Plum and posner’s diagnosis of stupor and coma fourth Edition series editor sid Gilman, md, frcp
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Desynchronized sleep, 16b Dexamethasone, 322 Diabetes mellitus autonomic neuropathy caused by, 234 coma in, 232t definition of, 232 hyperglycemia in, 233–234 hyperosmolality in, 232 hypoglycemia in, 234 renal insufficiency caused by, 234 stupor in, 232t Diabetic encephalopathy, 222 Diabetic ketoacidosis, 187, 232–234, 309 Diabetic lactic acidosis, 233 Dialysis disequilibrium syndrome, 229 Diencephalic stage, of central transtentorial herniation, 107–110, 108f–109f Diencephalon autoimmune disorders that affect, 115 compression of, 90 destruction disease of, 114–115 injuries to description of, 32–33 pupillary responses after, 58 lateral displacement of, 97b, 100 lesions of, 88 Diffuse axonal injury, 161 Diffusion tensor imaging, 371f Dipping, ocular, 69t, 71–72 Disorientation, 185 Disseminated intravascular coagulation, 217 Distal basilar occlusion, 152–154 Distractibility, 185 Do not resuscitate order, 376 Doll’s eye response in catatonia, 303 in central transtentorial herniation, 108f–109f definition of, 65 Dopamine, 209 Dorsal midbrain compression, 102, 110–112
Dorsal raphe nuclei, 15 Drop attacks, 213–214 Drowning, 260 Drug intoxications. See also Overdoses acetaminophen, 245, 326 antidepressants, 241, 245–246 antidotes for, 251t benzodiazepines, 242t, 245 evaluation of, 324 heroin, 243 list of, 242t management of, 326 opioids/opiates, 242t, 243 overview of, 240, 240t proconvulsants, 247t prognosis after, 357 sedatives, 240–241, 243–245 testing for, 240, 241t Drug withdrawal delirium, 283 Drug-induced delirium, 284 Drunkenness. See Ethanol intoxication Dural tumors, 120, 127, 144 Duret hemorrhages, 102, 103f Edinger-Westphal nucleus, 56–57 Elderly cerebellar infarction in, 148 hyperglycemia in, 222 meningitis in, 133, 263 traumatic brain injury in, 345 Electrocerebral inactivity, 337 Electroencephalography alpha pattern, 82 brain death determinations, 337–339, 338t catatonia evaluations, 304 delirium evaluations, 304 history of, 12 indications for, 82 sinusoidal appearance, 13b traumatic brain injury-related abnormalities, 346 Electromyogram, 16b Embolism to brain, 218 from cardiopulmonary bypass surgery, 218 fat, 217–218 pulmonary, 214 Empyema, 126–127, 144 Encephale isole, 12 Encephalitis, viral acute, 266–269 acute toxic encephalopathy during, 266, 269–271 cerebral biopsy for, 273 classification of, 266 description of, 156–157, 157t herpes simplex encephalitis, 157, 157t, 267–269, 315 overview of, 266–267 parainfectious encephalomyelitis, 266, 271–273 Encephalitis lethargica, 12 Encephalomyelitis, acute disseminated, 157–158 Encephalopathy delayed postanoxic, 219 diabetic, 222 Hashimoto’s, 237 hepatic
diagnosis of, 225 hyperventilation associated with, 224 mild, 227 onset of, 224 pathology of, 224 pupillary findings in, 225 hypernatremic, 256 hyponatremic, 254t hypoxic-ischemic, 352–354 metabolic. See Metabolic encephalopathy pancreatic, 231–232 pulmonary, 231 toxic, 262, 266, 269–271 uremic, 227–229 Wernicke’s causes of, 223 description of, 11 thiamine prophylaxis, 77, 223, 313 End artery hemorrhages, 137, 139 Epidural abscess, 126–127, 144 Epidural hematoma, 121–123, 143–144 Epilepsy, 280–281, 315 Epileptic seizures, 213–214, 304–306 Ethanol intoxication, 246, 248 Index 391
