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Consciousness obstacle

disease

This entry is made by Compilation and application of scientific encyclopedia entries of "Science Popularization China" authentication.

Consciousness refers to the individual's confirmation of the external environment, his own situation and their interrelationship. Consciousness activities include awakening and Consciousness content Two aspects. When Uplink reticular activation system and cerebral cortex The extensive damage of cerebral cortex can lead to the disorder of different levels of arousal, and the change of consciousness content is mainly caused by cerebral cortex lesions.

TCM disease name

Foreign name

Consciousness Disorders

Visiting department

Department of Neurology and Psychiatry

Common causes

Cerebrovascular diseases, brain trauma, intracranial space occupying lesions, diffuse brain lesions, seizures, and systemic diseases

common symptom

Blurred consciousness, drowsiness, lethargy, delirium, coma, etc

Science popularization in China

Committed to authoritative science communication

The certification expert of this term is

Ma Tao | Deputy chief physician

Department of Neurology, Wuxi Second People's Hospital to examine

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essential information

TCM disease name: Consciousness obstacle
Foreign name: Consciousness Disorders
Visiting department: Department of Neurology and Psychiatry

Common causes: Cerebrovascular diseases, brain trauma, intracranial space occupying lesions, diffuse brain lesions, seizures, and systemic diseases
common symptom: Blurred consciousness, drowsiness, lethargy, delirium, coma, etc

pathogeny

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1. Intracranial diseases

(1) Localized lesion ① Cerebral vascular disease cerebral hemorrhage 、 cerebral infarction Temporary cerebral ischemia Attack, etc.; ② Intracranial space occupying lesion Primary Or transferability Intracranial tumor 、 brain abscess 、 Cerebral granuloma , Brain parasite cyst Etc.; ③ Craniocerebral trauma Contusion and laceration of brain 、 intracranial hematoma Etc.

(2) Brain Diffuse Lesion ① Intracranial Infectivity Disease; various encephalitis 、 meningitis 、 Arachnoiditis , ependyma Membranitis Intracranial venous sinus Infection, etc.; ② Diffuse craniocerebral injury ；③ Subarachnoid hemorrhage ；④ Cerebral edema ；⑤ Brain degeneration and Demyelinating lesion 。

（3） Epilepsy

2. Systemic diseases

(1) Acute infectious disease various septicemia 、 Infectious toxic encephalopathy Etc.

(2) Endocrine and Metabolic disease as hepatic encephalopathy 、 Renal encephalopathy 、 Pulmonary encephalopathy 、 Diabetic coma 、 Myxedematous coma 、 pituitary crisis 、 Thyroid crisis 、 Adrenocortical hypofunction Sexual coma Lactic acidosis Etc.

（3） Exogenous Poisoning includes Industrial poison , drug, pesticide, plant or animal poisoning, etc.

(4) Lack of normal metabolic substances ① Oxygen deficiency. ② ischemia 。③ hypoglycemia 。

(5) Disturbance of water and electrolyte balance

(6) Physical damage Such as sunstroke Heat stroke 、 Electrical injury , drowning, etc.

clinical manifestation

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（1） Change in arousal

one Lethargy

The early manifestation of consciousness disorder, the patient often falls asleep, can be awakened, after waking up, the consciousness is basically normal, and continues to fall asleep after stopping the stimulation.

2 Sleeping

The patient is in a deep sleep. Generally, external stimuli cannot be awakened or answered. Stronger stimuli can have short duration Consciousness , you can answer questions briefly after waking up, and enter quickly when the stimulus is weakened Sleep state 。

3. Coma

The conscious activity is completely lost, unable to perceive various external stimuli or their own internal needs. There may be unconscious activities, and no stimulus can be awakened. Press Stimulus response And reflective activity can be divided into three degrees:

（1） Light coma Loss of random activities, response to pain stimuli, various Physiological reflex (Swallowing cough 、 Corneal reflex , pupillary response to light, etc.), and there is no obvious change in temperature, pulse and respiration.

（2） Moderate coma No response to general external stimuli, and strong pain stimuli can be seen Defensive reflex Activity, corneal reflex weakened or disappeared, Respiratory rhythm Disturbance, visible Periodic respiration Or central nervous Hyperventilation 。

（3） Deep coma Random activities completely disappear, no response to various stimuli, and various physiology Reflection disappears , irregular breathing, decreased blood pressure incontinence , whole body Muscle relaxation , decapitated ankylosis, etc.

(II) Consciousness content change

one Vagueness of consciousness

The patient has obvious obstacles in time, space and character orientation, incoherent thinking, often answers irrelevant questions, illusions can be prominent, and illusions are rare, Apathy 。

two Delirium

yes objective environment Cognitive ability level of reaction capacity All have declined, and their attention is lax, Disorientation ， Speech increase , incoherent thinking, often accompanied by awakening—— Sleep cycle Disorder.

3. Quasi coma state

Many different behavioral states can be similar to or confused with coma. Moreover, patients who started out as coma can gradually develop into one of these states after a different time. These behavior states mainly include: Locked in syndrome Also known as loss of efferent state persistence Vegetative state 、 Immobile mutism 、 Lack of will Symptoms Catatonia , False coma. Once the patient has a sleep wake cycle, the real coma no longer exists. Identification of these states from true coma, and proper treatment and judgment prognosis Is important.

inspect

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1. Determine if there is a conscious disorder.

2. Common methods to determine the degree or type of consciousness obstacle are:

(1) Clinical classification It is mainly to give speech and various stimuli, and observe the patient's reaction to judge. Such as calling his name, pushing and shaking his shoulder and arm, pressing the supraorbital notch acupuncture Skin, talking with them and asking them to perform purposeful actions.

(2) Glasgow Coma Scale This method is mainly based on the answer to eye opening, speech stimulation and command action to evaluate the degree of consciousness barrier.

3. Determine the cause of consciousness disorder.

4. Disordered consciousness Diagnostic procedures 。

(1) Focus on neurological signs and Meningeal irritation sign Pay attention to temperature, respiration, pulse, blood pressure, pupil, sclera, face, lip color, mouth and ear conditions, breath smell, etc.

（2） laboratory examination as Hemogram 、 veinal blood , urine, anal finger, stomach content Chest X-ray 、 electrocardiogram , ultrasonic cerebrospinal fluid , cranial radiography CT and MRI Etc.

treatment

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one Etiological treatment

as brain tumor Surgical resection diabetes use insulin Supplement sugar for hypoglycemia, detoxification for poisoning, etc.

two Symptomatic treatment

(1) Keep respiratory tract Smooth, give oxygen and inject respiratory center stimulants, if necessary Tracheotomy Or intubation with artificial respiration.

(2) Maintain effective circulatory function, give cardiotonic and pressor drugs, and correct shock.

(3) Yes Increased intracranial pressure Give dehydration and intracranial pressure reducing drugs, such as Corticosteroids 、 mannitol 、 Furosemide Isodiuresis Dehydrating agent Etc. Ventricular puncture and drainage should be performed when necessary.

(4) Antibacterial Drug prevention Infected.

(5) Control hypertension and hyperthermia.

(6) Control convulsions.

(7) Correction Water electrolyte balance Disorder, Supplemental nutrition 。

(8) Give brain metabolism accelerator 。 Awakening agent, etc. The former is as follows ATP 、 Coenzyme A 、 CDP choline Etc., the latter such as Chlorphenidate 、 Wake up your head and calm down Etc.

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