Deep coma

Introduction Deep coma The most serious disturbance of consciousness or loss of consciousness caused by the high inhibition of the cerebral cortex and subcortical network structure, no response to various external stimuli, various reflexes disappear, and the whole body muscles are relaxed. In patients with deep coma, the clinical manifestations are no response to any stimulation, no spontaneous activity, loose muscles, fixed eyeballs, dilated pupils, various reflexes disappear, vital signs of vital signs, such as irregular breathing, heart rhythm disorders, blood pressure Fluctuation, etc.

Cause

(a) coma with signs of nervous system positioning:

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

(B) coma with meningeal irritation:

Meningitis caused by various bacterial virus fungi, virtual meningitis caused by systemic infection, brain trauma such as cerebral hemorrhage. The blood enters the subarachnoid space, brain tumors, brain abscesses, encephalitis and other invading the subarachnoid space, as well as the subarachnoid space, bleeding and intracranial venous thrombosis and high intracranial pressure.

(3) Coma caused by systemic diseases:

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

1, infectious diseases 1 viral infections: such as epidemic encephalitis, forest encephalitis, meningoencephalitis, enteroviral encephalitis, epidemic hemorrhage, fever encephalitis, etc., ricketts infection , parasitic infections: such as cerebral malaria, acute cerebral schistosomiasis, diffuse cerebral cysticercosis, etc., infectious toxic encephalopathy: such as toxic pneumonia, toxic dysentery, sepsis, etc., spirochete infection.

2, endocrine and metabolic disorders: such as diabetes, ketoacidosis, spontaneous hypoglycemia, chronic renal failure, hepatic coma, pulmonary encephalopathy, cardio-cerebral syndrome, pancreatic disease, encephalopathy, thyroid crisis pituitary coma Chronic adrenal insufficiency coma, lactic acidosis, pregnancy poisoning, severe transfusion reaction and infusion reaction.

3, electrolyte disorders: such as hypochlore alkalosis, high chloride alkalosis, dilute hyponatremia.

4, other leukemia, encephalopathy, status epilepticus, asphyxia, circulatory arrest, etc.

an examination

Related inspection

EEG Dynamic Blood Pressure Monitoring (ABPM) Oxygen saturation

1. Focus on the examination of neurological signs and meningeal irritation, so as to quickly classify the cause of the disease and narrow the search range. The focus of the examination should be determined based on the clues provided. Pay attention to body temperature, breathing, pulse, blood pressure, pupil, sclera, face, lip color, oral and ear conditions, exhaled smell, etc.

2, necessary laboratory tests: such as blood, venous blood, urine, anal finger, stomach content, chest, ECG, ultrasound, cerebrospinal fluid, cranial radiography, CT and MRI examination.

Differential diagnosis

Differential diagnosis

False coma: A pseudo-coma is a state of mind in which consciousness is not truly lost, but cannot be expressed and reacted. It includes rickets, non-responsive states, stupor state, and atresia syndrome.

Wake-up coma: A wake-up coma is a special disturbance of consciousness that exists in the state of awakening and loss of consciousness. Clinically, there is a severe loss of language and motor response, while most of the functions under the cortex and the function of the medullary plant have been preserved or restored, and spontaneous open eye reactions and wake-sleep cycles exist. Can be seen in the cortical state, no movement silence and plant state.

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