Plum and posner’s diagnosis of stupor and coma fourth Edition series editor sid Gilman, md, frcp
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Index Page numbers followed by ‘‘t’’ denote tables; those followed by ‘‘b’’ denote boxes; and those followed by ‘‘f’’ denote figures Abducens nerve anatomy of, 61 course of, 100 palsy of, 77, 113 paralysis of, 100 Abscess brain, 141–142, 142f, 143t cerebellar, 149–150, 150t epidural, 126–127, 144 pontine, 170f Abulia, 8 Accidental hypothermia, 259–260 Acetaminophen overdose, 245, 326 Acetic acid, 250 Acetylcholine, 208–209 Acid-base imbalances acidosis. See Acidosis alkalosis. See Alkalosis hyperventilation and, 188–191 systemic, 258–259 treatment of, 315 Acidosis lactic, 233, 250 metabolic. See Metabolic acidosis respiratory, 192, 192t sodium bicarbonate for, 324, 326 Acute bacterial leptomeningitis, 262–265 Acute bacterial meningitis, 132–133, 133t, 263, 316f Acute cerebellar infarction, 139b Acute disseminated encephalomyelitis description of, 157–158, 267f, 271–273 outcomes, 356, 367 Acute hemorrhagic leukoencephalopathy, 272 Acute hypoxia, 211–214 Acute liver failure, 224 Acute massive cerebral infarction, 138b Acute subdural hematoma, 123 Acute toxic encephalopathy, 266, 269–271 Addison’s disease, 235–236 Adenosine triphosphate, 198 Adrenal disorders, 234–236 Adrenoleukodystrophy, 278 Advance care planning, 376 Agitation, 6, 317 Airway
description of, 42–43 obstruction of, 211, 311 Akinetic mutism, 8, 360–362, 361b, 375 Alcohol
delirium tremens after withdrawal from, 283 intoxication caused by. See Ethanol intoxication Alcoholic stupor, 242t, 243 Alcoholism, 246t Alkalosis metabolic, 191t, 191–192, 231, 258 respiratory, 189–191, 190t, 258 Alpha-ketoglutaramate, 225 Altered state of consciousness acutely, 6–7, 8t from basilar migraine, 168 chronic, 7–9, 8t descriptive terms for, 8t lateral displacement of the diencephalon and, 100 structural lesions associated with, 29–34 subacute, 7–9 Amphetamine, 242t Amyloid angiopathy, 139–140, 146 ‘‘Amytal interview,’’ 298, 307–308, 327 Anemia, 325 Anemic hypoxia, 211 Anesthesia barbiturate, 205–206, 323 description of, 205–206 malignant hyperthermia associated with, 262 profound, brain death diagnosis in, 338 Aneurysms bleeding by, 129 mycotic, 140 saccular, 129 vertebrobasilar, 145, 145t Angiogenesis, 94–95 Angiography computed tomography, 78 magnetic resonance, 79, 336 Anion gap, 240 Anoxemia, 201 Anoxia, 204, 212 Anoxic-ischemic brain damage description of, 206 focal ischemia, 207–208 global ischemia, 206–207 hypoxia, 208 Antidepressants, 241, 245–246 Antidotes administration of, 315–317 types of, 317t Antifreeze. See Ethylene glycol Anton’s syndrome, 154 Apathetic thyrotoxicosis, 237 Apnea. See also Sleep apnea in brain death, 334–335, 335t posthyperventilation, 49, 50f Apneusis, 50f Apneustic breathing, 51–52 387
Aquaporin-4, 215 Arachnoid villi, 92 Arousability, 40 Arousal
