Obtundation-Coma

Definitions

Clinical Patterns of Brain Dysfunction

  • Akinetic Mutism
  • Brain Death (see Brain Death, [[Brain Death]])
  • Coma (see Obtundation-Coma, [[Obtundation-Coma]])
  • Dementia (see Dementia, [[Dementia]])
  • Locked-In Syndrome (see Locked-In Syndrome, [[Locked-In Syndrome]])
  • Persistent Vegetative State: term was first used in 1972
  • Minimally Conscious State

BRAIN INJURY


Etiology

Structural

Infection

Metabolic

  • Central Pontine Myelinolysis (CPM) (see Central Pontine Myelinolysis, [[Central Pontine Myelinolysis]])
  • Hypercalcemia (see Hypercalcemia, [[Hypercalcemia]])
  • Hyperosmolar Hyperglycemic State (HHS) (see Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State, [[Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State]]): coma occurs in <20% of cases
  • Hypoxemia (see Hypoxemia, [[Hypoxemia]])
  • Lactic Acidosis (see Lactic Acidosis, [[Lactic Acidosis]])
  • Rapid Change in pCO2 During Mechanical Ventilation
    • Epidemiology: this may particularly occur during the initial mechanical ventilation of a patient with chronic hypercapnia (chronic hypoventilation)
    • Mechanism: rapid shift in arterial pCO2 is almost immediately transmitted throughout the total body water (including the intracellular fluid compartment, the brain, and the cerebrospinal fluid), resulting in potential neurologic injury (it is likely that the rapid change in pCO2 is responsible rather than the alkalosis itself)
    • Clinical
    • Prevention: maintain pCO2 near patient’s baseline (or gradually decrease the pCO2)
  • Metabolic Alkalosis (see Metabolic Alkalosis, [[Metabolic Alkalosis]]): with severe metabolic alkalosis
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Drug/Toxin

Other

  • Leukostasis (see Leukostasis, [[Leukostasis]])
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References

  • CNS Disorder During Mechanical Ventilation in Chronic Pulmonary Disease. JAMA. 1964;189:993 [MEDLINE]