Disturbance of

conscienceness

Shouye Zhao
Hepatobiliary Sugery Department
Abstract

 Definition: lost of awareness,acting,recognizing

 Differentiation syncope
psychological disease
Clinical occurence

 Somnolence(Lethargy )
 Confusion
 Stupor
 Coma
 delirium
Definition
 Lethargy (or somnolence): arousal, though
diminished, is maintained spontaneously or with
repeated light stimulation. weakness characterized by a
lack of vitality or energy
 Stupor: severely impaired arousal with some
responsiveness to vigorous stimuli.;marginal
consciousness
 Confusion: impaired attention and adequate arousal to
perform mental status tests of this ability. a mental state
characterized by a lack of clear and orderly thought and
behavior
Definition
 Coma: total or near-total unresponsiveness. a state
of deep and often prolonged unconsciousness; usually
the result of disease or injury
 Delirium: confusion with periods of agitation and
sometimes hypervigilance, active irritability, and
hallucinations, typically alternating with periods during
which the level of arousal is depressed. state of violent
mental agitation
Pathology and Etiology
Metabolic Encephalopathy
 Substrate deprivation
 Hypoxia
 Diffuse ischemia
 Hypoglycemia
 Vitamin deficiency
 Systemic diseases
 Respiratory failure (hypercapnia)
 Kidney failure (uremia)
 Liver failure
 Endocrine dysfunction
Parathyroid Adrenal
Pancreas
 Hypertensive encephalopathy
 Fever
 Sepsis
 Porphyria
 Poisoning
 Alcohol
 Prescribed drugs
 Poisons ---CO(carbon monoxide)
 Drug withdrawal
 Meningitis Encephalitis
Subarachnoid hemorrhage
Electrolyte disorders
 Water, sodium, calcium, Mg, Al.
Acid-base disorders Concussion-
Thyroid contusion Seizures or postictal
states Mixed metabolic
encephalopathy Intensive care
unit delirium
Pathology and Etiology

 Brain hernia
 Brainstem injury
DIFFERENTIAL DIAGNOSIS OF COMA AND CONFUSION
AND EARLY DIAGNOSTIC TESTS

 Head CT will be the first test after the examination.

 Radiographic contrast dye, or MR imaging with
gadolinium contrast.
 Diffusion-weighted imaging (DWI) can detect
hyperacute infarction, may also help to differentiate
between acute and subacute or chronic infarcts.
 When headache, fever, nuchal rigidity, or confusion
occur without coma or papilledema, it is best to
perform an LP(lumbar puncture, 腰穿 ) before CT
scanning.
DIFFERENTIAL DIAGNOSIS OF COMA AND CONFUSION
AND EARLY DIAGNOSTIC TESTS

 When coma accompanies possible acute meningitis,

antibiotics are given before a head CT with LP to follow
if not contraindicated by the CT findings.
 Signs of diffusely increased ICP, obstructive
hydrocephalus, a large intracranial mass, or spinal cord
compression contraindicate LP.
 Where the CT does not explain the cause of coma or
confusion and does not contraindicate LP, LP should
follow immediately.
 Early EEG to look for evidence of seizure.
Glasgow Coma Scale

 Best motor response:

 Obeys 6 Localizes 5
Withdrawl 4 Abnormal flexion 3
Extensor response 2 Nil 1
 Verbal response:
 Oriented 5 Inapropriate words 4
Incomprehensible 3 sounds 2
 Nil 1
 Eye opening:
 Spontaneous 4 To speech 3
To pain 2 Nil 1
Shouye zhao the hepatobiliary surgery department
Tel: 13455474902
E-mail: foxandkitty@hotmail.com