Plum and posner’s diagnosis of stupor and coma fourth Edition series editor sid Gilman, md, frcp
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Breathing abnormalities of, 46t, 46–47 apneustic, 51–52 ataxic, 50f, 52 cluster, 50f Kussmaul, 75–76 physiology of, 47–48 rhythmic, 49 Bremer, Frederic, 12 Brudzinski’s sign, 40, 263 Burst neurons, 13b Calcium abnormalities hypercalcemia, 256–257 hypocalcemia, 257–258 Caloric vestibulo-ocular responses, 65, 68 Canavan’s disease, 114 Cancer, 238–240 Carbon dioxide narcosis, 231 Cardiopulmonary arrest coma after outcomes, 352 pitfalls in evaluation of, 354–355 mortality rates for, 343 Cardiopulmonary bypass surgery, 218 Cardiopulmonary resuscitation, 206–207, 207f Carotid ischemic lesions, 152 Case law, 376–377 Cataplexy, 20b Catatonia, 299, 302–304, 303t Central homunculus, 27 Central Horner’s syndrome, 57–58 Central nervous system infections acute bacterial leptomeningitis, 262–265 diagnosis of, 262 differential diagnosis, 270t prognosis after, 356 Central neurogenic hyperventilation, 50f, 51 Central pontine myelinolysis, 171 Central sleep apnea, 52 Central transtentorial herniation clinical findings of, 107–110 description of, 101–102 diencephalic stage of, 107–108, 108f–109f medullary stage of, 109 midbrain stage of, 107–108 pontine stage of, 108–109 Central venous thrombosis, 169t Cerebellar abscess, 149–150, 150t Cerebellar cognitive affective syndrome, 306–307 Cerebellar hematoma, 323 Cerebellar hemorrhage algorithm for, 148f brainstem compression by, 145 clinical findings of, 146t computed tomography findings, 147 description of, 138b–139b hypertension and, 145–146 surgical interventions for, 147, 148f Cerebellar infarction, 139b, 148–149, 324 Cerebellar mass, 91 Cerebellar mutism, 306 Cerebellar tonsils, 100 Cerebellar tumors, 91, 150 Cerebellopontine angle lesion, 91 Cerebral angiography, 335–336 Cerebral artery infarction, 153f Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, 168, 276 Cerebral biopsy, 273 Cerebral blood flow brain death evaluations, 335–336 during cardiac arrest, 206 hypoglycemia effects on, 204 hypoxia effects on, 211 increases in, 45 during neural activity, 198, 200 normal levels of, 198 reductions in causes of, 200 in clouding of consciousness, 6 global, 200 loss of consciousness caused by, 201 regional, 200 regulation of, 43, 202 Cerebral cortex description of, 25 diffuse, bilateral destruction of, 114 hypoxia effects on, 31f Cerebral edema, 263 Cerebral glucose consumption, 204 Cerebral herniation, 263–265 Cerebral ischemia, multifocal, 215–216 Cerebral malaria, 217 Cerebral metabolic rate description of, 204 in minimally conscious state patients, 374 Cerebral metabolism, 374–375 Cerebral oxygen consumption, 6 Cerebral perfusion pressure decreased, 93 description of, 43, 45 intracranial pressure effects on, 93 Cerebral scintigraphy, 336 Cerebral vascular lesions, 137, 138b–139b Cerebral venous hypoxia, 211 Cerebrospinal fluid in herpes simplex encephalitis, 268 herpes simplex encephalitis findings, 157, 157t lumbar puncture evaluations, 81–82 meningitis findings, 134, 134t obstruction of, 91 subarachnoid hemorrhage evaluation, 130 systemic lupus erythematosus findings, 275 Cerebrospinal fluid pressure, 92 Cerveau isole, 12 Chemoreceptors, 188 Cheyne-Stokes respiration, 49–51, 50f, 75, 187 Chloromas, 144 Choline, 80 Cholinergic neurons, 15 Chronic liver failure, 224 Chronic meningitis, 133, 265–266 Chronic relapsing pancreatitis, 231 Chronic subdural hematoma, 123–124 Ciliospinal reflex, 54, 57, 59 Circulatory assessments, 313 Closed head traumatic brain injury, 159–161 Index
