Plum and posner’s diagnosis of stupor and coma fourth Edition series editor sid Gilman, md, frcp
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Mannitol, 322 Marchiafava-Bignami disease, 278 MDMA, 242t, 248 Mean arterial pressure, 313 Medial longitudinal fasciculus anatomy of, 60f lesions of, 63, 70 Median raphe nuclei, 15 Mediodorsal thalamic nucleus, 28 Medulla, respiratory control by, 49 Memory, 185–186 Meningeal neoplasms, 131 Meningiomas, 127, 144 Meningismus, 40 Meningitis aseptic, 134t aspergillus, 133 bacterial acute, 132–133, 133t, 263 algorithm for, 316f chronic, 133, 265–266 corticosteroids for, 322 regimen for, 325 treatment of, 316f, 322, 325 cephalosporins for, 134 cerebrospinal fluid findings in, 134, 134t in children, 133, 263 chronic, 133, 265–266 community-acquired, 132–133, 133t, 263 computed tomography of, 133–134, 135t corticosteroids for, 134, 322 description of, 80–81 in elderly, 133, 263 imaging of, 135t laboratory tests, 133–134 Listeria, 132 magnetic resonance imaging of, 135t nuchal rigidity associated with, 133 pathogens associated with, 132 pathophysiology of, 131–132 signs and symptoms of, 131 subacute, 133 treatment of, 134 tuberculous, 265 viral, 132 Mental status assessments affect, 186 arousal, 183–184 attention, 185 cognition, 185 Confusion Assessment Method for the Intensive Care Unit, 184t description of, 183–184 memory, 185–186 orientation, 185 pathogenesis of changes, 186 perception, 186 Meropenem, 134 Mesopontine afferents, 14 Mesopontine tegmentum, 14, 19 Metabolic acidosis description of, 258 diagnosis of, 324 drugs that cause, 248–251 hyperventilation and, 188–189, 228 Metabolic alkalosis, 191t, 191–192, 231, 258 Metabolic coma causes of, 210 characteristics of, 324 diagnosis of, 324 hypoglycemia and, 220–222 laboratory tests, 321t neurotransmitter changes in acetylcholine, 208–209 dopamine, 209 gamma-aminobutyric acid, 209 glutamate, 210–211 histamine, 209–210 norepinephrine, 210 serotonin, 209 ocular motor responses in, 76–77 oculocephalic responses in, 76–77 pupillary responses in, 76, 192–193 respiratory responses in, 75–76 structural coma vs., 89, 197–198 Metabolic encephalopathy arousal abnormalities in, 183 asterixis in, 195–197 cerebral symptoms of, 186 delirium associated with, 181, 183 hypoglycemia and, 221 management of, 324–326 memory loss in, 185–186 mental status in affect, 186 arousal, 183–184 attention, 185 cognition, 185 Confusion Assessment Method for the Intensive Care Unit, 184t description of, 183–184 memory, 185–186 orientation, 185 pathogenesis of changes, 186 perception, 186 mixed, 281–282 motor activity abnormalities in, 194–197 multifocal myoclonus in, 197 ocular motility in, 193 pupillary findings, 192–193 pupillary light reflex during, 59 respiratory changes in description of, 187 evaluation of, 187–188 hyperventilation. See Hyperventilation hypoventilation, 191–192 neurologic, 187–188 signs of, 181 tremor of, 195 Metabolic unresponsiveness, 197 Metachromatic leukodystrophy, 114 Metastatic tumors, 141 Methanol intoxication, 249 Methaqualone, 242t Methemoglobin, 324 Midazolam, 323 Midbrain destructive lesions of, 115 dorsal, compression, 90, 110–112 Midbrain hemorrhage, 166t, 167 Index 395
Midbrain stage, of central transtentorial herniation, 107–108 Midpontine destruction, 162 Miller Fisher syndrome, 76, 170 Minimally conscious state akinetic mutism and, 360–362, 361b case study of, 362–363 cerebral metabolic rates in, 374 definition of, 8, 360 diagnostic criteria for, 360t diffusion tensor imaging of, 371f emergence from, 379 functional imaging of, 369–372 late recoveries from, 363, 375 magnetic resonance imaging of, 370f residual cognitive capacity in, 372–376 studies of, 368–372 surrogate decision making in, 379 vegetative state vs., 360 Mixed metabolic encephalopathy, 281–282 Monoamine oxidase inhibitors, 245 Monoaminergic neurons, 15 Monroe-Kellie doctrine, 95 Motor abnormalities, 194–197 Motor examination description of, 72 motor responses, 73–75 motor tone, 72 muscle stretch reflexes, 72–73 Motor responses brain death and, 332 examination of, 73–75, 320 in metabolic coma, 77 Multifocal cerebral ischemia, 215–216 Multifocal myoclonus, 197 Multiple sclerosis, 158 Muscle stretch reflexes, 72–73 Mycotic aneurysms, 140 Myo-inositol, 80 Myorhythmias, 265 Myxedema coma, 236–237 N-Acetylaspartate, 80 Naloxone, 316 Narcolepsy characteristics of, 20b orexin and, 20b–22b Neurogenic pulmonary edema, 190 Neuroleptic malignant syndrome, 261 Neurologic examination, 9, 318–319. See also Examination Neurons, 200, 201f Neurosonography, 80 Neurotransmitters acetylcholine, 208–209 dopamine, 209 gamma-aminobutyric acid, 209 glutamate, 210–211 histamine, 209–210 norepinephrine, 210 serotonin, 209 NK-1 receptors, 52 N-Methyl-D-aspartate, 114, 205 Nonconjugate eye deviation, 70 Nonconvulsive status epilepticus, 281 Nonketotic hyperglycemic hyperosmolality, 256 Non-rapid eye movement sleep description of, 16b–17b flip-flop switching of, 24f switching of, to REM sleep, 24 ‘‘No-reflow phenomenon,’’ 206 Norepinephrine, 210 Nuchal rigidity, 318 Nucleus of the solitary tract, 45 Nystagmoid jerks, 71–72 Nystagmus, 71 Obstructive sleep apnea, 52–53 Obtundation, 6–7 Ocular bobbing, 69t, 71–72, 162 Ocular dipping, 69t, 71–72 Ocular dysmetria, 63 Ocular flutter, 63 Ocular motility, 193 Ocular motor examination abnormal movements, 68–72 description of, 63 eyelids, 64 motility, 64–68 Oculocephalic responses description of, 65, 66f–67f drugs that stimulate, 76 examination of, 319 in metabolic coma, 76–77 Oculogyric crises, 70 Oculomotor nerve anatomy of, 61 course of, 61, 97 impairment of, 70 medial temporal lobe and, 97, 100f posterior communicating artery and, 97, 99
Oculomotor nucleus description of, 61–62 lesion of, 70 Oculomotor system anatomy of, 61–63 central, 61–63 cortical descending inputs to, 62 peripheral, 60–61 Oligodendroglial cells, 198 Oligodendrogliomas, 140–141 Olivary pretectal nucleus, 111 Ondine’s curse, 52–53 Ophthalmoplegia, 63, 76 Opioids/opiates, 242t, 243, 316 Opportunistic infections, 230 Optic disk, 91 Orexin, 18, 20b–22b, 115 Orientation assessments, 185 Orthostatic hypotension, 46 Osmolality definition of, 251 expression of, 251, 253 Otitic hydrocephalus, 154 Outcomes. See also Prognosis factors that affect, 349 Glasgow Outcome Scale, 344, 344t mechanisms underlying, 364–365 nontraumatic coma, 347–355 396 Index
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