Apallic syndrome of toxic origin: the diagnostic criteria
Background. The global epidemic of strong synthetic opioids and “new” psychoactive substances has increased the number of overdoses that cause prolonged coma with subsequent persistent vegetative state or apallic syndrome. The purpose was to investigate the clinical manifestations, functional and pa...
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Zaslavsky O.Yu.
2024-11-01
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| Series: | Медицина неотложных состояний |
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| Online Access: | https://emergency.zaslavsky.com.ua/index.php/journal/article/view/1777 |
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| author | N.V. Kurdil A.O. Volosovets O.V. Ivashchenko V.S. Lisovska H.M. Balan O.M. Rozhkova V.V. Andriushchenko |
| author_facet | N.V. Kurdil A.O. Volosovets O.V. Ivashchenko V.S. Lisovska H.M. Balan O.M. Rozhkova V.V. Andriushchenko |
| author_sort | N.V. Kurdil |
| collection | DOAJ |
| description | Background. The global epidemic of strong synthetic opioids and “new” psychoactive substances has increased the number of overdoses that cause prolonged coma with subsequent persistent vegetative state or apallic syndrome. The purpose was to investigate the clinical manifestations, functional and pathohistological changes of the brain in apallic syndrome due to severe drug poisoning (overdose). Materials and methods. A retrospective analysis of the medical data of six people aged 21–38 years with drug poisoning involving illegal methadone, psychostimulants, barbiturates and alcohol was carried out. Results. Among the patients of the toxicology department of the Kyiv City Clinical Emergency Hospital in 2008–2020, an increase in the number of cases of apallic syndrome was noted from 0.025 to 0.14 ‰, which correlates with mass poisonings with illegal methadone. A key role in the diagnosis of apallic syndrome of toxic origin belongs to the neurological and behavioural examination of the patient, which should be carried out by experienced neurologists specialising in counselling people with poisoning. Functional magnetic resonance imaging and positron emission tomography are the modern standard for diagnosing vegetative states; however, these methods are still difficult to access in Ukraine. The visualization zones of the pathological process in the brain in case of toxic damage are mainly basal ganglia and/or thalamus and dentate nucleus, cortical zone of grey matter, periventricular zone of white matter, corticospinal tract and corpus callosum; asymmetric white matter damage as a sign of demyelination; parietal-occipital subcortical vasogenic edema and lesions of the central pons are characteristic. Forensic and histological studies of the cerebral cortex revealed diffuse loss of neurons, neuronophagia, satellitosis, deformed pyramidal neurons with apical dendrites and manifestations of homogenising necrosis, angiomatosis microfoci and neuropil vacuolation, mineralization of the tissue and a moderate glial reaction around the petrifications. Conclusions. For the health care system of Ukraine, it remains relevant to improve the existing definitions and diagnostic criteria of the apallic syndrome, which attracts the attention of doctors in connection with an increase in cases of life extension of patients after waking up from a long coma. |
| format | Article |
| id | doaj-art-96ebefc047b946a58d38a71d4a511ebe |
| institution | Kabale University |
| issn | 2224-0586 2307-1230 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | Zaslavsky O.Yu. |
| record_format | Article |
| series | Медицина неотложных состояний |
