Plum and posner’s diagnosis of stupor and coma fourth Edition series editor sid Gilman, md, frcp
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| Index Page numbers followed by ‘‘t’’ denote tables; those followed by ‘‘b’’ denote boxes; and those followed by ‘‘f’’ denote figures Abducens nerve anatomy of, 61 course of, 100 palsy of, 77, 113 paralysis of, 100 Abscess brain, 141–142, 142f, 143t cerebellar, 149–150, 150t epidural, 126–127, 144 pontine, 170f Abulia, 8 Accidental hypothermia, 259–260 Acetaminophen overdose, 245, 326 Acetic acid, 250 Acetylcholine, 208–209 Acid-base imbalances acidosis. See Acidosis alkalosis. See Alkalosis hyperventilation and, 188–191 systemic, 258–259 treatment of, 315 Acidosis lactic, 233, 250 metabolic. See Metabolic acidosis respiratory, 192, 192t sodium bicarbonate for, 324, 326 Acute bacterial leptomeningitis, 262–265 Acute bacterial meningitis, 132–133, 133t, 263, 316f Acute cerebellar infarction, 139b Acute disseminated encephalomyelitis description of, 157–158, 267f, 271–273 outcomes, 356, 367 Acute hemorrhagic leukoencephalopathy, 272 Acute hypoxia, 211–214 Acute liver failure, 224 Acute massive cerebral infarction, 138b Acute subdural hematoma, 123 Acute toxic encephalopathy, 266, 269–271 Addison’s disease, 235–236 Adenosine triphosphate, 198 Adrenal disorders, 234–236 Adrenoleukodystrophy, 278 Advance care planning, 376 Agitation, 6, 317 Airway
description of, 42–43 obstruction of, 211, 311 Akinetic mutism, 8, 360–362, 361b, 375 Alcohol
delirium tremens after withdrawal from, 283 intoxication caused by. See Ethanol intoxication Alcoholic stupor, 242t, 243 Alcoholism, 246t Alkalosis metabolic, 191t, 191–192, 231, 258 respiratory, 189–191, 190t, 258 Alpha-ketoglutaramate, 225 Altered state of consciousness acutely, 6–7, 8t from basilar migraine, 168 chronic, 7–9, 8t descriptive terms for, 8t lateral displacement of the diencephalon and, 100 structural lesions associated with, 29–34 subacute, 7–9 Amphetamine, 242t Amyloid angiopathy, 139–140, 146 ‘‘Amytal interview,’’ 298, 307–308, 327 Anemia, 325 Anemic hypoxia, 211 Anesthesia barbiturate, 205–206, 323 description of, 205–206 malignant hyperthermia associated with, 262 profound, brain death diagnosis in, 338 Aneurysms bleeding by, 129 mycotic, 140 saccular, 129 vertebrobasilar, 145, 145t Angiogenesis, 94–95 Angiography computed tomography, 78 magnetic resonance, 79, 336 Anion gap, 240 Anoxemia, 201 Anoxia, 204, 212 Anoxic-ischemic brain damage description of, 206 focal ischemia, 207–208 global ischemia, 206–207 hypoxia, 208 Antidepressants, 241, 245–246 Antidotes administration of, 315–317 types of, 317t Antifreeze. See Ethylene glycol Anton’s syndrome, 154 Apathetic thyrotoxicosis, 237 Apnea. See also Sleep apnea in brain death, 334–335, 335t posthyperventilation, 49, 50f Apneusis, 50f Apneustic breathing, 51–52 387
Aquaporin-4, 215 Arachnoid villi, 92 Arousability, 40 Arousal
abnormalities of, 183–184 deficits in, 111 definition of, 183 Arousal system compressive lesions effect on, 90–95 structural processes that impair, 9 Arteriovenous malformations, 140 Ascending arousal system behavioral state switching, 22, 24–25 description of, 11–22, 19f distortion of, 101 interconnectivity of, 22 pathways of, 39 Aseptic meningitis, 134t Aspergillus meningitis, 133 Asterixis, 195–197 Astrocytes description of, 198 glutamate-induced glycolysis in, 199f hepatic encephalopathy pathology in, 224 Astrocytomas, 141 Asystole, 213 Ataxia, 113 Ataxic breathing, 50f, 52 Atropine-scopolamine, 242t Attention, 185 Autonomic neuropathy, 234 Axonal shearing, 161 Bacterial encephalitis, 262–263 Bacterial leptomeningitis, acute, 262–265 Bacterial meningitis acute, 132–133, 133t, 263 chronic, 133, 265–266 treatment of algorithm for, 316f corticosteroids, 322 regimen for, 325 Barbiturates anesthesia using, 205–206, 323 delirium caused by, 242t Baroreceptor reflex arc, 46 Basal forebrain, 13b–14b Basal ganglionic hemorrhages, 137 Basilar artery description of, 96, 99f posterior cerebral arteries from, 153 Basilar artery occlusion description of, 163 distal, 152–154 prodromal symptoms in, 214t signs and symptoms of, 164t Basilar migraine, 168 Battle’s sign, 40, 121 Behavioral state switching, 22, 24–25 Behc¸et’s disease, 115, 276 Benzodiazepines ‘‘Amytal interview’’ using, 307 description of, 242t, 245 overdose of, 316 Berger, Hans, 12 Bickerstaff’s brainstem encephalitis, 170 Blepharospasm, 64 Blood pressure, 45, 216 Blood tests, 77 Blood-brain barrier, 202 Bobbing, ocular, 69t, 71–72, 162 Brain cardiovascular control pathways in, 47f cerebral perfusion pressure, 43 oxygen deprivation effects, 46 regionally selective injuries that affect, 374–376 temperature fluctuations in, 259 traumatic injury to. See Traumatic brain injury venous sinus thrombosis of, 154, 156 Brain abscess, 141–142, 142f, 143t Brain death apnea, 334–335, 335t brainstem function findings, 333–335 cerebral scintigraphy evaluations, 336 characteristics of, 8–9 criteria for, 331–333, 332t decision making regarding, 378 definition of, 8 determination of, 331–333 electroencephalography evaluations, 337–339, 338t etiology of, 332–333, 333t evoked potential measurements, 337–338 laboratory tests, 335–338 magnetic resonance angiography evaluations, 336 medical extension of life, 331–332 motor activity, 334 motor responses, 332, 339 neurologic examination, 332 ocular movements in, 334 organ donation considerations, 331 organ survival, 338–339 pitfalls in diagnosis of, 338–339 in profound anesthesia, 338 pupillary findings, 333–334 reflex activity, 334 sensory activity, 334 signs of, 333–335 transcranial Doppler ultrasonography evaluations, 336 vestibulo-ocular responses, 339 Brainstem compression of, 91, 145, 150 lesions of, 30f, 115–116 rostrocaudal deterioration of, 102 trauma to, 116 upper, injury to, 33–34 upward herniation, 102–103 vascular destruction disorders of basilar artery occlusion, 163–166 basilar migraine, 168 brainstem hemorrhage, 166–168 description of, 163 posterior reversible leukoencephalopathy syndrome, 168–169, 169t Brainstem auditory-evoked responses, 354 Brainstem gliomas, 51 Brainstem hemorrhage, 166–168 Brainstem infarction, 165t Brainstem tumors, 170 388
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