389 Clouding of consciousness cerebral oxygen consumption reductions associated with, 6 definition of, 6 Cluster breathing, 50f Cocaine, 210, 242t Cofactor deficiency, 223–224 Cognition, 185, 373 Cognitive deficits, 7 Cold caloric stimulation, 193 Collier’s sign, 64 Coma
causes of, 4t definition of, 7 depth of, 7 diagnosis of, 9, 309–311 drug-induced causes of. See Drug intoxications duration of, 346, 349 history-taking, 9 hypoglycemic, 210 locked-in syndrome vs., 7 metabolic. See Metabolic coma premonitory causes of, 39–40 prognosis in, 343–344 sleep vs., 5, 25 structural. See Structural coma thalamic causes of, 33 Coma cocktail, 316 Coma of unknown origin, 332, 338 Coma scales description of, 41b FOUR Score, 41b, 311 Glasgow Coma Scale. See Glasgow Coma Scale Community-acquired meningitis, 132–133, 133t Compressive lesions angiogenesis caused by, 94 arousal system affected by, 90 consciousness impairments caused by, 88–90 diencephalon, 90 infratentorial, 142–143 local tissue ischemia induced by, 94 mechanism of action, 89–90 midbrain, 90 posterior fossa, 90–91 sites of, 89t supratentorial, 120 types of, 121t Computed tomography brain abscess findings, 142f cerebellar hemorrhage findings, 147 description of, 78, 79f epidural hematoma findings, 122f hepatic encephalopathy evaluations, 225 intracerebral hemorrhage findings, 136f meningioma evaluation, 127 meningitis evaluations, 133–134, 135t subarachnoid hemorrhage findings, 130, 130f subdural hematoma evaluations, 125, 125f supratentorial mass lesion evaluations, 321 Computed tomography angiography, 78 Concussion, 161 Confusion Assessment Method for the Intensive Care Unit, 184t Conjugate lateral deviation, 69–70 Conjugate vertical deviation, 70 Consciousness altered state of. See Altered state of consciousness clouding of, 6 components of, 5 content of, 5 definition of, 5 loss of. See Loss of consciousness Convergence nystagmus, 71 Conversion hysteria, 299 Conversion reactions, 299–302 Corneal erosions, 317 Corneal reflex, 64 Corneal responses, 64, 320 Corneal trauma, 64 Cortical blindness, 77 Corticosteroids Cushing’s syndrome treated with, 235–236 in diabetes mellitus patients, 233 herniation treated with, 322 meningitis treated with, 134, 322 Coup-contrecoup injury, 159 Craniopharyngiomas, 128 Creatine, 80 Creutzfeldt-Jakob disease, 266, 277 Cushing reflex, 44, 97b Cushing’s disease, 236 Cushing’s syndrome, 235–236 Cutaneous reflexes, 72 Cytotoxic edema, 94f, 95 Decerebrate rigidity, 74–75, 77, 324 Decompressive craniotomy, 152, 323 Decorticate rigidity, 74, 77, 324 Delayed encephalopathy, 161–162, 219 Delirium
acute states, 282–284 with agitation, 6, 317 ‘‘Amytal interview’’ for, 307–308, 327 attention disorders in, 185 characteristics of, 181 definition of, 6 dementia and, 8 drug withdrawal, 283 drug-induced, 284 electroencephalogram evaluations, 304 intensive care unit, 283–284 postoperative, 283 signs and symptoms of, 6 Delirium tremens, 283 Delusions, 6 Dementia, 7–8 Depressant drug coma, 241, 245t, 357 Descending sympathoexcitatory pathways, 44 Destructive lesions description of, 88, 114 infratentorial, 162–163 sites of, 89t supratentorial. See Supratentorial destructive lesions types of, 121t 390
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