Plum and posner’s diagnosis of stupor and coma fourth Edition series editor sid Gilman, md, frcp
Yüklə 9,02 Mb. Pdf görüntüsü
|
|
vascular disease, 355–356 vegetative state, 357–360 Progressive multifocal leukoencephalopathy, 266, 279, 280f Propofol, 323 Propylene glycol, 250 Psychogenic seizures, 304–306 Psychogenic unresponsiveness ‘‘Amytal interview,’’ 298, 307–308, 327 catatonia, 299, 302–304, 303t characteristics of, 310t, 327 conversion reactions, 299–302 description of, 197 Index
397 Psychogenic unresponsiveness (continued) diagnostic approach to, 297–299 laboratory tests, 299 malingering, 299–300 management of, 327 psychiatric disorders that cause, 299 psychiatrist involvement for, 324 signs and symptoms of, 298t studies of, 298–299 Pull reflex, 72 Pulmonary disease, 230–231 Pulmonary embolism, 214 Pulmonary encephalopathy, 231 Pulmonary stretch receptors, 51 Pulse oximetry, 312 Pupil(s)
brain death-related findings, 333–334 examination of, 54–55 ipsilateral, 101, 122 reactions of, 319, 333 Pupillary dilation description of, 57 in uncal herniation syndrome, 101, 105–106 Pupillary fixation, 339 Pupillary light reflex description of, 54 metabolic encephalopathy effects, 59 retinal ganglion cells, 57 Pupillary responses abnormal, 58–59 central pathways of, 56–57 diencephalic injury effects on, 58 examination of, 54–55 in hypoxia, 59 in metabolic coma, 76, 193 midbrain injury effects on, 58–59 pathophysiology of, 55–56 seizure effects, 59 traumatic brain injury outcome and, 346 in uncal herniation syndrome, 101 Pupilloconstrictor muscle, 56 Pupilloconstrictor neurons, 56 Pupillodilator muscle, 55 Pupillomotor system, 56 Pure adrenal myeloneuropathy, 278 Quadrigeminal cistern, 96 Raeder’s paratrigeminal syndrome, 55, 58 Reactive hyperemia, 200 Reflex syncopal attacks, 213 Refractory nystagmus, 71 Relative afferent pupillary defect, 54 REM sleep cholinergic influences on, 24 definition of, 22 description of, 16b monoaminergic influences on, 24 NREM sleep switched to, 24 Renal bicarbonate excretion, 231 Renal disease description of, 227 dialysis disequilibrium syndrome, 229 uremic encephalopathy, 227–229 Renal failure, 228 Renal transplant, 229–230 Respiration abnormalities of, 46t, 46–47 in brain death patients, 334–335 in central transtentorial herniation, 107 Cheyne-Stokes, 49–51, 50f, 75, 187 control pathways for, 48f diabetic ketoacidosis effects on, 187 evaluation of, 319 functions of, 47–48 medullary control of, 49 in uncal herniation, 105f–106f Respiratory acidosis, 192, 192t Respiratory alkalosis, 189–191, 190t, 258 Respiratory rhythm, 48–49 Resting eye movements, 69 Retinal ganglion cells, 57 Reverse ocular bobbing, 69t, 71 Reverse ocular dipping, 69t Reye’s syndrome, 271 Rostrocaudal brainstem deterioration, 102 Roving eye movements, 70–71 Saccular aneurysms, 129, 136 Sagittal sinus thrombosis, 154 Salicylate intoxication/poisoning, 190, 250–251 Schilder’s disease, 278 Scotoma, 92 Sedatives, 76, 240–241, 243–245 Seesaw nystagmus, 71 Seizures cessation of, 313–315 characteristics of, 280 epileptic, 213–214, 280, 304–306 postictal coma, 280–281 psychogenic, 304–306 pupillary responses affected by, 59 status epilepticus, 82, 281, 314f Self-determination, 376 Sentinel headache, 129 Sepsis, 190 Serotonin, 209 Serotonin syndrome, 262 Sheehan’s syndrome, 237–238 Skeletal muscle tone, 320 Skew deviation, 70 Sleep coma vs., 5, 25 definition of, 5 non-rapid eye movement, 16b–17b paradoxical, 22 REM, 16b, 22, 24 slow-wave, 16b Sleep apnea. See also Apnea central, 52 obstructive, 52–53 pathologic breathing patterns vs., 75 Slow syndrome, 361b Slow-wave sleep, 16b Sodium, 253 Sodium bicarbonate, 324, 326 Somatosensory evoked potentials in anoxic-ischemic encephalopathy, 354t description of, 346 Spontaneous blinking, 64 398
