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Altered Mental Status and Coma
 

Altered Mental Status and Coma

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Altered Mental Status and Coma

Altered Mental Status and Coma
意識不清與昏迷

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    Altered Mental Status and Coma Altered Mental Status and Coma Presentation Transcript

    • Altered Mental Status and Coma
      意識不清與昏迷
      Adapted from Rosen's Emergency Medicine, 7E
      Chapter e14 Depressed Consciousness and Coma
    • Glasgow Coma Scale (Teasdale & Jennett, 1977)
    • 意識之成分
      喚醒度(Arousal):意識之原動力
      臨床現象:外表上呈醒的狀態
      (能主動睜眼或對外界刺激有睜眼反應)
      是腦幹之網狀系統(RAS)活動的表現
      主為腦幹之功能
      覺察能力(Awareness):意識之內容
      綜合認知和情感之腦功能
      臨床現象:有意義的動作和語言
      主為大腦半球的功能
    • Brainstem RAS (Mid-Pons Rostrally) and Its Projections to the Hemispheres
    • Anatomic basis of coma (results from lesions that affect either the RAS or both hemispheres)
    • Mnemonic for Treatable Causes of AMS (AEIOU-TIPS)
      A Alcohol
      E Endocrine Electrolytes Encephalopathy
      I Insulin
      O O2
      Opiates
      U Uremia
      T Trauma
      I Infection
      Intra-cranial
      P Poisoning
      S Seizure
      Stroke
      Sepsis
      Shock
    • Reversible cause of altered mental status
      Hypoglycemia, narcotic overdose, hypoxia, hypercarbia should be quickly investigation and treatment
      If structural lesion etiology is indicated non-contrast head CT
    • Delirium
      Diffuse metabolic and multifocal cerebral lesion, generalized impairment of brain functions or at least a bilateral involvement
      limbic structure
    • Major brainstem reflexes used in coma examination
      2進3出
      5進7出
      8進6出
    • Pupils in comatose patients
    • Caloric Test for Vestibular Function (30-100 cc ice water for oculovestibular reflexes in comatose patients)
    • Brainstem pathways mediating conjugate horizontal eye movements
    • Oculocephalogyric (caloric) responses to various central nervous system pathologic conditions. MLF, medial longitudinal fasciculus
    • Oculocephalic and Oculovestiblar reflexes in comatose patients with:
      Brainstem intact (doll’ head eye phenomenon)
      Bil. MLF involvement
      Low brainstem lesion
    • Motor responses to
      noxious stimulation
      in acute cerebral
      dysfunction.
      A = Rt hemisphere
      B = Diencephalon
      C = Mibrain/Pons
      D = Medulla
    • Sudden weakness or numbness of arm or leg especially on one side of the body
      Sudden trouble in walking or dizziness, vertigo, loss of balance or coordination.
      Facial Weakness/Numbness
      Sudden severe headaches
      Altered consciousness