Plum and posner’s diagnosis of stupor and coma fourth Edition series editor sid Gilman, md, frcp
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Hematoma epidural, 121–123, 143–144 subdural description of, 123–126, 124t posterior fossa, 144 Hemiparesis, 101, 106 Hemodialysis, for uremia, 229 Hemorrhage brainstem, 166–168 cerebellar. See Cerebellar hemorrhage intraventricular, 137 lobar, 136, 136f midbrain, 166t, 167 perimesencephalic, 145 pontine clinical findings of, 167t coma caused by, 167 description of, 138b, 150–151 origin of, 167 pupillary findings, 167 subarachnoid description of, 129–131, 139b grading system for, 356t outcomes after, 355–356 posterior fossa, 145 thalamic, 137, 138b, 139 into tumors, 140 Hepatic coma description of, 190, 225 prognosis for, 356–357 Hepatic encephalopathy diagnosis of, 225 hyperventilation associated with, 224 mild, 227 onset of, 224 pathology of, 224 pupillary findings in, 225 Herniation syndromes central transtentorial herniation, 101–102, 107–110 corticosteroids for, 322 falcine herniation, 100 historical view of, 97b intracranial compartments, 95–100 lateral displacement of the diencephalon, 97b, 100 Monroe-Kellie doctrine, 95 rostrocaudal brainstem deterioration, 102 tonsillar, 102, 103f–104f uncal. See Uncal herniation upward brainstem herniation, 102–103 Heroin, 243 Herpes simplex encephalitis, 157, 157t, 267–269, 315 Herpes zoster, 275–276 Herring-Breuer reflex, 49 Hiccupping, 53 Hippocampus bilateral, 31–32 CA1 region of, 30 Histamine, 209–210 Histidine decarboxylase, 18, 209 History-taking, 39–40, 317–318 Histotoxic hypoxia, 211 Horner’s syndrome central, 57–58 clinical features of, 55 peripheral, 58 Hyperarousal, 183–184 Hyperbaric oxygenation, 325 Hypercalcemia, 256–257 Hypercarbia, 230 Hyperglycemia, 203, 222–223, 234, 313 Hyperglycemic hyperosmolar coma, 256 Hyperkinetic movement disorders, 28 Hypermagnesemia, 258 Hypernatremia, 255–256 Hypernatremic encephalopathy, 256 Hyperosmolality, 232 Hyperosmolar agents, 321–322 Hyperosmolar states, 255–256 Hyperphosphatemia, 258 Hypersomnia, 8 Hyperthermia, 260–262, 315 Hyperthyroidism, 237 Hyperventilation acid-base imbalances with metabolic acidosis, 188–189 respiratory alkalosis, 189–191, 190t in comatose patients, 51 in hepatic encephalopathy, 224 intracranial pressure reduced with, 321 sepsis and, 190 Hypocalcemia, 257–258 Hypocretin, 21b, 115. See also Orexin Hypoglycemia, 203–205, 234, 313 Hypomagnesemia, 258 Hyponatremia, 228–229, 237, 252f, 253–255 Hyponatremic encephalopathy, 254t Hypo-osmolar states, 253–255 Hypophosphatemia, 258 Hypothalamic ischemic lesions, 33 Hypothermia, 259–260, 315, 335 Hypothyroidism, 236–237 Hypoventilation, 191–192, 230 Hypoxia acute, 211–214 airway obstruction and, 211 anemic, 211 anoxic-ischemic brain damage caused by, 208 carbon dioxide narcosis and, 231 causes of, 210–211 cerebral malaria and, 217 cerebral venous, 211 delayed postanoxic encephalopathy after, 219 disseminated intravascular coagulation and, 217 fat embolism and, 217 histotoxic, 211 hypoxic, 211 intermittent, 215–219 ischemic, 211 multifocal cerebral ischemia and, 215–216 pupillary responses in, 59 sequelae of, 219–220 sustained, 215–219 traumatic brain injury and, 346 Hypoxic inducible factor, 212 Hypoxic-ischemic attacks, 212 Hypoxic-ischemic encephalopathy, 352–354 Hysteresis, 50–51 Index 393