| spelling | doaj-art-96ebefc047b946a58d38a71d4a511ebe2025-01-12T11:41:05ZengZaslavsky O.Yu.Медицина неотложных состояний2224-05862307-12302024-11-0120758459310.22141/2224-0586.20.7.2024.17771777Apallic syndrome of toxic origin: the diagnostic criteriaN.V. Kurdil0https://orcid.org/0000-0001-7726-503XA.O. Volosovets1https://orcid.org/0000-0002-5225-1480O.V. Ivashchenko2https://orcid.org/0000-0003-2866-707XV.S. Lisovska3https://orcid.org/0009-0004-1040-708XH.M. Balan4https://orcid.org/0009-0005-9666-8914O.M. Rozhkova5https://orcid.org/0009-0002-7415-3061V.V. Andriushchenko6https://orcid.org/0000-0002-0893-3329State Enterprise “L.I. Medved’s Research Center of Preventive Toxicology, Food and Chemical Safety of the Ministry of Health of Ukraine”, Kyiv, UkraineShupyk National Healthcare University of Ukraine, Kyiv, UkraineShupyk National Healthcare University of Ukraine, Kyiv, UkraineState Enterprise “L.I. Medved’s Research Center of Preventive Toxicology, Food and Chemical Safety of the Ministry of Health of Ukraine”, Kyiv, UkraineState Enterprise “L.I. Medved’s Research Center of Preventive Toxicology, Food and Chemical Safety of the Ministry of Health of Ukraine”, Kyiv, UkraineKyiv Regional Bureau of Forensic Medical Examination, Kyiv, UkraineCommunal Non-Commercial Enterprise “Kyiv City Clinical Emergency Hospital”, Kyiv, UkraineBackground. The global epidemic of strong synthetic opioids and “new” psychoactive substances has increased the number of overdoses that cause prolonged coma with subsequent persistent vegetative state or apallic syndrome. The purpose was to investigate the clinical manifestations, functional and pathohistological changes of the brain in apallic syndrome due to severe drug poisoning (overdose). Materials and methods. A retrospective analysis of the medical data of six people aged 21–38 years with drug poisoning involving illegal methadone, psychostimulants, barbiturates and alcohol was carried out. Results. Among the patients of the toxicology department of the Kyiv City Clinical Emergency Hospital in 2008–2020, an increase in the number of cases of apallic syndrome was noted from 0.025 to 0.14 ‰, which correlates with mass poisonings with illegal methadone. A key role in the diagnosis of apallic syndrome of toxic origin belongs to the neurological and behavioural examination of the patient, which should be carried out by experienced neurologists specialising in counselling people with poisoning. Functional magnetic resonance imaging and positron emission tomography are the modern standard for diagnosing vegetative states; however, these methods are still difficult to access in Ukraine. The visualization zones of the pathological process in the brain in case of toxic damage are mainly basal ganglia and/or thalamus and dentate nucleus, cortical zone of grey matter, periventricular zone of white matter, corticospinal tract and corpus callosum; asymmetric white matter damage as a sign of demyelination; parietal-occipital subcortical vasogenic edema and lesions of the central pons are characteristic. Forensic and histological studies of the cerebral cortex revealed diffuse loss of neurons, neuronophagia, satellitosis, deformed pyramidal neurons with apical dendrites and manifestations of homogenising necrosis, angiomatosis microfoci and neuropil vacuolation, mineralization of the tissue and a moderate glial reaction around the petrifications. Conclusions. For the health care system of Ukraine, it remains relevant to improve the existing definitions and diagnostic criteria of the apallic syndrome, which attracts the attention of doctors in connection with an increase in cases of life extension of patients after waking up from a long coma.https://emergency.zaslavsky.com.ua/index.php/journal/article/view/1777persistent vegetative stateapallic syndromedrug poisoning |
| spellingShingle | N.V. Kurdil A.O. Volosovets O.V. Ivashchenko V.S. Lisovska H.M. Balan O.M. Rozhkova V.V. Andriushchenko Apallic syndrome of toxic origin: the diagnostic criteria Медицина неотложных состояний persistent vegetative state apallic syndrome drug poisoning |
| title | Apallic syndrome of toxic origin: the diagnostic criteria |
| title_full | Apallic syndrome of toxic origin: the diagnostic criteria |
| title_fullStr | Apallic syndrome of toxic origin: the diagnostic criteria |
| title_full_unstemmed | Apallic syndrome of toxic origin: the diagnostic criteria |
| title_short | Apallic syndrome of toxic origin: the diagnostic criteria |
| title_sort | apallic syndrome of toxic origin the diagnostic criteria |
| topic | persistent vegetative state apallic syndrome drug poisoning |
| url | https://emergency.zaslavsky.com.ua/index.php/journal/article/view/1777 |
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