Ethylene glycol, 250 Evoked potentials brain death determinations, 337–338, 338t description of, 82–83 somatosensory in anoxic-ischemic encephalopathy, 354t description of, 346 vegetative state evaluations, 359–360 Examination airway, 42–43 circulation, 43–46 coma scales. See Coma scales corneal responses, 320 eye opening, 319 history-taking, 39–40, 317–318 motor responses, 320 neurologic, 9, 318–319 oculocephalic responses, 319 overview of, 38–39, 39t physical, 40 pupillary reactions, 319 respiration. See Respiration skeletal muscle tone, 320 tendon reflexes, 320 of unconscious patient, 317–320 verbal responses, 319 vestibulo-ocular responses, 65, 320 Excitatory amino acids, 114 Extradural hematoma, 309–310 Eye(s)
conjugate lateral deviation, 69–70 conjugate vertical deviation, 70 nystagmoid jerks of, 71–72 opening of, 319 Eye movements in brainstem infarcts, 165t conjugate lateral deviation, 69–70 conjugate vertical deviation, 70 nonconjugate eye deviation, 70 oculocephalic stimulation of, 65 pathways for, 60f periodic alternating, 71 resting, 69 roving, 70–71 skew deviation, 70 spontaneous, 69, 69t Eyelids, 64 Falcine herniation, 100 Falx cerebri, 95–96, 96f–97f Families
considerations for, 379–380 functional communication with, 380 Fat embolism, 217–218 Fatal familial insomnia, 115, 277–278 Fever, 260–261, 282–283 Flumazenil, 316 Flunitrazepam, 248 Focal continuous epilepsy, 315 Focal ischemia, 207–208 Foramen magnum, 100 Forced duction of globe, 68 Forebrain arousal of, 14 mesopontine tegmentum, 14 Foster-Kennedy syndrome, 92 FOUR Score, 41b, 311 14–3–3, 277 Fourth ventricle compression, 148 Fractional loss of consciousness, 5, 27 Frontal eye fields, 62 Frontoparietal hemorrhage, 138b GABA
A receptors, 18b, 209, 246 Gag reflex, 334 Galvanic stimulation, 65 Gamma-aminobutyric acid, 209 Gamma-aminobutyric acid-ergic neurons, 205 Gamma-hydroxybutyrate, 209 Gastric lavage, 326 General anesthesia description of, 205–206 malignant hyperthermia associated with, 262 Gerstmann-Strau¨ssler disease, 277 GHB, 248
Glasgow Coma Scale description of, 42b in traumatic brain injury prognosis, 345, 345t Glasgow Outcome Scale, 344, 344t Glia, 198 Glial fibrillary acidic protein, 347 Gliomas, 140–141 Gliomatosis cerebri, 278–279 Global ischemia, 206–207 Globe forced duction of, 68 lateral movement of, 60–61 Globus pallidus, 28 Glucagon-like peptide-1, 53 Glucose
brain utilization of, 202 cerebral consumption of, 204 deprivation of, 202 measurement of, 313 metabolism of, 202–205 Glucose disorders hyperglycemia, 203, 222–223, 313 hypoglycemia, 203–205, 220–222, 313 Glut-1, 202 Glutamate, 80, 210–211, 223 Glutamine, 80 Glutethimide, 59 Gnosis, 186 Granulomas, 141–142 Granulomatous angiitis, 156, 273–274 Grasp reflex, 72 Great vein of Galen, 102 Guillain-Barre´ syndrome, 76–77, 170 Hallucinations, 6 Hashimoto’s encephalopathy, 237 Headaches increased intracranial pressure as cause of, 92 in infratentorial mass lesions, 323 in subdural hematoma, 124 supratentorial mass lesions and, 320 Heart rate, 45 Heatstroke, 260–261 392
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