchicha]

This event happened prior to development of the Glasgow Coma Scale.  Need to determine an estimated GCS score.

In 1973 18 yo pt huffed aerosol deodorant.  Pt became disoriented, agitated then collapsed.  Cessation of heartbeat & breathing, bystander CPR 2-3 times outside hosp.  Presented at ER flat-lined on EKG-rescusc with closed chest massage & ventilatory support. Intermittent decerebrate posturing, no corneal or abdominal reflexes & totally unresponsive except for pupillary.  Admit to ICU endotrach in place, unresponsive for 18-24 hours.  Next few days remained somewhat unresponsive although at times would cry out.  After 3 wks transferred to 2nd hosp for neuro eval.  Days prior to transfer progressed to sit up in bed & would cry out occasionally.

Admit 2nd hosp, not alert, somewhat unresponsive to verbal commands, quite agitated with excessive restlessness, increased physical activity & crying out episodes.  Pt could doll's eye, fundo exam well-defined disc margins, bilat corneal reflex, pupillary reflex.  Reflexes diminished bilat ankles, absent L abdominal reflex, unsustained clonus bilaterally.    

During 2 wk stay EKG sinus tach, persistent daily crying out & episodes of extreme emotional lability with great deal of motor activity.  Response to verbal command, could talk although somewhat incoherently-dysarthria. Recent memory poor, past memory fairly well intact.  EEG indicative of generalized encephalopathy.  Changes consistent with organic mental syndrome 2d to inhalation of halogenated hydrocarbon which caused previous CP arrest and led to anoxic brain damage. d/c home 31 days post-event in hopes familiar surroundings would aid in adjustment to new condition.

Current psych has opined pt lacks competency to give meaningful consent or handle funds.  Also opined there is a strong likelihood that patient's current level of functioning is related to obs sustained in 1973.  Is this opinion consistent with patient's history as reported above?

[mchicha]

Fair enough, thank you.

This patient appears to be a rare survivor of the syndrome known as "sudden sniffing death".  In my research, I have not located any cases describing a survivor of cardiopulmonary arrest following huffing/sniffing.  Are you aware of any cases/studies that you could point me to?

I appreciate your time, Dr. Ghosh.

[Abhijeet Ghosh]

Friend,
GCS can't be determined theoretically. It has to be detected practically. And hence i would not be able to comment presently.
Regards

[mchicha]

Thank you for your response.  Whether the present condition is related to the 1973 episode was only a secondary question and I appreciate your position.  

Is it possible to determine an estimated GCS based upon the only information available?  I understand that this would not be a reliable determination, but rather conjecture based solely upon what has been presented.

[Abhijeet Ghosh]

Dear Friend,
It's really tough to answer as my views would be 100% biased, as i will need to answer based on the inputs provided by you only. So this is not a right forum to ask, when you need an opinion so perfect.
Well nothing can be reported by me, whether the present condition is related to 1973 episode or not.
Please let me know, if i can help you in some other way.
Regards