abnormalities of, 183–184 deficits in, 111 definition of, 183 Arousal system compressive lesions effect on, 90–95 structural processes that impair, 9 Arteriovenous malformations, 140 Ascending arousal system behavioral state switching, 22, 24–25 description of, 11–22, 19f distortion of, 101 interconnectivity of, 22 pathways of, 39 Aseptic meningitis, 134t Aspergillus meningitis, 133 Asterixis, 195–197 Astrocytes description of, 198 glutamate-induced glycolysis in, 199f hepatic encephalopathy pathology in, 224 Astrocytomas, 141 Asystole, 213 Ataxia, 113 Ataxic breathing, 50f, 52 Atropine-scopolamine, 242t Attention, 185 Autonomic neuropathy, 234 Axonal shearing, 161 Bacterial encephalitis, 262–263 Bacterial leptomeningitis, acute, 262–265 Bacterial meningitis acute, 132–133, 133t, 263 chronic, 133, 265–266 treatment of algorithm for, 316f corticosteroids, 322 regimen for, 325 Barbiturates anesthesia using, 205–206, 323 delirium caused by, 242t Baroreceptor reflex arc, 46 Basal forebrain, 13b–14b Basal ganglionic hemorrhages, 137 Basilar artery description of, 96, 99f posterior cerebral arteries from, 153 Basilar artery occlusion description of, 163 distal, 152–154 prodromal symptoms in, 214t signs and symptoms of, 164t Basilar migraine, 168 Battle’s sign, 40, 121 Behavioral state switching, 22, 24–25 Behc¸et’s disease, 115, 276 Benzodiazepines ‘‘Amytal interview’’ using, 307 description of, 242t, 245 overdose of, 316 Berger, Hans, 12 Bickerstaff’s brainstem encephalitis, 170 Blepharospasm, 64 Blood pressure, 45, 216 Blood tests, 77 Blood-brain barrier, 202 Bobbing, ocular, 69t, 71–72, 162 Brain cardiovascular control pathways in, 47f cerebral perfusion pressure, 43 oxygen deprivation effects, 46 regionally selective injuries that affect, 374–376 temperature fluctuations in, 259 traumatic injury to. See Traumatic brain injury venous sinus thrombosis of, 154, 156 Brain abscess, 141–142, 142f, 143t Brain death apnea, 334–335, 335t brainstem function findings, 333–335 cerebral scintigraphy evaluations, 336 characteristics of, 8–9 criteria for, 331–333, 332t decision making regarding, 378 definition of, 8 determination of, 331–333 electroencephalography evaluations, 337–339, 338t etiology of, 332–333, 333t evoked potential measurements, 337–338 laboratory tests, 335–338 magnetic resonance angiography evaluations, 336 medical extension of life, 331–332 motor activity, 334 motor responses, 332, 339 neurologic examination, 332 ocular movements in, 334 organ donation considerations, 331 organ survival, 338–339 pitfalls in diagnosis of, 338–339 in profound anesthesia, 338 pupillary findings, 333–334 reflex activity, 334 sensory activity, 334 signs of, 333–335 transcranial Doppler ultrasonography evaluations, 336 vestibulo-ocular responses, 339 Brainstem compression of, 91, 145, 150 lesions of, 30f, 115–116 rostrocaudal deterioration of, 102 trauma to, 116 upper, injury to, 33–34 upward herniation, 102–103 vascular destruction disorders of basilar artery occlusion, 163–166 basilar migraine, 168 brainstem hemorrhage, 166–168 description of, 163 posterior reversible leukoencephalopathy syndrome, 168–169, 169t Brainstem auditory-evoked responses, 354 Brainstem gliomas, 51 Brainstem hemorrhage, 166–168 Brainstem infarction, 165t Brainstem tumors, 170 388
