Plum and Posner's Diagnosis and Treatment of Stupor and Coma

Description

Cover Series PLUM AND POSNER’S DIAGNOSIS AND TREATMENT OF STUPOR AND COMA Copyright Contents Preface to the Fifth Edition 1. Pathophysiology of Signs and Symptoms of Coma Altered States of Consciousness Definitions Consciousness Subacute or Chronic Alterations of Consciousness Approach to the Diagnosis of the Comatose Patient Physiology and Pathophysiology of Consciousness and Coma The Ascending Arousal System Structural Lesions that Cause Altered Consciousness in Humans 2. Examination of the Comatose Patient Overview History General Physical Examination Level of Consciousness ABC: Airway, Breathing, Circulation Respiration Pupillary Responses Examine the Pupils and Their Responses Metabolic and Pharmacologic Causes of Abnormal Pupillary Response Oculomotor Responses Motor Tone Motor Responses False Localizing Signs in Patients with Metabolic Coma Respiratory Responses Major Laboratory Diagnostic Aids Blood and Urine Testing 3. Structural Causes of Stupor and Coma Compressive Lesions as a Cause of Coma Compressive Lesions May Directly Distort the Arousal System Compression at Different Levels of the Central Nervous System Presents in Distinct Ways Herniation Syndromes: Intracranial Shifts in the Pathogenesis of Coma False Localizing Signs in the Diagnosis of Structural Coma Destructive Lesions as a Cause of Coma 4. Specific Causes of Structural Coma Introduction Supratentorial Compressive Lesions Epidural, Dural, and Subdural Masses Epidural Hematoma Dural and Subdural Tumors Subarachnoid Lesions Subarachnoid Hemorrhage Subarachnoid Infection Intracerebral Masses Intracerebral Hemorrhage Brain Abscess and Granuloma Infratentorial Compressive Lesions Epidural and Dural Masses Epidural Hematoma Subdural Posterior Fossa Compressive Lesions Subdural Empyema Subdural Tumors Subarachnoid Posterior Fossa Lesions Intraparenchymal Posterior Fossa Mass Lesions Cerebellar Hemorrhage Pontine Hemorrhage Supratentorial Destructive Lesions Causing Coma Vascular Causes of Supratentorial Destructive Lesions Carotid Ischemic Lesions Vasculitis Infections and Inflammatory Causes of Supratentorial Destructive Lesions Viral Encephalitis Acute Disseminated Encephalomyelitis Concussion and Other Traumatic Brain Injuries Delayed Encephalopathy After Head Injury Infratentorial Destructive Lesions Brainstem Vascular Destructive Disorders Brainstem Hemorrhage Posterior Reversible Leukoencephalopathy Syndrome Infratentorial Inflammatory Disorders Infratentorial Tumors Central Pontine Myelinolysis 5. Metabolic and Diffuse Encephalopathies: Disruption of the Internal Milieu Part 1: Distinguishing Metabolic from Structural Coma Key Features of the Neurological Examination in Metabolic Encephalopathies Part 2: The Internal Milieu: An Overview of Cerebral Metabolism and the Environment Necessary to Maintain Normal Neuronal Function Cerebral Blood Flow, Oxygen, and Glucose Utilization Synaptic Environment in the Brain and Seizures Part 3: Disorders of the Internal Milieu: Lack of Substrate Cerebral Hypoxia and Ischemia Part 4: Disorders of the Internal Milieu: Ionic and Osmotic Environment Hyperglycemic Hyperosmolar State Part 5: Disorders of the Internal Milieu: Hormonal and Temperature Hypothyroidism Hyperthermia Part 6: Disorders of the Internal Milieu: Electrical Environment Seizure Disorders Cortical Spreading Depression Part 7: Disorders of the Internal Milieu: Abnormal CSF Pressure or Constituents Part 8: Disorders of Endogenous Toxins Hypercarbia Autoimmune Disorders: Specific Antibodies Part 9: Disorders of Exogenous Toxins 6. Psychogenic Unresponsiveness Conversion Reactions Catatonia Psychogenic Seizures Cerebellar Cognitive Affective Syndrome “Amytal Interview” 7. Initial Management of Patients with Stupor and Coma A Clinical Regimen for Diagnosis and Management Algorithm and Principles of Emergency Management History, Exam, and Basic Diagnostics Skeletal Muscle Tone Emergent Treatment for All Patients with Stupor or Coma Hypoglycemia or Hyperglycemia Protect the Eyes More Definitive Diagnosis and Treatment of Specific Etiologies of Stupor and Coma 8. Management of Frequently Encountered Causes of Unconsciousness Structural Lesions: Supratentorial or Infratentorial Compressive/​Destructive Etiologies Aneurysmal Subarachnoid Hemorrhage Brain Abscess Nonstructural Lesions: Metabolic, Diffuse, or Multifocal Coma Central Nervous System Infections Metabolic Coma General Management Considerations Applying to All or Most Brain-​Injured patients Goals of Care A Final Word 9. Prognosis in Coma and Related Disorders of Consciousness and Mechanisms Underlying Outcomes Introduction 380 Prognosis in Coma 381 Traumatic Brain Injury Prognosis in Disorders of Consciousness 398 Vegetative State Mechanisms Underlying Outcomes of Coma: Investigational Studies of Disorders of Consciousness 405 Functional Imaging of the Vegetative State 10. Brain Death Determination of Brain Death Clinical Signs of Brain Death Brainstem Function 11. Disorders of Consciousness in Clinical Practice: Ethical, Legal and Policy Considerations Professional Obligations and Clinical Discernment 450 An Emerging Nosology and Ethic of Care 450 Brain States 452 Neuroethics of Covert Consciousness 459 Capacity, Competence, and Surrogate Decision-​Making 462 Decision-​Making Capacity Mosaic Decision-​Making Communication Strategies 464 Goals of Care Institutional Context of Care 467 Rehabilitation and Long-​Term Care Neuropalliative Care 470 Rights Come to Mind 472 Index