NEUROLOGICAL ASSESSMENT OF COMA
The neurologist is often required to evaluate the unconscious patient from both the diagnostic and prognostic perspective. Knowledge of the anatomical basis of coma is essential for competent evaluation but must be combined with an understanding of the many, often multi factorial, medical conditions that result in impaired consciousness.
moncler outlet online Consciousness is a state of awareness of self and the environment. This state is determined by two separate functions: moncler outlet online
These are dependant moncler sale upon separate physiological and anatomical systems. Coma is caused by disordered arousal rather than impairment of the content of consciousness, this being the sum of cognitive and affective mental function, dependent on an intact cerebral cortex. The absence of all content of consciousness is the basis for the vegetative state.
moncler jacket sale Arousal depends on an intact ascending reticular activating system and connections with diencephalic structures. Like awareness, arousal is not an all or nothing concept and gradations in awareness have been described in the past as inattentiveness, stupor, and obtundation. Such terms lack precision and coma can be more objectively assessed using measures such as the Glasgow coma scale (GCS) (table 1). This analyses three markers of consciousness moncler outlet sale eye opening, and motor and verbal responses bringing a degree of accuracy to evaluation. moncler jacket sale
moncler outlet uk View this table:View inline moncler outlet uk
cheap moncler jackets sale View popup cheap moncler jackets sale
cheap moncler jackets The GCS arbitrarily defines coma as a failure to open eyes in response to verbal command (E2), perform no better than weak flexion (M4), and utter only unrecognisable sounds in response to pain (V2). The GCS cheap moncler coats is of no diagnostic value, but is a reliable way of objectively monitoring the clinical course of the patient moncler outlet store with an acute cranial insult without elucidating cause. cheap moncler jackets
NEUROANATOMICAL BASIS OF COMA
moncler sale outlet Clinicopathological correlation and neurophysiological experimentation has shown that coma is caused by diffuse bilateral hemisphere damage, failure of the ascending reticular activating system, or both. The reticular activating system is a core of grey matter continuous caudally with the reticular intermediate grey lamina of the spinal cord and rostrally with monlcer down jackets the subthalamus, hypothalamus, and thalamic nuclei. It runs in the dorsal part of the brain stem in the paramedian tegmental zone. moncler sale outlet
cheap moncler A unilateral hemisphere lesion will not result in coma unless there is moncler outlet online secondary brain stem compression, caused by moncler mens jackets herniation, compromising the ascending reticular activating system. Extensive bilateral damage or disturbance of the hemisphere function is required to produce coma. Bilateral thalamic and hypothalamic lesions also moncler outlet cause coma by interrupting activation of the cortex mediated through these structures. In hypothalamic lesions, phenomena associated with sleep, such as yawning, stretching, and sighing, are prominent. The speed of onset, site, and size of a brainstem lesion determine whether it results in coma, so brain stem infarction or haemorrhage often causes coma while other brain stem conditions such as multiple sclerosis or tumour rarely do so. Lesions below the level of the pons do not cheap moncler sale normally result in coma. Drugs and metabolic disease produce coma by a depression of both cortex and ascending reticular activating system function. cheap moncler
moncler outlet sale Assessment of coma moncler outlet sale
moncler sale Coma is an acute, life threatening situation. Evaluation must be swift, comprehensive, and undertaken while urgent steps are taken to minimise further neurological damage.3 Emergency management should include: resuscitation with support of cardiovascular and respiratory system; correction of immediate metabolic upset, notably control of blood glucose and thiamine if indicated; control of seizures and body temperature; any specific treatments for example, naloxone for opiate overdose. moncler sale
cheap moncler coats Assessment now should comprise:Neurological diagnosis is based on history, thoughtful examination, and the appropriate choice of investigations. This is the most common form of coma and results from anoxic ischaemic, metabolic https://www.moncleroutletssale.com , toxic, and drug induced insults, infections, and post ictal states. cheap moncler coats
Coma without focal signs with meningism. This results from subarachnoid haemorrhage, meningitis, and meningoencephalitis.
moncler factory outlet Coma with focal signs. This results from intracranial haemorrhage, infarction, tumour or abscess. moncler factory outlet
moncler jackets outlet Monitoring the subsequent course of coma with serial GCS assessment and formal neurological examination is essential, especially in the case of mass lesions where management of raised intracranial pressure either pharmacologically or by surgery may be necessary. moncler jackets outlet
cheap moncler outlet Multifocal structural pathology Moncler Outlet , such as buy moncler jackets venous sinus thrombosis, bilateral subdural haematomas, vasculitis or meningitis, can present with coma without focal signs or meningism and so mimic toxic or metabolic pathologies. Conversely, any toxic/metabolic cause for coma may be associated with focal findings for example, hypoglycaemic or hepatic encephalopathy. Also focal signs may cheap moncler outlet be the consequence of pre existing structural disease; in the septicaemic patient with a previous lacunar infarct, for example, the focal neurology may be mistakenly accepted as signs of the current illness. cheap moncler outlet
moncler outlet Supratentorial mass lesion with secondary brain stem compression ipsilateral third nerve palsy contralateral moncler sale outlet hemiplegia moncler outlet
Brain stem lesion early eye movement disorder: abnormal OCR or calorics asymmetrical motor responses
moncler outlet jackets Toxic/metabolic normal pupils: single most important criterion (except opiate poisoning) ocular motility: rove randomly in mild cheap moncler jackets coma and come to rest in primary position with deepening coma absent OCR and calorics decorticate and decerebrate rigidity or flaccidity multifocal myoclonus moncler outlet jackets.