Index Breathing abnormalities of, 46t, 46–47 apneustic, 51–52 ataxic, 50f, 52 cluster, 50f Kussmaul, 75–76 physiology of, 47–48 rhythmic, 49 Bremer, Frederic, 12 Brudzinski’s sign, 40, 263 Burst neurons, 13b Calcium abnormalities hypercalcemia, 256–257 hypocalcemia, 257–258 Caloric vestibulo-ocular responses, 65, 68 Canavan’s disease, 114 Cancer, 238–240 Carbon dioxide narcosis, 231 Cardiopulmonary arrest coma after outcomes, 352 pitfalls in evaluation of, 354–355 mortality rates for, 343 Cardiopulmonary bypass surgery, 218 Cardiopulmonary resuscitation, 206–207, 207f Carotid ischemic lesions, 152 Case law, 376–377 Cataplexy, 20b Catatonia, 299, 302–304, 303t Central homunculus, 27 Central Horner’s syndrome, 57–58 Central nervous system infections acute bacterial leptomeningitis, 262–265 diagnosis of, 262 differential diagnosis, 270t prognosis after, 356 Central neurogenic hyperventilation, 50f, 51 Central pontine myelinolysis, 171 Central sleep apnea, 52 Central transtentorial herniation 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 Central venous thrombosis, 169t Cerebellar abscess, 149–150, 150t Cerebellar cognitive affective syndrome, 306–307 Cerebellar hematoma, 323 Cerebellar hemorrhage algorithm for, 148f brainstem compression by, 145 clinical findings of, 146t computed tomography findings, 147 description of, 138b–139b hypertension and, 145–146 surgical interventions for, 147, 148f Cerebellar infarction, 139b, 148–149, 324 Cerebellar mass, 91 Cerebellar mutism, 306 Cerebellar tonsils, 100 Cerebellar tumors, 91, 150 Cerebellopontine angle lesion, 91 Cerebral angiography, 335–336 Cerebral artery infarction, 153f Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, 168, 276 Cerebral biopsy, 273 Cerebral blood flow brain death evaluations, 335–336 during cardiac arrest, 206 hypoglycemia effects on, 204 hypoxia effects on, 211 increases in, 45 during neural activity, 198, 200 normal levels of, 198 reductions in causes of, 200 in clouding of consciousness, 6 global, 200 loss of consciousness caused by, 201 regional, 200 regulation of, 43, 202 Cerebral cortex description of, 25 diffuse, bilateral destruction of, 114 hypoxia effects on, 31f Cerebral edema, 263 Cerebral glucose consumption, 204 Cerebral herniation, 263–265 Cerebral ischemia, multifocal, 215–216 Cerebral malaria, 217 Cerebral metabolic rate description of, 204 in minimally conscious state patients, 374 Cerebral metabolism, 374–375 Cerebral oxygen consumption, 6 Cerebral perfusion pressure decreased, 93 description of, 43, 45 intracranial pressure effects on, 93 Cerebral scintigraphy, 336 Cerebral vascular lesions, 137, 138b–139b Cerebral venous hypoxia, 211 Cerebrospinal fluid in herpes simplex encephalitis, 268 herpes simplex encephalitis findings, 157, 157t lumbar puncture evaluations, 81–82 meningitis findings, 134, 134t obstruction of, 91 subarachnoid hemorrhage evaluation, 130 systemic lupus erythematosus findings, 275 Cerebrospinal fluid pressure, 92 Cerveau isole, 12 Chemoreceptors, 188 Cheyne-Stokes respiration, 49–51, 50f, 75, 187 Chloromas, 144 Choline, 80 Cholinergic neurons, 15 Chronic liver failure, 224 Chronic meningitis, 133, 265–266 Chronic relapsing pancreatitis, 231 Chronic subdural hematoma, 123–124 Ciliospinal reflex, 54, 57, 59 Circulatory assessments, 313 Closed head traumatic brain injury, 159–161 Index
389 Clouding of consciousness cerebral oxygen consumption reductions associated with, 6 definition of, 6 Cluster breathing, 50f Cocaine, 210, 242t Cofactor deficiency, 223–224 Cognition, 185, 373 Cognitive deficits, 7 Cold caloric stimulation, 193 Collier’s sign, 64 Coma
