Clinical Staging of Reye's Syndrome

Description

Children with Reye's Syndrome can be staged clinically by their signs and symptoms.

Findings evaluated:

(1) level of consciousness

(2) posture

(3) response to painful stimuli

(4) pupillary response to light

(5) oculocephalic reflex (doll's eyes)

Finding	Stage 0	Stage I	Stage II
level of consciousness	normal	lethargic but follows verbal commands	combative to stuporous; verbalizes inappropriately
posture	normal	normal	normal
response to painful stimuli	purposeful	purposeful	purposeful to nonpurposeful
pupillary reaction to light	brisk	brisk	sluggish
oculocephalic reflex (doll's eyes)	normal	normal	conjugate deviation of eyes

Finding	Stage III	Stage IV	Stage V
level of consciousness	comatose	comatose	comatose
posture	decorticate	decerebrate	flaccid
response to painful stimuli	decorticate	decerebrate	no response
pupillary reaction to light	sluggish	sluggish	no response
oculocephalic reflex (doll's eyes)	conjugate deviation of eyes	inconsistent or no response	no response

where (Plum and Posner, 1982):

• decorticate posture = abnormal flexor response in the arm with extension of the leg

• decerebrate posture = abnormal extensor response in the arms and legs

• oculocephalic reflex = First, one holds the patient's eyelids open and briskly rotates the head from one side to the other. A positive response is contraversive conjugate eye deviation (if the head is rotated to the left, the eyes deviate to the right). Then the neck is briskly flexed and then extended. A positive response is deviation of the eyes upward when the neck is flexed and downward when the neck is extended. The doll's head phenomenon is the opening of the eyelids reflexly when the neck is flexed.

To read more or access our algorithms and calculators, please log in or register.

Description

Specialty