burst suppression pattern is a peculiar eeg sign which is observed in some special conditions : deep general anesthesia , cerebral hypoxia , hypothermia , early infantile encephalopathy , baclofen overdose , and dengue encephalopathy . the brain condition associated with this eeg pattern is serious and irreversible in many causes , but it may be reversible in cases resulting from anesthesia or drug intoxication . amanita pantherina is a mushroom which is widespread in asia , on the north american continent , in europe , and in some areas of the southern hemisphere . we report on a patient with a. pantherina poisoning who developed a comatose state associated with a burst suppression pattern on eeg and recovered to a normal state after treatment . a 68-year - old woman was transferred to our emergency room because of an acute comatose state ( glasgow coma scale , e1v1m2 ) and vomiting . the blood pressure , pulse rate , body temperature , and oxygen saturation were 120/66  mm  hg , 45  beats / min , 35.6  c , and 100% with an oxygen supply of 6  l / min through a face mask . routine laboratory tests , including blood glucose , electrolytes , and ammonia , as well as cerebrospinal fluid were unremarkable . electroencephalogram ( eeg ) recorded 4  h after admission showed a burst suppression pattern ( fig . it was disclosed that the patient had eaten some pieces of wild mushrooms grown in her yard 3  h before admission mistaken for edible ones , and the species was identified from the remaining mushrooms as a. pantherina ( fig . we diagnosed her as having a. pantherina poisoning and gave her a supportive treatment with a relatively rapid supplement of fluid infusion . she became alert on day 2 after ingestion , but showed depression for the following few days ; the follow - up eeg recorded 29  h after ingestion returned to normal activity . as the patient developed coma 3  h after ingestion of a. pantherina without any other cause , she was diagnosed as having a. pantherina poisoning , though a chromatographic assay of the poison was not performed . clinical symptoms of a. pantherina poisoning consist of a dysfunction of the peripheral autonomic nerves , gastrointestinal tract , and central nervous system and appear from 30  min to 2  h after ingestion [ 79 ] . amanita pantherina poisoning is less lethal compared with poisoning by some other species of the amanita genus , and patients suffering from the poisoning usually recover without consequences . the course of illness in our patient fits well with that of a. pantherina poisoning , but the severity of symptoms may vary depending on the amount ingested and individual susceptibility to the toxins [ 79 ] . this is the first report on burst suppression pattern on eeg caused by mushroom poisoning . burst suppression pattern is a peculiar eeg sign which is defined as alternating bursts and periods of electrical silence . with regard to changes in the neuronal membrane underlying this pattern , bursts are associated with phasic depolarization , and suppression episodes are associated with an electrical silence in anesthetized cats . the synaptic mechanism of burst suppression eeg includes glutamate and gamma - aminobutyric acid ( gaba ) transmission in the neocortex . amanita pantherina contains several kinds of toxins , but the major active toxins have been found to be ibotenic acid and muscimol , possibly together with their metabolites . ibotenic acid acts as an excitatory amino acid at the glutamate receptors , and muscimol acts as an agonist of the gaba receptors . it was observed that muscimol produced burst suppression activity in a rat neocortical slice eeg preparation . therefore , general administration of these two toxins may be hypothesized to potentiate glutamate and gaba transmission in the central nervous system , leading to burst suppression pattern on eeg .
we report on a patient with amanita pantherina poisoning who showed a burst suppression pattern on electroencephalography during a comatose state . 
 the patient recovered without sequelae a week after ingestion . 
 burst suppression pattern is defined as alternating bursts and periods of electrical silence , and it is associated with comatose states of various causes . 
 the major toxins contained in a. pantherina are ibotenic acid , an excitatory amino acid at the glutamate receptors , and muscimol , an agonist of the gamma - aminobutyric acid receptors . 
 alteration of the synaptic transmission in the central nervous system by these toxins may lead to a burst suppression pattern .