causes of, 4t definition of, 7 depth of, 7 diagnosis of, 9, 309–311 drug-induced causes of. See Drug intoxications duration of, 346, 349 history-taking, 9 hypoglycemic, 210 locked-in syndrome vs., 7 metabolic. See Metabolic coma premonitory causes of, 39–40 prognosis in, 343–344 sleep vs., 5, 25 structural. See Structural coma thalamic causes of, 33 Coma cocktail, 316 Coma of unknown origin, 332, 338 Coma scales description of, 41b FOUR Score, 41b, 311 Glasgow Coma Scale. See Glasgow Coma Scale Community-acquired meningitis, 132–133, 133t Compressive lesions angiogenesis caused by, 94 arousal system affected by, 90 consciousness impairments caused by, 88–90 diencephalon, 90 infratentorial, 142–143 local tissue ischemia induced by, 94 mechanism of action, 89–90 midbrain, 90 posterior fossa, 90–91 sites of, 89t supratentorial, 120 types of, 121t Computed tomography brain abscess findings, 142f cerebellar hemorrhage findings, 147 description of, 78, 79f epidural hematoma findings, 122f hepatic encephalopathy evaluations, 225 intracerebral hemorrhage findings, 136f meningioma evaluation, 127 meningitis evaluations, 133–134, 135t subarachnoid hemorrhage findings, 130, 130f subdural hematoma evaluations, 125, 125f supratentorial mass lesion evaluations, 321 Computed tomography angiography, 78 Concussion, 161 Confusion Assessment Method for the Intensive Care Unit, 184t Conjugate lateral deviation, 69–70 Conjugate vertical deviation, 70 Consciousness altered state of. See Altered state of consciousness clouding of, 6 components of, 5 content of, 5 definition of, 5 loss of. See Loss of consciousness Convergence nystagmus, 71 Conversion hysteria, 299 Conversion reactions, 299–302 Corneal erosions, 317 Corneal reflex, 64 Corneal responses, 64, 320 Corneal trauma, 64 Cortical blindness, 77 Corticosteroids Cushing’s syndrome treated with, 235–236 in diabetes mellitus patients, 233 herniation treated with, 322 meningitis treated with, 134, 322 Coup-contrecoup injury, 159 Craniopharyngiomas, 128 Creatine, 80 Creutzfeldt-Jakob disease, 266, 277 Cushing reflex, 44, 97b Cushing’s disease, 236 Cushing’s syndrome, 235–236 Cutaneous reflexes, 72 Cytotoxic edema, 94f, 95 Decerebrate rigidity, 74–75, 77, 324 Decompressive craniotomy, 152, 323 Decorticate rigidity, 74, 77, 324 Delayed encephalopathy, 161–162, 219 Delirium
acute states, 282–284 with agitation, 6, 317 ‘‘Amytal interview’’ for, 307–308, 327 attention disorders in, 185 characteristics of, 181 definition of, 6 dementia and, 8 drug withdrawal, 283 drug-induced, 284 electroencephalogram evaluations, 304 intensive care unit, 283–284 postoperative, 283 signs and symptoms of, 6 Delirium tremens, 283 Delusions, 6 Dementia, 7–8 Depressant drug coma, 241, 245t, 357 Descending sympathoexcitatory pathways, 44 Destructive lesions description of, 88, 114 infratentorial, 162–163 sites of, 89t supratentorial. See Supratentorial destructive lesions types of, 121t 390
Index Desynchronized sleep, 16b Dexamethasone, 322 Diabetes mellitus autonomic neuropathy caused by, 234 coma in, 232t definition of, 232 hyperglycemia in, 233–234 hyperosmolality in, 232 hypoglycemia in, 234 renal insufficiency caused by, 234 stupor in, 232t Diabetic encephalopathy, 222 Diabetic ketoacidosis, 187, 232–234, 309 Diabetic lactic acidosis, 233 Dialysis disequilibrium syndrome, 229 Diencephalic stage, of central transtentorial herniation, 107–110, 108f–109f Diencephalon autoimmune disorders that affect, 115 compression of, 90 destruction disease of, 114–115 injuries to description of, 32–33 pupillary responses after, 58 lateral displacement of, 97b, 100 lesions of, 88 Diffuse axonal injury, 161 Diffusion tensor imaging, 371f Dipping, ocular, 69t, 71–72 Disorientation, 185 Disseminated intravascular coagulation, 217 Distal basilar occlusion, 152–154 Distractibility, 185 Do not resuscitate order, 376 Doll’s eye response in catatonia, 303 in central transtentorial herniation, 108f–109f definition of, 65 Dopamine, 209 Dorsal midbrain compression, 102, 110–112
