Stupor

Introduction Stupor is a highly psychoactive state of inhibition, which refers to the complete inhibition or reduction of motor behavior and speech activity, and often maintains a fixed posture. Severe stupor is called stabbing, and the patient speaks without words, does not move, does not eat, has a fixed facial expression, has a defecation, and lacks response to stimulation. Improper treatment or improper care can be maintained for a long time and can cause serious consequences and complications. Stupor is more common in schizophrenia, called tensional stiffness. In addition to tensional stiffness, clinical depression can also be seen in depressive stiffening of depression, psychogenic stasis of psychogenic disorders, and organic stiffness of brain-induced mental disorders.

Cause

Stupor and coma are extreme forms, and when they are fainting, there is a short-lived confusion. When a seizure seizure occurs, the consciousness is more persistent and lasts longer. When a mild concussion occurs, the coma can last up to an hour. Complete coma lasts for more than a few hours and is usually caused by severe intracranial or metabolic diseases. Lighter injuries can cause apathy, loss of attention, and excessive sleep (sleeping too long or too deep, only by stimulating the patient to wake up). Jealousy is also a state in which awakening and attention are hindered. Dementia is a severe cognitive dysfunction that is usually not accompanied by an awakening disorder.

Newly occurring insanity, severe apathy, stupor or coma all suggest dysfunction of the cerebral hemisphere, the diencephalon or the upper brain stem. Focal lesions on the superficial cerebellar structure can extensively damage both sides of the cerebral hemisphere. It is also possible to press the hemispherical structure to the activation system of the diencephalon and the midbrain through severe brain edema, causing brain stem damage caused by cerebral palsy through the cerebellum. The primary cerebellar (brain stem or cerebellum) lesion can compress or directly damage the reticular formation from anywhere in the middle of the midbrain to the diencephalon (by upward compression). Metabolic or infectious diseases can inhibit the function of the cerebral hemisphere and brainstem through changes in blood components or the presence of direct toxins. A decrease in cerebral blood flow (such as syncope or severe heart failure) or a change in the electrical activity of the brain (such as a seizure) can also cause disturbance of consciousness. Concussion, anxiolytics, and anesthetics can cause disturbances of consciousness without the detectable structural changes in the brain.

an examination

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The cause of disturbance of consciousness is often not immediately clear. The diagnosis depends on taking orderly steps. First, it is necessary to ensure the patient's airway is unobstructed, check blood pressure and pulse, and perform an electrocardiogram to determine whether the heart output is sufficient.

Differential diagnosis

Stupor can be seen in organic encephalopathy, schizophrenia (especially stress), depression, hysteria, and acute stress response. Should pay attention to distinguish the cause.

1. Clinical manifestations and signs

The patient complained of bloating pain, difficulty breathing, irritability, oliguria to no urine, pale complexion, weak pulse, and sometimes sputum and odd veins. Blood pressure drops or cannot be measured, but the venous pressure rises above 1.47 kPa (15 cm H2O).

2. Diagnosis

In patients with closed chest injury, where appears:

(1) Increased venous pressure.

(2) The heart beats weakly and the heart sounds far away.

(3) Arterial pressure is reduced. Suspected of pericardial tamponade, can be pericardial puncture under the left rib arch under the xiphoid process, such as pumping out blood, you can confirm the diagnosis. Two-dimensional echocardiography can also determine the diagnosis of pericardial hemorrhage.

3. Acute pericardial tamponade is often critical, can be used for pericardial puncture and decompression to relieve symptoms, while transfusion and rehydration, to fight for thoracic rescue time.

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