Loss of wakefulness

Introduction The conscious state of the coma patient is lost, and the clinical manifestation is that the patient's awakening-sleep cycle disappears and is in a continuous "deep sleep" and cannot be awakened. Many psychological activities such as patient perception, attention, thinking, emotion, orientation, judgment, and memory are lost. No understanding of themselves and the external environment, no response to external stimuli. Cannot be executed for simple commands. Gives a strong painful stimulus, except for sometimes a painful expression or a sputum, a completely unconscious reaction.

Cause

(1) coma with signs of nervous system localization

Cerebral hemorrhage, cerebral infarction, brain trauma, brain tumor, brain abscess, encephalitis, brain parasitic disease and cerebral palsy.

(B) coma with meningeal irritation

Various kinds of bacteria, viruses, fungi caused by meningitis, virtual meningitis caused by systemic infection, cerebral hemorrhage, brain trauma and other blood into the subarachnoid space, brain tumors, brain abscesses, encephalitis and other invasion of the subarachnoid space, And subarachnoid hemorrhage, intracranial venous thrombosis, high intracranial pressure and so on.

(3) Coma caused by systemic diseases

Found in severe infections and endocrine and metabolic disorders, electrolyte disorders and so on.

an examination

Related inspection

Brain CT examination brain MRI examination EEG examination brain nerve examination

The complete diagnosis and identification of coma should include three aspects: localization diagnosis, qualitative diagnosis and etiological diagnosis.

(1) Localization diagnosis: coma marks acute brain failure, which has a rule of deterioration along the nerve axis. Generally, only by monitoring the brain function of the bedside, it is possible to determine the plane of brain damage and the remaining functional plane of the comatose patient.

(2) Qualitative diagnosis: mainly seen in extracranial systemic diseases, including most metabolic encephalopathy and toxic encephalopathy, but also in a few intracranial diffuse diseases, such as diffuse axonal injury, status epilepticus, hypertensive encephalopathy And some encephalitis and so on. In the differential diagnosis, attention should be paid to the past medical history, general examination and blood biochemistry and organ function examination.

Differential diagnosis

(1) Atresia syndrome: Locked? in syndrome is also called deafferented state. The patient remains alert and aware of his or her situation, but the paralysis of the limbs and the cranial nerves below the motor nerves are caused by bilateral ventral cerebral palpebral lesions involving the corticospinal tract, the cortical pons, and the cortical medulla oblongata. The patient is conscious, but It can only be indicated by the vertical movement of the eye and the blink of an eye. This disease is common in cerebral infarction caused by basilar artery thrombosis. Other causes include brain stem tumor and central pontine myelinolysis. Severe polyneuropathy, especially Guillain-Barré syndrome, myasthenia gravis and A sputum state similar to the atresia syndrome can also occur with neuromuscular junction blockers.

(2) Persistent vegetative state: A persistent vegetative state of a patient loses cognitive neurological function but retains autonomic functions such as cardiac activity, breathing, and maintenance of blood pressure. This state occurs after a coma, characterized by an unconscious or cognitive deficit in the surrounding things, but maintaining a sleep-wake cycle. Spontaneous movements can occur, blinking the outside world, but not speaking or obeying orders. Many syndromes that are not exactly defined are used as synonyms for persistent vegetative states, including alpha coma, neocortical death, and permanent unconsciousness. These names lack precision and are avoided as much as possible. The diagnosis of this disease should be cautious and can only be made after a long period of observation.

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