ASPECTS OF CEREBRAL METABOLISM PERTINENT
TO COMA 198
CEREBRAL BLOOD FLOW 198
GLUCOSE METABOLISM 202
Hyperglycemia
Hypoglycemia
ANESTHESIA 205
MECHANISMS OF IRREVERSIBLE ANOXIC-ISCHEMIC
BRAIN DAMAGE 206
Global Ischemia
Focal Ischemia
Hypoxia
EVALUATION OF NEUROTRANSMITTER CHANGES IN
METABOLIC COMA 208
Acetylcholine
Dopamine
Gamma-Aminobutyric
Acid
Serotonin
Histamine
Glutamate
Norepinephrine
SPECIFIC CAUSES OF METABOLIC COMA 210
ISCHEMIA AND HYPOXIA 210
Acute, Diffuse (or Global) Hypoxia or Ischemia
Intermittent or Sustained
Hypoxia
Sequelae of Hypoxia
DISORDERS OF GLUCOSE OR COFACTOR AVAILABILITY 220
Hypoglycemia
Hyperglycemia
Cofactor Deficiency
DISEASES OF ORGAN SYSTEMS OTHER THAN BRAIN 224
Liver Disease
Renal Disease
Pulmonary Disease
Pancreatic
Encephalopathy
Diabetes Mellitus
Adrenal Disorders
Thyroid
Disorders
Pituitary Disorders
Cancer
EXOGENOUS INTOXICATIONS 240
Sedative and Psychotropic Drugs
Intoxication With Other Common
Medications
Ethanol Intoxication
Intoxication With Drugs of Abuse
Intoxication
With Drugs Causing Metabolic Acidosis
ABNORMALITIES OF IONIC OR ACID-BASE ENVIRONMENT
OF THE CENTRAL NERVOUS SYSTEM 251
Hypo-osmolar States
Hyperosmolar States
Calcium
Other
Electrolytes
Disorders of Systemic Acid-Base Balance
DISORDERS OF THERMOREGULATION 259
Hypothermia
Hyperthermia
INFECTIOUS DISORDERS OF THE CENTRAL NERVOUS
SYSTEM: BACTERIAL 262
Acute Bacterial Leptomeningitis
Chronic Bacterial Meningitis
INFECTIOUS DISORDERS OF THE CENTRAL NERVOUS
SYSTEM: VIRAL 266
Overview of Viral Encephalitis
Acute Viral Encephalitis
Acute Toxic
Encephalopathy During Viral Encephalitis
Parainfectious Encephalitis
(Acute Disseminated Encephalomyelitis)
Cerebral Biopsy
for Diagnosis of Encephalitis
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Contents
CEREBRAL VASCULITIS AND OTHER VASCULOPATHIES 273
Granulomatous Central Nervous System Angiitis
Systemic Lupus
Erythematosus
Subacute Diencephalic Angioencephalopathy
Varicella-Zoster
Vasculitis
Behc¸et’s Syndrome
Cerebral Autosomal Dominant Arteriopathy
With Subcortical Infarcts and Leukoencephalopathy
MISCELLANEOUS NEURONAL AND GLIAL DISORDERS 276
Prion Diseases
Adrenoleukodystrophy (Schilder’s Disease)
Marchiafava-Bignami
Disease
Gliomatosis Cerebri
Progressive Multifocal Leukoencephalopathy
Epilepsy
Mixed Metabolic Encephalopathy
ACUTE DELIRIOUS STATES 282
Drug Withdrawal Delirium (Delirium Tremens)
Postoperative Delirium
Intensive
Care Unit Delirium
Drug-Induced Delirium
6. PSYCHOGENIC UNRESPONSIVENESS 297
CONVERSION REACTIONS 299
CATATONIA 302
PSYCHOGENIC SEIZURES 304
CEREBELLAR COGNITIVE AFFECTIVE SYNDROME 306
‘‘AMYTAL INTERVIEW’’ 307
7. APPROACH TO MANAGEMENT OF THE UNCONSCIOUS PATIENT 309
A CLINICAL REGIMEN FOR DIAGNOSIS AND MANAGEMENT 309
PRINCIPLES OF EMERGENCY MANAGEMENT 311
Ensure Oxygenation, Airway, and Ventilation
Maintain the Circulation
Measure
the Glucose
Lower the Intracranial Pressure
Stop Seizures
Treat Infection
Restore
Acid-Base Balance
Adjust Body Temperature
Administer Specific Antidotes
Control
Agitation
Protect the Eyes
EXAMINATION OF THE PATIENT 317
Verbal Responses
Respiratory Pattern
Eye Opening
Pupillary
Reactions
Spontaneous Eye Movement
Oculocephalic Responses
Caloric
Vestibulo-Ocular Responses
Corneal Responses
Motor Responses
Tendon
Reflexes
Skeletal Muscle Tone
GUIDES TO SPECIFIC MANAGEMENT 320
Supratentorial Mass Lesions
Infratentorial Mass Lesions
Metabolic
Encephalopathy
Psychogenic Unresponsiveness
A FINAL WORD 327
8. BRAIN DEATH 331
DETERMINATION OF BRAIN DEATH 331
CLINICAL SIGNS OF BRAIN DEATH 333
Brainstem Function
Confirmatory Laboratory Tests and Diagnosis
Diagnosis of
Brain Death in Profound Anesthesia or Coma of Undetermined Etiology
Pitfalls in
the Diagnosis of Brain Death
Contents
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