Index Spontaneous eye movements, 69, 69t Status epilepticus, 82, 228, 281, 314f Stokes-Adams attacks, 44–45 Stroke, 355 Stroke volume, 45 Structural coma diagnosis of, 9, 113–114 false localizing signs in, 113–114 metabolic coma vs., 89, 197–198 Stupor
catatonic, 302 causes of, 4t definition of, 7 drug-induced causes of. See Drug intoxications Subacute dementia, 277 Subacute diencephalic angioencephalopathy, 275 Subacute meningitis, 133 Subacute sclerosing panencephalitis, 114 Subarachnoid hemorrhage description of, 129–131, 139b grading system for, 356t outcomes after, 355–356 posterior fossa, 145 Subarachnoid infection, 131–135 Subarachnoid tumors, 131 Subdural empyema, 144 Subdural hematoma description of, 123–126, 124t posterior fossa, 144 Subdural hygroma, 124 Subdural tumors, 127, 144 Subendocardial ischemia, 44 Subfalcine herniation, 103f Subtentorial lesions diagnostic characteristics of, 310t list of, 4t Sulfhemoglobin, 324 Sundowning, 183 Suprachiasmatic nucleus, 57 Supranuclear bulbar weakness, 113 Suprasellar tumors, 115 Supratentorial destructive lesions causes of acute disseminated encephalomyelitis, 157–158 carotid ischemic lesions, 152 distal basilar occlusion, 152–154 vascular, 152–156 vasculitis, 156, 156t venous sinus thrombosis, 154, 156 viral encephalitis, 156–157, 157t description of, 151–152 Supratentorial mass lesions computed tomography evaluations, 321 diagnostic characteristics of, 310t historical view of, 97b list of, 4t management of, 320–323 tentorium cerebelli’s role in, 96 Surrogate decision making in brain death situations, 378 description of, 376–377 in minimally conscious state situations, 379 time-delimited prognostication, 377–379 in vegetative state situations, 378–379 Sympathoexcitation, 44 Sympathoexcitatory system, 44 Syncope causes of, 213t description of, 212 pulmonary embolism and, 214 Systemic lupus erythematosus, 274–275 Temporal lobe herniation, 97b Tendon reflexes, 320 Tentorium cerebelli description of, 96 opening, 96–97 Thalamic infarction, 154 Thalamic relay neurons, 13b–14b Thalamus arterial supply of, 155t bilateral infarction of, in paramedian regions, 138b coma caused by injury to, 33 hemorrhage of, 137, 138b, 139 Thermoregulation disorders description of, 259 fever, 260–261 heatstroke, 260–261 hyperthermia, 260–262, 315 hypothermia, 259–260, 315, 335 treatment of, 315 Thiamine, 223, 313 Thyroid disorders, 236–237 Thyrotoxicosis, 237 ‘‘Tip of the basilar’’ syndrome, 32 Todd’s paralysis of gaze, 69 Tonsillar herniation, 102, 103f–104f Toxic encephalopathy, 262, 266, 269–271 Toxoplasmosis, 141 Transient ischemic attacks, vertebrobasilar, 213 Transtentorial herniation central clinical findings of, 107–110 description of, 101–102 diencephalic stage of, 107–108, 108f–109f medullary stage of, 109 midbrain stage of, 107–108 pontine stage of, 108–109 description of, 99 evaluation of, 321 Traumatic brain injury cerebral metabolism affected by, 374–375 closed head, 159–161 delayed encephalopathy after, 161–162 diagnosis of, 159 diffuse axonal injury, 161 in elderly, 345 hyperthermia associated with, 261 hypotension with, 346 hypoxia with, 346 late recovery after, 373 mortality rates for, 343 prevalence of, 344 prognostic and outcome factors age, 345–346 biochemical markers, 347 coma duration, 346 electrophysiologic measures, 346–347 Glasgow Coma Scale, 345, 345t motor findings, 345 Index
