Coma

Coma

    * Introduction
    * Fiziopatogenia state of coma
    * Clinical
    * Glasgow Liege Scale
    * Diagnostic Laboratory
    * Treatment of coma
    * Evolution and complications
Coma is a clinical syndrome characterized by severe quantitative disturbance of consciousness with profound alterations in the functions and relationship to maintain a certain level of autonomic functions. Coma, though somewhat resembling sleep, it differs radically in that the patient is in coma areactiv to stimuli of any kind. Consciousness, defined as a state of normal brain activity in which the individual is aware of itself and the environment, is the result of neuro-biological processes that occur in the central nervous system. Consciousness is a distributive process, with the continuous change of participants, the work is being carried out an algorithm. Stay awake activator reticulated system is on the ascendant and the cerebral cortex. Coma occurs following bilateral damage to the cerebral cortex, the ascending activating system reticulated or extratalamice horses enter in the toxic-metabolic state of severe or extensive structural damage and impaction with mass effect and brainstem arterial system. In some cases patients survive severe destruction of the mid-brain, but may remain in coma for life. Death occurs after autonomic disorders include increasing blood pressure, heart rhythm disturbances, respiratory distress, profuse sweating, grafted onto a poor neurological or systemic. In the case of cranio-cerebral trauma, the appearance state of coma resulting from two events: diffuse axonal injury and intracranial hypertension. Diffuse axonal lesions induced coma by interrupting or damage horses interemisferice reticulated system activator bottom. Coma of these lesions is installed immediately after the injury. Cause intracranial hypertension by inducing a state of coma, diffuse cerebral suffering due to lower cerebral blood flow or diencephalon or brainstem damage. Coma of intracranial hypertension is installed later after the onset of hypertension. Once published, the state of coma may be exacerbated by cerebral hypoxia or respiratory failure or seizures.
Classification of coma Two classifications are currently used in clinical practice:
Classification I
Come nonstructurale symmetrical with the right reasons: - Toxic: lead, cyanide, mushrooms, ethylene, carbon monoxide - Drugs: sedatives, barbiturates, tranquilizers, alcohol, opiates, amphetamines, fenolciclidine - Metabolism: hypoxia, hypercapnia, hypo and hypernatremia, hypo and hyperglycemia, lactic acidosis, hipermagneziemia, aminoacidemia, Reye's encephalopathy, hepatic encephalopathy - Infections: encefalitele viral, bacterial meningitis, encephalomyelitis postinfectioasa, syphilis, septicemia, malaria, typhoid - Pshihiatrice reactor conversion Catatonia Come symmetrical structures: - Supratentorial: Bilateral internal carotid artery occlusion and previous cerebral artery bilaterally talamica hemorrhage, subarachnoid hemorrhage, hydrocephalus - Subtentoriale: basilar artery occlusion, hemorrhage pontine origin, tumors of the midline of the brainstem Come asymmetric structure: - Supratentorial: disseminated intravascular coagulation, thrombotic thrombocytopenic purpura, bacterial endocarditis and subacute thrombotic nonbacteriana, fatty embolism, subdural hematoma, supratentorial bilateral massive infarction, JC - Subtentorial: infarcts of the brainstem, brain stem hemorrhage
Classification II in terms of etiologic
- Metabolic comas caused by diabetes, hypoxia-ischemic encephalopathy anoxo, hepatic encephalopathy, dialysis encephalopathy, uremia, prolonged hypoglycemia, hypo-or hypernatremia, hypo-or hypercalcemia, hypothyroidism, thyrotoxicosis - Come by diffuse structural damage of the central nervous system caused by: encephalitis, axonal injury, subarachnoid hemorrhage, meningitis or viral nonvirale, diffuse axonal injury, epilepsy - Come by focal brain structural damage. They are determined by: - Structural supratentorial lesions: intracerebral hemorrhage, cerebral infarction, brain abscess, subdural and epidural hematoma, primary or metastatic brain tumors - Subtentoriale structural damage: hemorrhage of the brainstem, brainstem infarction, primary or metastatic brain tumors, trauma, abscesses of the brain stem, brain stem encephalitis of - Joint structural damage over and subtentoriale: hemorrhage, cerebral infarction, abscess, primary or metastatic brain tumors, trauma

    * Fiziopatogenia state of coma
    * Clinical
    * Glasgow Liege Scale
    * Diagnostic Laboratory
    * Treatment of coma
    * Evolution and complications