Dorsal raphe nuclei, 15 Drop attacks, 213–214 Drowning, 260 Drug intoxications. See also Overdoses acetaminophen, 245, 326 antidepressants, 241, 245–246 antidotes for, 251t benzodiazepines, 242t, 245 evaluation of, 324 heroin, 243 list of, 242t management of, 326 opioids/opiates, 242t, 243 overview of, 240, 240t proconvulsants, 247t prognosis after, 357 sedatives, 240–241, 243–245 testing for, 240, 241t Drug withdrawal delirium, 283 Drug-induced delirium, 284 Drunkenness. See Ethanol intoxication Dural tumors, 120, 127, 144 Duret hemorrhages, 102, 103f Edinger-Westphal nucleus, 56–57 Elderly cerebellar infarction in, 148 hyperglycemia in, 222 meningitis in, 133, 263 traumatic brain injury in, 345 Electrocerebral inactivity, 337 Electroencephalography alpha pattern, 82 brain death determinations, 337–339, 338t catatonia evaluations, 304 delirium evaluations, 304 history of, 12 indications for, 82 sinusoidal appearance, 13b traumatic brain injury-related abnormalities, 346 Electromyogram, 16b Embolism to brain, 218 from cardiopulmonary bypass surgery, 218 fat, 217–218 pulmonary, 214 Empyema, 126–127, 144 Encephale isole, 12 Encephalitis, viral 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 Encephalitis lethargica, 12 Encephalomyelitis, acute disseminated, 157–158 Encephalopathy delayed postanoxic, 219 diabetic, 222 Hashimoto’s, 237 hepatic
diagnosis of, 225 hyperventilation associated with, 224 mild, 227 onset of, 224 pathology of, 224 pupillary findings in, 225 hypernatremic, 256 hyponatremic, 254t hypoxic-ischemic, 352–354 metabolic. See Metabolic encephalopathy pancreatic, 231–232 pulmonary, 231 toxic, 262, 266, 269–271 uremic, 227–229 Wernicke’s causes of, 223 description of, 11 thiamine prophylaxis, 77, 223, 313 End artery hemorrhages, 137, 139 Epidural abscess, 126–127, 144 Epidural hematoma, 121–123, 143–144 Epilepsy, 280–281, 315 Epileptic seizures, 213–214, 304–306 Ethanol intoxication, 246, 248 Index 391
Ethylene glycol, 250 Evoked potentials brain death determinations, 337–338, 338t description of, 82–83 somatosensory in anoxic-ischemic encephalopathy, 354t description of, 346 vegetative state evaluations, 359–360 Examination airway, 42–43 circulation, 43–46 coma scales. See Coma scales corneal responses, 320 eye opening, 319 history-taking, 39–40, 317–318 motor responses, 320 neurologic, 9, 318–319 oculocephalic responses, 319 overview of, 38–39, 39t physical, 40 pupillary reactions, 319 respiration. See Respiration skeletal muscle tone, 320 tendon reflexes, 320 of unconscious patient, 317–320 verbal responses, 319 vestibulo-ocular responses, 65, 320 Excitatory amino acids, 114 Extradural hematoma, 309–310 Eye(s)
conjugate lateral deviation, 69–70 conjugate vertical deviation, 70 nystagmoid jerks of, 71–72 opening of, 319 Eye movements in brainstem infarcts, 165t Yüklə 9,02 Mb. Dostları ilə paylaş:
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