Disturbance of consciousness

Introduction Consciousness refers to the state of perception of oneself and the surrounding environment, which can be expressed through words and actions. The disturbance of consciousness refers to the obstacles to the recognition and awareness of the surrounding environment and its own state. One is characterized by decreased excitability, manifested as lethargy, confusion, lethargy until coma; the other is characterized by increased excitability, the state of consciousness manifests as a state of high-level central acute disturbance, including confusion, loss of orientation Feeling confused, restless, confused and so on.

Cause

(1) Intracranial diseases:

1. Localized lesions:

(1) cerebrovascular disease: cerebral hemorrhage, cerebral infarction, transient ischemic attack, etc.;

(2) intracranial space-occupying lesions: primary or metastatic intracranial tumors, brain abscess, brain granuloma, brain parasitic cysts, etc.;

(3) craniocerebral trauma: brain contusion, intracranial hematoma and so on.

2. Diffuse brain lesions:

(1) Intracranial infectious diseases: various encephalitis, meningitis, arachnoiditis, ependymitis, intracranial sinus infection, etc.;

(2) diffuse head injury;

(3) subarachnoid hemorrhage;

(4) cerebral edema;

(5) Brain degeneration and demyelinating lesions.

3. Seizures.

(2) Extracranial diseases (systemic diseases):

1. Acute infectious diseases: various sepsis, infectious toxic encephalopathy, etc.

2. Endocrine and metabolic diseases (endogenous poisoning): such as hepatic encephalopathy, renal encephalopathy, pulmonary encephalopathy, diabetic coma, mucous edema coma, pituitary crisis, thyroid crisis, adrenal insufficiency coma , lactic acidosis and so on.

3. Exogenous poisoning: including industrial poisons, drugs, pesticides, plant or animal poisoning.

4. Lack of normal metabolites:

(1) Hypoxia (normal cerebral blood flow) Blood oxygen partial pressure is normal and oxygen content is reduced, such as carbon monoxide poisoning, severe anemia and degenerative hemoglobinemia; blood oxygen partial pressure and decreased oxygen content have lung diseases, Asphyxiation and mountain sickness.

(2) Ischemia (reduced cerebral blood flow) is seen in various arrhythmias, heart failure, cardiac arrest, myocardial infarction with reduced cardiac output; hypertensive encephalopathy with increased cerebral vascular resistance, hyperviscosity; Shock and so on.

(3) hypoglycemia such as insulinoma, severe liver disease, post-gastrectomy, excessive insulin injection and starvation.

5. Water and electrolyte balance disorders: such as hyperosmolar coma, hypotonic coma, acidosis, alkalosis, hypernatremia, hyponatremia, hypokalemia.

6. Physical damage: such as sunburst, heat shot, electric shock, drowning, etc.

an examination

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(1) Determine whether there is a disturbance of consciousness.

(2) Determine the degree or type of disturbance of consciousness. Common methods are:

1. Clinical classification, mainly to give speech and various stimuli, to observe the patient's reaction and judge. Such as breathing their name, pushing their shoulders and arms, pressing on the upper notch, acupuncture the skin, talking to it, and performing its purposeful movements.

2. Glasgow Coma Scale Assessment Method: This method is based on the evaluation of the degree of disturbance of consciousness in response to blinking, verbal stimuli, and command actions.

(3) Identify the cause of the disturbance of consciousness.

(4) Diagnostic procedures for disturbance of consciousness.

1. Focus on the examination of neurological signs and meningeal irritation. Pay attention to body temperature, breathing, pulse, blood pressure, pupil, sclera, face, lip color, oral and ear conditions, exhaled smell, etc.

2. Laboratory tests: such as blood, venous blood, urine, anal finger, stomach content, chest, electrocardiogram, ultrasound, cerebrospinal fluid, cranial radiography, CT and MRI.

Differential diagnosis

Symptoms of confusion that are confusing to each other identify each other:

(1) Drowsiness: It is the shallowest degree of consciousness disorder. Patients are often in a state of sleep. They can be awakened with a slight stimulation. After waking up, the consciousness activity is close to normal, but the ability to distinguish the surrounding environment is poor and unresponsive. The stimulation stops and goes back to sleep.

(2) Drowsiness: (abouling) A deeper disturbance of consciousness than sleepiness, manifested as a marked reduction in the scope of consciousness, extremely slow mental activity, and a response to strong stimuli. It is not easy to wake up, blinking when blinking, but lacking expression. It is difficult to make simple answers to repeated questions. The answer is ambiguous, often answering questions, and various reflex activities exist.

(3) Coma: Loss of consciousness activity, can not be perceived by various external stimuli or internal needs. There can be unconscious activities, and no stimulus can be awakened. According to the stimulus response and reflection activities, etc. can be divided into three degrees:

Light coma: random activity disappears, responds to painful stimuli, various physiological reflexes (swallowing, coughing, corneal reflex, pupillary response to light, etc.) exist, body temperature, pulse, and breathing are not significantly changed, and may be accompanied by convulsions or agitation.

Deep coma: Random activities completely disappeared, no response to various stimuli, various physiological reflexes disappeared, and there may be irregular breathing, decreased blood pressure, incontinence, muscle relaxation, and brain rigidity.

Extremely coma: Also known as brain death. The patient was in a state of sudden death, no spontaneous breathing, various reflexes disappeared, EEG showed pathological electrical rest, and brain function loss lasted for more than 24 hours, excluding the influence of drug factors.

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