Disclosures: Mina S. Gayed, DO: Nothing to disclose

Case Description: Patient was admitted to acute rehabilitation 8 weeks with a prolonged disorder of consciousness after resection of a calcified fourth ventricle tumor with subsequent development of status epilepticus. Patient required three different antiepileptic drugs to keep the seizures abated. Since the fourth ventricle is anatomically close in location to the ascending reticular activating system (ARAS), it was postulated that there could be damage there. In order to stimulate the ARAS without lowering the seizure threshold, we elected to use bromocriptine as our agent of choice. Upon initiation and gradual uptitration of bromocriptine, the patient’s Coma Recovery Scale-Revised (CRS-R) went from 4 upon admission to 19 out of 23 upon discharge over 3.5 weeks of treatment while keeping the patient seizure-free. The ARAS is mediated by multiple neurotransmitters including dopamine, norepinephrine, serotonin, histamine, acetylcholine, and glutamate. We targeted the dopamine aspect with bromocriptine as other medications such as amantadine can lower the seizure threshold. This patient began to verbalize and nodded to questioning with 80% accuracy. She also became able to follow simple commands.

Setting: Inpatient rehabilitation brain trauma unit.

Patient: A 50-year-old otherwise healthy female who developed a disorder of consciousness after resection of a calcified fourth ventricle tumor.

Assessment/Results: With the use of bromocriptine, her CRS-R score dramatically improved in this patient who presented with a very prolonged disorder of consciousness.

Discussion: Given that the patient had status epilepticus requiring multiple AEDs to keep seizures abated, we had to target the ARAS with a very tailored therapeutic plan. We elected to use bromocriptine to avoid potentially lowering the seizure threshold with medications such as amantadine or selective serotonin re-uptake inhibitors.

Conclusion: With the incredible success that we had with awakening the patient from her disorder of consciousness, future studies should look into bromocriptine as a potent stimulant in those with very prolonged disorders of consciousness.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/specially-tailored-treatment-in-a-disorder-of-consciousness-post-fourth-ventricle-tumor-resection-a-case-report/