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The author presents a comparative analysis of vascular and tissue reactions in brain contusion foci in the acute period of a craniocerebral injury involving various degrees of consciousness disorders. These reactions were found to depend on the periods elapsed since the injury and the severity of consciousness disorders.
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The two physiologic components of conscious behaviour, namely arousal (vigilance) and content of consciousness (presence of mind), may be affected differently, depending on the type and distribution of the underlying brain disease. Disturbance of arousal primarily affects wakefulness and awareness and leads to obtundation, stupor and coma. States of reduced arousal are caused by bilateral lesions of the so-called ascending reticular activating system (ARAS), which is situated in the upper brainstem and the paramedian diencephalon. If, on the other hand, cognitive and mnemic function are degraded, the contents of consciousness are disordered; depending on the extent of the disturbance, confusion, lethargy and, finally, a vegetative state ensues. The chronic vegetative state (coma vigil) describes a condition of total mental loss with preserved vegetative functions and arousal. Degraded cognitive and mnenic functions results from either toxic-metabolic or extensive structural disorders of the cerebral cortex, where the limbic and mesial frontal areas play a dominant role for conscious behaviour. If the function of extensive areas of both hemispheres is suddenly depressed, temporarily reduced arousal also results. In order to differentiate between toxic-metabolic and structural brain diseases, the motor reactions, the ocular and the pupillary reflexes must be examined apart from responsiveness.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
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The peculiarities of consciousness disturbances in 289 patients with grave brain stroke were studied. Eight informative clinical syndromes, including the awakeness level, brain stem reflex functions as well as vegetative-visceral functions were described. Two levels and eleven corresponding to them phases of damaged consciousness were singled out. The scale of quantitative estimation of each phase of the consciousness damage was established for practical use by the computer method of plural step by step regression; dynamics of phases was shown also.
Psychogenic loss of consciousness often leads to clinical situations where making decisions is difficult and psychiatric consultation becomes necessary. The function of the consultation/liaison-psychiatrist consists in rendering information from the psychosocial context comprehensible after establishing a first contact with the patient and his family and after the first psychiatric assessment. In a second step, the CL-psychiatrist then may make further recommendations how to deal with the patient, possibly not only in a patient-centered, but also team-centered manner. This article demonstrates a possible approach and differential diagnosis in the light of two clinical case reports. The theoretical part defines and classifies psychogenic loss of consciousness. It then deals with disorders of consciousness in epilepsy and the psychodynamics of psychogenic seizures as a subconscious expression of unbearable or unsolvable conflicts.
The range of surgical management of the carotid arteries becomes every day wider. The most common cause of carotid arteries disease is atherosclerosis and its consequences for the brain, and more rarely anatomical anomalies. The majority of our patients had cerebral damage prior to the surgical procedure, so we have taken particular care to prevent cerebral perfusion disturbances following the operation. Consciousness disorders are not always the consequence of disturbed cerebral perfusion, but their cause may have effect on it. Our experience and observations are presented with the aim to alert those considered to the potential problems.
Prognostic criteria of outcomes after severe craniocerebral traumas observed in 66 patients have been presented with the account of the degree of consciousness disorders in the acute phase. Favourable outcomes were confirmed in subjects whose level of consciousness impairments was not below 20 points according to coma quantity classification accepted at the N. N. Burdenko Institute of Neurosurgery.
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The effectiveness of treatment with piracetam of 32 patients with acute and chronic consciousness disturbances caused by clinical syndromes of cerebrovascular disease (strokes, syndromes of dementia) was studied. The drug was administered in drip infusions in daily doses of 6 g for 10 days. A statistically significant improvement was obtained in the signs belonging to the syndrome of consciousness disturbances. No significant difference was observed in the power of action of the drug in acute and chronic consciousness disturbances.