Immunosuppression, 229–230 Infarction brainstem, 165t cerebellar, 139b, 148–149, 324 cerebral artery, 153f thalamic, 154 Wallenberg’s lateral medullary, 59 Infection central nervous system. See Central nervous system infections opportunistic, 230 prion, 266, 277–278 subarachnoid, 131–135 treatment of, 315 Infratentorial inflammatory disorders, 169–170 Infratentorial lesions compressive, 142–143 destructive, 162–163 mass, 323–324 Infratentorial tumors, 170 Insulin, 202 Intensive care unit delirium, 283–284 Intention myoclonus, 220 Intermittent hypoxia, 215–219 Internuclear ophthalmoplegia, 63, 76 Interstitial nucleus of Cajal, 62 Intoxication. See also Drug intoxications drugs of abuse, 248 ethanol, 246, 248 methanol, 249 paraldehyde, 249–250 Intracerebral hemorrhage computed tomography of, 136f lobar hemorrhage, 136, 136f pathophysiology of, 135–136, 139–140 treatment of, 137 Intracerebral tumors, 140–141 Intracranial compartments, 95–100 Intracranial hypertension, 321, 323 Intracranial pressure, increased abducens palsy caused by, 113 cerebral arterial supply impairment secondary to, 92 compensatory mechanisms of brain to, 92–93 headaches caused by, 92 hyperventilation for, 321 papilledema caused by, 91–92 paroxysmal symptoms caused by, 93t patient positioning, 312 reduction of, 321 Intraventricular hemorrhage, 137 Intubation, 311–312 Ischemia focal, 207–208 global, 206–207 vertebrobasilar, 213 Ischemic anoxia, 212 Ischemic hypoxia, 211 Ischemic lesions, carotid, 152 Kernig sign, 133, 263 Kernohan’s notch, 101 Ketamine, 248 Ketone bodies, 202 Kussmaul breathing, 75–76 Laboratory tests blood tests, 77 computed tomography. See Computed tomography computed tomography angiography, 78 electroencephalography, 82–83 evoked potentials, 82–83 lumbar puncture. See Lumbar puncture magnetic resonance angiography, 79, 336 magnetic resonance imaging. See Magnetic resonance imaging magnetic resonance spectroscopy, 79–80 neurosonography, 80 urine tests, 77 Lactate, 80, 203 Lactic acidosis, 233, 250 Lateral displacement of the diencephalon, 97b, 100 Lateral rectus muscle, 60–61 Lateral sinus thrombosis, 92, 154 Lazarus sign, 334 Leptomeningeal tumors, 131 Leptomeningitis, 262–265 Level of consciousness determination of, 5, 9 evaluation of, 40, 42 reduced, 5 Libman-Sachs endocarditis, 274 Lipid peak, 80 Listeria meningitis, 132 Listeria monocytogenes, 116, 170, 263, 315 Lithium, 242t, 245–246 Liver failure acute, 224 chronic, 224 Lobar hemorrhage, 136, 136f Locked-in syndrome/state, 7, 363–364, 380 Locus coeruleus, 15 Loss of consciousness from cerebral blood flow reductions, 201 in concussion, 161 fractional, 5, 27 Lower motor neuron palsy, 113 Lumbar puncture description of, 80–82 safety of, 112–113 in subdural hematoma patient, 126 Magnetic resonance angiography, 79, 336 Magnetic resonance imaging description of, 78–79 fat embolism evaluations, 217–218 hepatic encephalopathy evaluations, 225, 226f herpes simplex encephalitis findings, 158f Marchiafava-Bignami disease evaluations, 278 meningeal tumors, 132f meningioma evaluation, 127 meningitis evaluation, 135t, 264f minimally conscious state findings, 370f progressive multifocal leukoencephalopathy evaluations, 280f subarachnoid hemorrhage findings, 130 subdural hematoma evaluations, 125 Magnetic resonance spectroscopy, 79–80 Malaria, cerebral, 217 Malignant hyperthermia, 262 Malingering, 299–300 394 Index
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