loss of consciousness
Introduction
Introduction The patient does not have spontaneous movement and does not respond to any stimuli. At this time, many reflexes such as swallowing, defense, and even pupil-to-light reaction disappear, and pathological reflex can be induced. Expressed as a coma. Coma is the most serious disturbance of consciousness, that is, the loss of persistent consciousness is completely lost; it is also one of the main manifestations of brain failure. The loss of purely conscious content does not mean loss of consciousness. The meaning of loss of consciousness includes both the loss of consciousness and the loss of awakening state. Therefore, it is simple and accurate to say that coma is a very serious disturbance of consciousness that is completely abolished by the state of consciousness and the content of consciousness and body movement, and cannot be awakened by strong painful stimuli.
Cause
Cause
The cause of loss of consciousness:
The patient does not have spontaneous movement and does not respond to any stimuli. At this time, many reflexes such as swallowing, defense, and even pupil-to-light reaction disappear, and pathological reflex can be induced.
Intracranial disease:
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.
Examine
an examination
Related inspection
Ideological state brain CT examination
According to the state of awakening, the content of consciousness and the progression of physical loss and the extent and extent of impaired brain function, clinical coma is usually divided into four stages.
1. Light coma: clinical manifestations of blinking reaction disappeared or occasionally semi-closed state, language loss, spontaneous movement is rare, all kinds of stimulation and internal needs of the outside, completely unaware and reaction. However, strong painful stimuli can be seen in patients with painful expressions, paralyzed or limb defenses and increased breathing. Brainstem reflexes such as swallowing reflexes, cough reflexes, corneal reflexes, and pupils are still present for light reflections, and ocular brain reflexes may also be present. There is no significant change in breathing, pulse, and blood pressure. Defecation or incontinence.
2. Moderate coma: The patient's blink, language and spontaneous movement have been lost, and there is no response to various external stimuli. For strong pain stimuli, defensive reflexes may occur. There is no movement in the eyeball, the corneal reflex is weakened, the pupil is slow to reflect light, and the breathing is slowed or increased. Central respiratory disorder such as periodic breathing and central neuron hyperventilation can be seen. Pulse and blood pressure have also changed. With or without limb tonic extension and angulation (de-cortical rigidity). Defecation or incontinence.
3. Deep coma: Muscle relaxation in the whole body, and strong pain stimulation can not lead to escape response and cortical rigidity. The eyeball was fixed, the pupil was significantly enlarged, and the pupil was completely lost to light reflection, corneal reflex, anterior chamber reflex, swallowing reflex, cough reflex, and sacral reflex. Irregular breathing, blood pressure may drop, incontinence, and even detention.
4. Brain death: manifested as unresponsive deep coma, spontaneous breathing stopped, pupil dilated and fixed, brainstem reflex disappeared, accompanied by decreased body temperature and blood pressure. EEG is silent, and cerebral angiography is not developed. At this time, even if the heartbeat is still maintained, the whole brain function will never recover, and the heartbeat will stop in a certain period of time.
Diagnosis
Differential diagnosis
Identification of loss of consciousness and confusion:
According to the state of awakening, the content of consciousness and the progression of physical loss and the extent and extent of impaired brain function, clinical coma is usually divided into four stages.
1. Light coma: clinical manifestations of blinking reaction disappeared or occasionally semi-closed state, language loss, spontaneous movement is rare, all kinds of stimulation and internal needs of the outside, completely unaware and reaction. However, strong painful stimuli can be seen in patients with painful expressions, paralyzed or limb defenses and increased breathing. Brainstem reflexes such as swallowing reflexes, cough reflexes, corneal reflexes, and pupils are still present for light reflections, and ocular brain reflexes may also be present. There is no significant change in breathing, pulse, and blood pressure. Defecation or incontinence.
2. Moderate coma: The patient's blink, language and spontaneous movement have been lost, and there is no response to various external stimuli. For strong pain stimuli, defensive reflexes may occur. There is no movement in the eyeball, the corneal reflex is weakened, the pupil is slow to reflect light, and the breathing is slowed or increased. Central respiratory disorder such as periodic breathing and central neuron hyperventilation can be seen. Pulse and blood pressure have also changed. With or without limb tonic extension and angulation (de-cortical rigidity). Defecation or incontinence.
3. Deep coma: Muscle relaxation in the whole body, and strong pain stimulation can not lead to escape response and cortical rigidity. The eyeball was fixed, the pupil was significantly enlarged, and the pupil was completely lost to light reflection, corneal reflex, anterior chamber reflex, swallowing reflex, cough reflex, and sacral reflex. Irregular breathing, blood pressure may drop, incontinence, and even detention.
4. Brain death: manifested as unresponsive deep coma, spontaneous breathing stopped, pupil dilated and fixed, brainstem reflex disappeared, accompanied by decreased body temperature and blood pressure. EEG is silent, and cerebral angiography is not developed. At this time, even if the heartbeat is still maintained, the whole brain function will never recover, and the heartbeat will stop in a certain period of time.