399 Traumatic brain injury (continued) neuroimaging findings, 346 neuro-ophthalmologic signs, 346 overview of, 344–345 secondary injuries, 346 Tremor, 195 Tricyclic antidepressants, 242t Trochlear nerve anatomy of, 61 course of, 99 impairment of, 70 Tuberculous meningitis, 265 Tuberomammillary nucleus, 18 Tuberothalamic artery, 155t Tumors brainstem, 170 cerebellar, 91, 150 dural, 120, 127, 144 hemorrhage into, 140 infratentorial, 170 intracerebral, 140–141 leptomeningeal, 131 metastatic, 141 parietal lobe, 26–27 pineal, 129 pituitary, 127–128 subarachnoid, 131 subdural, 127, 144 suprasellar, 115 Uncal herniation breathing patterns in, 105f–106f clinical features and findings of, 101, 103–107 early third nerve stage, 103–105, 105f hemiparesis caused by, 101, 106 late third nerve stage, 105–106, 106f midbrain-upper pontine stage, 106–107 pathophysiology of, 100–101 pupil findings, 103, 105–106 pupillary dilation in, 101 signs of, 105f Unconscious patients clinical regimen for, 309–311 eliciting responses from, 40f examination of, 317–320 management of acid-base balance, 315 agitation control, 317 algorithm, 312f antidotes, 315–317 body temperature restoration, 315 circulation, 313 eye protection, 317 glucose measurements, 313 infection, 315 intubation, 311–312 oxygenation, 311–313 patient positioning, 312 respiratory excursions, 312–313 seizure cessation, 313–315 thiamine, 313 ventilation assessments, 312 Uncus, 97 Uniform Determination of Death Act, 331 Upper motor neuron facial palsy, 113 Upward brainstem herniation, 102–103 Uremic encephalopathy, 227–229 Valproic acid, 314 Varicella-zoster vasculitis, 275–276 Vascular malformations, 140 Vasculitis bacterial encephalitis and, 262–263 Behc¸et’s disease, 115, 276 cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, 168, 276 classification of, 274t description of, 273 granulomatous angiitis, 156, 273–274 subacute diencephalic angioencephalopathy, 275 supratentorial destructive lesions caused by, 156, 156t in systemic lupus erythematosus, 274–275 varicella-zoster, 275–276 Vasoactive mediators, 200, 201f Vasodepressor syncope, 213 Vasogenic edema, 94f, 95, 124, 169 Vasopressin, 313 Vasovagal syncope, 212 Vegetative state characteristics of, 357 coma progression to, 378 definition of, 8, 357 evoked potentials evaluation, 359–360 locked-in state vs., 380 minimally conscious state vs., 360 N-acetylaspartate-to-creatine ratio in, 359 persistent atypical behavioral features in, 365–366 brain metabolism areas in, 365–366 cortical responses, 366–372 definition of, 8 fluorodeoxyglucose-positron emission tomography evaluations, 365, 367f functional imaging of, 365–372 prognosis in, 357–360 Venous sinus thrombosis, 154, 156 Ventrolateral preoptic neurons, 22 Ventrolateral preoptic nucleus, 23f Vertebrobasilar aneurysms, 145, 145t Vertebrobasilar transient ischemic attacks, 213 Vertical ‘‘myoclonus,’’ 69t Vestibulocerebellum, 63 Vestibulo-ocular responses, 65, 320, 339 Video-oculography, 65 Viral encephalitis acute, 266–269 acute toxic encephalopathy during, 266, 269–271
cerebral biopsy for, 273 classification of, 266 description of, 156–157, 157t herpes simplex encephalitis, 157, 157t, 267–269, 315 overview of, 266–267 parainfectious encephalomyelitis, 266, 271–273
Viral meningitis, 132 Virchow-Robin spaces, 131 400 Index
Visual obscurations, 93 Vomiting, 53–54 von Economo von San Serff, Baron Constantin, 10b–11b, 12 Wada test, 27, 152 Wake-sleep states, 16b–17b Wallenberg’s lateral medullary infarction, 59 Warfarin, 123 Water intoxication, 228–229, 253–254 Wernicke-Korsakoff syndrome, 186 Wernicke’s aphasia, 27 Wernicke’s encephalopathy causes of, 223 description of, 11 thiamine prophylaxis, 77, 223, 313 Whipple’s disease, 265–266 Xanthochromia, 82 Yawning, 53 Index
401 Yüklə 9,02 Mb. Dostları ilə paylaş:
|