Altered Mental Status and Coma
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Altered Mental Status and Coma
意識不清與昏迷

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  • 1. 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
  • 2. Glasgow Coma Scale (Teasdale & Jennett, 1977)
  • 3. 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
  • 4. Brainstem RAS (Mid-Pons Rostrally) and Its Projections to the Hemispheres
  • 5. Anatomic basis of coma (results from lesions that affect either the RAS or both hemispheres)
  • 6. 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
  • 7. 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
  • 8. Delirium
    Diffuse metabolic and multifocal cerebral lesion, generalized impairment of brain functions or at least a bilateral involvement
    limbic structure
  • 9. Major brainstem reflexes used in coma examination
    2進3出
    5進7出
    8進6出
  • 10. Pupils in comatose patients
  • 11. Caloric Test for Vestibular Function (30-100 cc ice water for oculovestibular reflexes in comatose patients)
  • 12. Brainstem pathways mediating conjugate horizontal eye movements
  • 13. Oculocephalogyric (caloric) responses to various central nervous system pathologic conditions. MLF, medial longitudinal fasciculus
  • 14. Oculocephalic and Oculovestiblar reflexes in comatose patients with:
    Brainstem intact (doll’ head eye phenomenon)
    Bil. MLF involvement
    Low brainstem lesion
  • 15. Motor responses to
    noxious stimulation
    in acute cerebral
    dysfunction.
    A = Rt hemisphere
    B = Diencephalon
    C = Mibrain/Pons
    D = Medulla
  • 16. 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