Lethargy

Introduction Exercise and speech suppression of conscious disorders are called lethargy or coma. In medical observation, the level of consciousness of consciousness is lower than that of consciousness, the environmental consciousness and self-consciousness are lost, the patient is in a state of being asleep, and it is not easy to wake up. The strong stimulus can be awakened. After waking up, the answer is not answered. . Sleeping is not the same as a coma. Psychomotor inhibition is a significant reduction in activity and speech. The patient feels that thinking and physical activity as well as speech are difficult. In the eyes of others, the patient's activities are significantly reduced and slow, and even sit still all day long. In severe cases, it can be stuck in a stiff state. The psychomotor inhibition mentioned here is generally unconscious.

Cause

Psychomotor inhibition can be divided into partial or systemic. Sudden localized motor depression caused by mental or suggestive effects, such as loss of speech or paralysis, is seen in the conversion disorder. Stupor and waxy flexion are special manifestations of psychomotor inhibition, and mutism is a typical manifestation of speech inhibition. Sleeping sickness is a disease caused by parasitic infections called trypanosomes and is prevalent in Central Africa. In the 14th century, Mari Jati, the king of Mali, contracted the disease and died after sleeping for about two years. This is an earlier case of lethargy. Centuries later, when Western colonists expanded their trade to West Africa, they discovered this strange disease. People's explanations for the cause are also strange: some people think that it is caused by drinking too much, and some people think that it is caused by overdose of marijuana, eating spoiled food, or trauma. Later, the explorers discovered the connection between a local worm called Tsetse fly and the disease, calling it "fly disease."

an examination

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Bayer's evoked test brain CT magnetic resonance imaging (MRI)

EEG and brain CT examination are required. Sleeping sickness is also known as sleep sickness, with excessive sleep as the main clinical manifestation. Various complications can occur during the disease of sleeping sickness in Africa. Complications are related to the progression of the disease, such as myocarditis, affecting growth and development.

The acute phase presents signs of acute infectious diseases. Rhodesian sleeping sickness is acute and severe, manifested as relaxation type hyperthermia, severe headache, dizziness, fatigue, anemia, subcutaneous edema, pain in the hands and feet and periorbital tissue, and typical ring erythema. Lymph node enlargement, tender lymph node disease, hepatosplenomegaly in the posterior triangle of the neck. Gambi is sicker and sicker with milder illnesses, signs and symptoms intermittently in months and years, and neurological damage occurs several years later.

Sleep disorders occur later in the course of the disease. With the direct involvement of brain tissue, neuropsychiatric symptoms appear, and excessive sleep is a prominent clinical feature. Patients often have no expression, drooping eyes, listlessness, lack of vitality, unresponsiveness, and low speech. During the day, sleep increases, and even sleeps when eating, and the continuity of sleep at night is poor. According to the degree of involvement of the nervous system, the corresponding signs can appear: finger tremor, tongue jitter or dance-like movements. Seizures are common, especially in the early stages of brain tissue involvement or after epileptic seizures. If the disease is not treated in time, the patient will gradually become extremely debilitated, entering epilepticus, high fever, secondary infection and coma, often leading to death. Rhodesian sleeping sickness is the most serious type and usually dies within 1 year without treatment.

Differential diagnosis

Mania and dizziness alternate: due to the influence of disease factors such as rabies in children, there is an alternation of mania and lethargy, and the violent episodes are abnormal. Rabies is a zoonotic acute infectious disease caused by rabies virus. Because rabies patients have a prominent clinical manifestation of fear of drinking water, this disease has also been called "hydrophobia", but sick animals do not have this feature. The main clinical manifestations are peculiar arrogance, fear and anxiety, fear of wind and water, runny nose and pharyngeal muscle spasm, which eventually lead to paralysis and life-threatening. Coma is the most serious disturbance of consciousness due to the high degree of inhibition of the cerebral cortex and subcortical reticular formation, that is, the continuous interruption or complete loss of consciousness, and the high inhibition of the highest level of neurological activity.

1, shallow coma, free movement, only less unconscious spontaneous movements, painful stimulation (such as pressure on the upper edge), there are evasive reactions and painful expressions, but can not answer questions or perform simple orders. Swallowing reflexes, cough reflexes, corneal reflexes, and pupils are still present for light reflections, sputum reflexes, and no significant changes in vital signs. It can be accompanied by sputum and swaying.

2, deep coma spontaneous movement completely disappeared, muscle relaxation, no response to external stimuli, corneal reflex, pupillary reflex, cough reflex, swallowing reflex and tendon reflex disappeared, irregular breathing, blood pressure decreased. That is, various reactions and reflections disappear. Pathological signs continue to exist or disappear, and there may be changes in vital signs.

3. Oversleeping refers to a pathological increase of 25% in absolute sleep time. Causes of chronic oversleeping may involve space-occupying lesions of the hypothalamus or upper brainstem, increased intracranial pressure, excessive application or abuse of hypnotics or certain illicit drugs, or certain types of encephalitis. It can also be used as a symptom of depression. Acute, relatively short-lived oversleeping is usually a concomitant symptom of an acute systemic disease such as influenza.

4. Drowsiness is a neurological disease that can cause irreversible sleep. Drowsiness is an excessive daytime sleep or sleep episode. These stages of sleep often occur and are prone to inappropriate times, such as when talking, eating, or driving. Although sleep can occur at any time, the most common occurrence is in the inactive or monotonous, repetitive activity phase.

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