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Disorders of consciousness are common:there always signify a disorder of the nervous system.Assesment should determine whether there is change in level of conciousness(drowsy,stuporous,comatous)and/or content of conciousness (confusion,perseveration,hallucinations).Confusion is a lack of clarity in thinking with inattentiveness;stupor,a state in vigorous stimuli are needed to elicit a response;coma,a condition of unresponsiveness.Patients in such states are usually seriously ill,and etiologic factors must be assessed.

 

Different Diagnosis of Coma

1.Diseas that cause no focal or lateralizing neurologic sign,usually with normal brainstem function;CT scan and cellular content of the CSF are normal.

-Intoxications:alcohol,sedative drugs,opiates,etc

-Metabolic disturbances:anoxya,hyponatremia,hypernatremia,hypercalcemia,diabetic acidosis,nonketotic hyperosmolar hyperglycemia,hypoglycemia,uremia,hepatic coma,hypercarbia,addisonian crisis,hypo-hypertyroid states,profound nutritional deficiency

-Severe systemic infections: pneumonia,septicemia,typhoid fever,malaria,Waterhouse-Friderichsen syndrome

-Shock from any cause

-Post seizure states,status epilepticus,subclinical epilepsy

-Hypertensive encephalopathy,eclampsia

-Severe hypernatremia,hypotermia

-Concussion

-Acute hydrocephalus

 

2.Diseases that cause meningeal irritation with or without fever,and with an excess of WBCs or RBCs in the CSF,usually without focal or lateralizing cerebral or brainstem signs; CT or MRI show no mass lession

-Subarachnoid hemorrhage from ruptureed aneurysm,Arteriovenous malformation,trauma

-Acute bacterial meningitis

-Viral encephalitis

Miscellaneous:Fat embolism,cholesterol embolism,carcinomatous and lymphomatous meningitis,etc

 

3.Diseases that causefocal brainstem or lateralizing cerebral sign,with or without changes in the CSF;CT and MRI are abnormal.

-Hemispheral hemorrhage (basal ganglionic,thalamic) or infarction (large middle cerebral artery territory) with secondary brainstem compression

-Brainstem infarction due to basilar artery trombosis or embolism

-Brain abcess,subdural empyema

-Epidural and subdural hemorrhage,brain contusion

-Brain tumor with surrounding edema

-Cerebellar and pontine hemorrhage and infarction

-Widespread traumatic brain injury

-Metabolic coma with pre existing focal damage

-Miscelaneous:cortical vein thrombosis,herpes simplex encephalitis,multuple cerebral emboli due to bacterial endocarditis,acute hemorrhagic leukoencephalitis,acute disseminated (post infectious),encephalomyelitis,thrombotic thrombocytopenic purpura,cerebral vasculitis,gliomatosis cerebri,pituitary apoplexy,intravascular lymphoma