From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: sci.med
Subject: Re: cerebral coma
Date: Tue, 25 Feb 2003 11:41:39 -0800
Message-ID: <b3ggpo$k4k$1@slb9.atl.mindspring.net>

<mapsitna@attbi.com> wrote in message
news:24kl5vko8gipo7dud1t9q2qnfl9bief2a7@4ax.com...
> "C.V. Compton Shaw" <misters@swbell.net> wrote:
>
> >I am not a physician. However, the one thing that I would assess for is
> >increased intracranial pressure which would be evidenced by "Cheyene
> >Stokes" respiration's.
>
> Cheyene-Stokes respirations are a terminal sign.  If the patient is
> exhibiting them, he will probably be dead before your reply is received.
> I'm pretty sure the doctor who posted the question is well aware of
> that.  I think he's looking for something with a little more depth.


While Cheyene-Stokes can be a terminal sign, it isn't close
to being either sensitive or specific. It gets its bad
reputation because it appears in the sequence of signs of
people dying of intercranial hypertension, but in the
absence of that, or at least low CO2 levels, it's not a
particularly morbid sign. It's commonly seen in patients
with mild cortical dysfunction, including a lot of non-fatal
stroke patients during many phases of non-REM sleep, and
it's also seen in people with lung dysfunction, including
all grades of CHF (which certainly isn't usually fatal).
Even normal people exhibit Cheyene-Stokes commonly for a bit
in the transition from wakefulness to the first stages of
sleep, when breathing becomes more regular. Listen to your
spouse fall asleep and you'll recognize it.

SBH


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From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: sci.med
Subject: Re: cerebral coma
Date: Tue, 25 Feb 2003 14:34:30 -0800
Message-ID: <b3gqtr$tv7$1@slb9.atl.mindspring.net>

<mapsitna@attbi.com> wrote in message
news:fson5v4c9irs3tgods3fk7t2bdkmeltqso@4ax.com...
> "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
wrote:
>
> >While Cheyene-Stokes can be a terminal sign, it isn't close
> >to being either sensitive or specific. It gets its bad
> >reputation because it appears in the sequence of signs of
> >people dying of intercranial hypertension, but in the
> >absence of that, or at least low CO2 levels, it's not a
> >particularly morbid sign. It's commonly seen in patients
> >with mild cortical dysfunction, including a lot of non-fatal
> >stroke patients during many phases of non-REM sleep, and
> >it's also seen in people with lung dysfunction, including
> >all grades of CHF (which certainly isn't usually fatal).
> >Even normal people exhibit Cheyene-Stokes commonly for a bit
> >in the transition from wakefulness to the first stages of
> >sleep, when breathing becomes more regular. Listen to your
> >spouse fall asleep and you'll recognize it.
>
> All well and good, but the patient described in the original post was
> already critical and unresponsive.  Post-arrest, as I recall.


Hey listen, if somebody post-cardiac arrest is well enough
to have ANY respiration, let alone the relatively
dysfunctional Cheyne Stokes, it's a GOOD sign.  People dying
of post resuscitation encephalopathy don't generally die the
classic high intracranial pressure/herniation death, anyway.
That's brain trauma people, a small subset of people with
VERY large ischemic strokes, and also of course some
intracerebral bleeders.



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