Critical Care >Principles of Neurosciences Critical Care

John M. Oropello, Stephen M. Pastores, Vladimir Kvetan+

Table 48A–1JPathophysiologic mechanisms of encephalopathy, stupor, and coma.

Mechanism Examples

Failure of substrate delivery Hypoxemia, severe anemia, hypoglycemia, hypotension, cardiogenic shock

Metabolically or pharmacologically induced neuronal dysfunction Uremia, hyponatremia, liver failure, hypercarbia, drug ingestion, toxidrome, hypothermia

Primary disturbance in neuronal function or physiology Seizures, convulsive or nonconvulsive status epilepticus

Primary diffuse, bihemispheric cortical pathology Encephalitis, acute demyelinating Encephalomyelitis, CNS vasculitis

Focal lesion of the ARAS Acute basilar thrombosis, brainstem intracerebral hemorrhage

Anatomic distortion or compression of the ARAS Hydrocephalus, SDH with uncal herniation, pineal gland tumor with dorsal midbrain compression

Intracranial hypertension Acute aSAH, dural sinus thrombosis, meningitis

ARAS, ascending reticular activating system; SDH, subdural hematoma; aSAH, aneurysmal subarachnoid hemorrhage.

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