| Objective: To investigate the prognostic factors of coma due to intracranial in children,in order to judge the prognosis of coma earlier and guide appropriate treatment.Methods: (1) Collected the clinical data of 39 comatose children due to intracranial admitted into Department of Neurology in Children's Hospital of Chongqing Medical University from July to September 2007 and 2009, and analyzed their age and sex distribution,causes of coma,symptoms onset,clinical manifestations,laboratory examinations,Neural electrophysiological examinations and imaging examinations retrospectively. (2)Implemented the Glasgow coma score among these children immediately after admission, and collected the serum and cerebrospinal fluid within 24-48 hours, then measured the NSE levels. (3)Followed up these children 3 months after discharge, and analyzed the relationships between prognosis and age,sex,GCS,etiology,fever duration,coma duration,protein content in CSF,NSE levels in Serum and CSF.Results: (1)In the cases studied, the age range was from 9 months to 14 years, the average age was (4.25±2.82) years, 9 months~3 years, 3~5 years,5~11years,≥11 years were accounted for 33.3%, 30.8%, 30.8%, 5.1% respectively. There were 24 males and 15 females, the gender ratio (male-to-female) was 1.6:1.(2) The group of 39 patients include Japanese encephalitis (23 cases, 59%), Viral encephalitis (5 cases, 12.8%), Tuberculous meningitis (5 cases, 12.8%), Acute disseminated encephalomyelitis (5 cases, 12.8%) and Purulent meningitis (1 cases, 2.6%).(3)The main symptoms onset included fever (37 cases, 94.9%), convulsion (19 cases, 48.7%), disturbance of consciousness (18 cases, 46.2%), headache (10 cases, 25.6%).(4) 33 patients accepted CSF examination, white blood cell count increased in 15 cases (45.5%), its value was 16×109-1182×109个/L, protein increased in 18 cases (54.5%), content of 0.47-4.33g/L. 38 patients accepted blood routine examination, leukocytosis in 19 patients (50%), increased range is 10.43×109-29.88×109个/L.(5)93.9% of the EEG examinations were abnormal, mainly showed slow wave and wave attack. 41.7% of the BAEP examinations were abnormal, mainly included extension of PL or IPL of each wave behind the I wave, or lack of wave. 72.7% of the SEP examinations were abnormal, mainly included abnormal cortical potentials, extension of PL, amplitude decreased, discrete or lack of waveform. (6)The imaging performances were different with different causes, the positive rate of CT examination was 53.8%, and the positive rate of MRI examination was 100%.(7)The statistical analysis showed that the causes,fever duration,coma duration,CSF protein content,,serum and cerebrospinal fluid NSE levels were correlated with the prognosis, and the age,sex,GCS had no correlation with the prognosis.Conclusions: (1) In this group of 39 patients, the incidence of children under 5 years old was the highest in this group. And the incidence of boys was higher than girls.(2) Infectious diseases were the most common cause of coma in children, the causes of this group included Japanese encephalitis,Viral encephalitis,Tuberculous meningitis,Acute disseminated encephalomyelitis and Purulent meningitis.(3)Fever was the most common manifestation of coma due to infectious disease, fever and coma duration were correlated with the prognosis, the prognosis was worse if the fever or coma lasted longer.(4)Cerebrospinal fluid protein content was correlated with the prognosis, the prognosis were worse as the higher protein content.(5) EEG,BAEP,SEP in comatose children had important value for prognosis, as their limitations, combined with three was more meaningful in assessment of the comatose patients. (6) GCS was an important way to determine the brain injury and cerebral vascular disease severity and prognosis, but can not rely solely on their prognosis.(7) NSE was a specific biochemical parameter of pathological damage nerve tissue, serum NSE levels can indirectly reflect the changes in CSF.
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