Recommended
More Related Content
What's hot
What's hot (20)
Similar to Altered states of consciousness
Similar to Altered states of consciousness (20)
More from pune2013
More from pune2013 (19)
Recently uploaded
Recently uploaded (20)
Altered states of consciousness
- 1. Dr Isha Deshmukh Assistant Professor Department of Pediatics BJGMC, Pune 15/08/2021 Altered States Of Consciousness
- 2. Encephalopathy Describes a diffuse disorder of the brain in which at least two of the following symptoms are present : Altered states of consciousness Altered cognition or personality Seizures. Encephalitis – encephalopathy + CSF Pleocytosis
- 3. States of Decreased Consciousness Term Definition Lethargy Difficult to maintain the aroused state Obtundation Responsive to stimulation other than pain Stupor Responsive only to pain Coma Unresponsive to pain
- 4. Careful History should include The events leading to behavioural change Drug or toxic substance exposure Personal or family history of migraine or epilepsy Recent or concurrent fever, infectious disease, or systemic illness A previous personal or family history of encephalopathy History of blurring of vision, nystagmus, impaired eye movements History of trauma/ needle prick marks/ sting marks/ meningismus History of cardiac diseases.
- 5. Causes of Agitation & Confusion Epileptic syndromes Absence status Complex partial seizures Migraine Acute confusional state Aphasic migraine Transient global amnesia Psychological Panic disorder Schizophrenia
- 6. Causes of Agitation & Confusion Infectious Disorders Bacterial infections – Cat scratch disease, Meningitis Rickettsial infections – Lyme Disease , Rocky mountain spotted fever Viral infections – Aseptic meningitis, Arboviruses, HSV Encephalitis, Measles encephalitis, Post-infectious encephalomyelitis, Reye syndrome
- 7. Causes of Agitation & Confusion Metabolic and Systemic disorders Disorders of osmolality- hypoglycemia, hyponatremia Endocrine disorders – Adrenal insufficiency, hypoparathyroidism, thyroid disorders Hepatic encephalopathy IEM – Disorders of pyruvate metabolism, Med Chain Acyl CoA dehydrogenase def, Respiratory chain disorders, Urea cycle disorders Renal disease – Hypertensive encephalopathy , Uremic Encephalopathy
- 8. Causes of Agitation & Confusion Toxic substances Immunosuppressive drugs Toxins AED Abuse Vascular causes CCF Embolism HTN SLE SAH, IVH Vasculitis
- 9. Abnormal physical examination Periods of apnoea, bradycardia, reduced respiratory effort, apneustic breathing, ataxic breathing, Ondine’s curse Abnormal pupillary size, nystagmus, odour, abnormal urine colour, Jaundice Arrhythmias, AV Block, CVA, TIA, RBBB, Cardiomyopathies Opisthotonus, Decerebrate Rigidity, Neck hyper- extension, Clenching of teeth, myoclonus Anemia, Signs of Vitamin Deficiency, Evidence of malnutrition Neuromuscular disorders- GBS & variants, SMA,
- 10. Laboratory Investigations Complete Blood count Blood culture ESR Toxicity screen, ABG, Anion gap Blood glucose level Serum electrolytes, Serum calcium level BUN, Serum creatinine Serum Ammonia Free T3, Free T4, TSH Liver Function Tests- SGOT, SGPT, Serum Bilirubin level, Coagulation Profile,
- 11. Radiological Investigations Chest X ray , X Ray abdomen Ultrasound Abdomen Ultrasound AF when AF is open USG Doppler study to check for thrombosis CT Brain (P+C), MRI Brain + Spine , CT Angiography , MR Spectrometry ECG- 12 lead, 2D ECHO, EEG CSF Analysis – cytology , microbiology , tests for CSF PCR for Virology
- 12. EEG Findings Slowing of posterior rhythm- SE Burst suppression pattern – HIE Severe encephalopathy – diffuse theta & delta activity , absence of faster frequencies, intermittent rhythmic delta activity Hepatic / Uremic Encephalopathy – Epileptiform activity consistent with absence or complex partial seizures , triphasic waves Herpes encephalitis- Periodic lateralizing epileptiform discharges in one temporal lobe
- 13. Persistent Vegetative State The term PVS describes patients , who , after recovery from coma, return to a state of wakefulness without cognition. C/F – loss of cognitive function, eyes open permanent unconsciousness , loss of awareness. Survival is indefinite with good nursing care.