List the symptoms of impaired consciousness. Impaired consciousness. Diagnosis and treatment of pathology of consciousness

Clear consciousness- its complete safety, adequate reaction to the environment, full orientation, wakefulness.

Moderate stun- moderate drowsiness, partial disorientation, delayed answers to questions (repetition is often required), slow execution of commands.

Deep Stun- deep drowsiness, disorientation, almost complete sleepiness, limited and difficult speech contact, monosyllabic answers to repeated questions, following only simple commands.

Sopor (unconsciousness, deep sleep) - almost complete lack of consciousness, preservation of purposeful, coordinated defensive movements, opening of the eyes to painful and sound stimuli, occasional monosyllabic answers to multiple repetitions of a question, immobility or automated stereotypic movements, loss of control over pelvic functions.

Moderate coma(I) - inability to wake up, chaotic uncoordinated defensive movements to painful stimuli, lack of opening the eyes to stimuli and control of pelvic functions, mild respiratory and cardiovascular problems are possible.

Deep coma(II) - inability to wake up, lack of protective movements, impaired muscle tone, inhibition of tendon reflexes, severe respiratory impairment, cardiovascular decompensation.

Transcendental (terminal) coma(III) - atonal state, atony, areflexia, vital functions are supported by breathing apparatus and cardiovascular drugs.

Assessing the depth of impairment of consciousness in emergency situations in an adult, without resorting to special research methods, it can be carried out using the Glasgow scale, where each answer corresponds to a certain score (see Table 14), and in newborns - using the Apgar scale.

Assessing the State of Consciousness is made by totaling points from each subgroup. 15 points correspond to a state of clear consciousness, 13-14 - stunned, 9-12 - stupor, 4-8. - coma, 3 points - brain death.

Note. Correlation between indicators Glasgow scale and mortality in coma is highly reliable. The number of points from 3 to 8 corresponds to a mortality rate of 60%, from 9 to 12 - 2%, from 13 to 15 about 0 (D. R. Shtulman, N. N. Yakhno).

Educational video of degree of impairment of consciousness and Glasgow Coma Scale

1. Fainting. Collapse. Coma. Acute vascular insufficiency. Definition. Terminology. Definition of coma, collapse, fainting.
2. Classification of depression of consciousness (A. I. Konovalova). Assessment of the state of consciousness. Degrees of depression of consciousness. Glasgow scale.

Disturbances of consciousness are manifestations of dysfunction of certain areas of the brain, which may be accompanied by a temporary complete or partial loss of connection with reality, hallucinations, delusions, aggression or a feeling of fear.

Disturbances of consciousness include stupor, stupor, coma, twilight stupefaction and some other conditions in which the patient is not capable of adequate perception of reality.

Why does consciousness disappear?

The main causes of disturbances of consciousness include:

• without visible structural changes in the brain;
• and electrical activity of the brain;
• , metabolic and mental diseases;
• drug addiction, alcoholism, substance abuse;

Types of disorders and disorders of consciousness

Disorders of consciousness are divided into two large groups: quantitative and qualitative. The quantitative group includes coma, stupor (somnolence) and stupor. Qualitative ones include twilight stupefaction, ambulatory automatism, fugue and some other disorders of brain activity.

Main types of disturbance and/or clouding of consciousness:

1. Stupor (). Translated from Latin, this word means “numbness.” A patient in a stupor stops reacting to the surrounding reality. Even strong noise and inconvenience, such as a wet bed, do not cause a reaction in him. During natural disasters (fires, earthquakes, floods), the patient does not realize that he is in danger and does not move. Stupor is accompanied by movement disorders and lack of response to pain.
2. Twilight stupefaction. This type of disorder is characterized by sudden and also suddenly disappearing disorientation in space. A person retains the ability to reproduce automated habitual actions.
3. Locked-in syndrome. This is the name of a condition in which the patient completely loses the ability to speak, move, express emotions, etc. Those around him mistakenly believe that the patient is in a state of flux and cannot adequately respond to what is happening. In reality, the person is conscious. He is aware of everything that is happening around him, but due to paralysis of his entire body, he is unable to even express emotions. Only the eyes remain mobile, through the movement of which the patient communicates with others.
4. . This is a condition in which the patient is conscious but confused. Him understanding of the surrounding reality is maintained. The patient easily finds the source of sounds and reacts to pain. At the same time, he completely or practically loses the ability to speak and move. After their healing, patients say that they were fully aware of everything that was happening around them, but some force prevented them from adequately responding to reality.
5. . Characterized by a constant desire to sleep. At night, sleep lasts much longer than it should. Awakening usually does not occur without artificial stimulation, such as an alarm clock. It is necessary to distinguish between 2 types of hypersomnia: the one that occurs in a completely healthy person, and the one that is typical for people with mental and other types of disabilities. In the first case, increased drowsiness may be a consequence of chronic fatigue syndrome or. In the second case, hypersomnia indicates the presence of a disease.
6. Stun(or stunned consciousness syndrome). During deafening, the already mentioned hypersomnia and a significant increase in the threshold of perception of all external stimuli are observed. The patient may experience partial amnesia. The patient is unable to answer the simplest questions, hearing voices and knowing where the source of the sound is. There are 2 types of stunning consciousness. In a milder form, the patient can carry out the commands given to him, moderate drowsiness and partial disorientation in space are observed. In a more severe form, the patient performs only the simplest commands, his level of drowsiness will be much higher, and disorientation in space will be complete.
7. Wakeful coma (). Develops after serious ones. This condition received the name “coma” because, despite being conscious, the patient is not able to come into contact with the outside world. The patient's eyes are open and the eyeballs are rotating. At the same time, the gaze is not fixed. The patient has no emotional reactions and speech. The patient does not perceive commands, but is able to experience pain, reacting to it with inarticulate sounds and chaotic movements.
8. . A mental disorder that occurs with disturbances of consciousness. The patient suffers from visual hallucinations. Him disorientation in time is observed, orientation in space is partially impaired. There can be many causes of delirium. Elderly people and alcoholics suffer from hallucinations. Delirium may also indicate the presence of schizophrenia.
9. . Due to injury and for some other reasons, a person loses the ability to be mentally active. The patient's motor reflexes are preserved. The cycle of sleep and wakefulness is maintained.
10. Dissociative fugue. A type of mental disorder in which the patient completely loses his previous personality and begins a new life. The patient usually seeks to move to a new place of residence, where no one knows him. Some patients change their habits and tastes and take a different name. A fugue can last from several hours (the patient, as a rule, does not have time to radically change his life) to several years. Over time, there is a return to the previous personality. The patient may lose all memories of the life he led during the fugue period. A mental disorder can be caused by events of a traumatic nature to the psyche: the death of a loved one, divorce, rape, etc. Psychiatrists believe that fugue is a special defense mechanism of our body, allowing us to symbolically “escape” from ourselves.
11. . A confusional disorder in which the patient loses the ability to synthesize. For him, the overall picture of the world falls apart into separate fragments. The inability to connect these elements with each other leads the patient to complete disorientation. The patient is not capable of productive contact with the surrounding reality due to incoherent speech, meaningless movements and the gradual loss of his own personality.
12. Coma. The patient is in an unconscious state, from which it is impossible to revive him using conventional methods. There are 3 degrees of this condition. In a first-degree coma, the patient is able to respond to stimuli and pain. He does not regain consciousness, but responds to irritation with defensive movements. While in a second-degree coma, a person is unable to respond to stimuli or experience pain. In third degree coma, vital functions are in a catastrophic state, muscle weakness is observed atony.
13. Short-term loss of consciousness (,). Fainting is caused by a temporary disruption of cerebral blood flow. The causes of short-term loss of consciousness can be conditions of low oxygen content in the blood, as well as conditions accompanied by disturbances in the nervous regulation of blood vessels. Syncope is also possible with some neurological diseases.

Twilight state of consciousness and its types

Stupefaction (twilight) occurs with, and. This type of disorder of consciousness is called transient, that is, it occurs unexpectedly and passes quickly.

Long-term stupefactions (up to several days) are possible mainly in epileptics. This condition may be accompanied by fear, aggression and some other negative emotions.

Twilight disorder of consciousness is characterized by hallucinations and delusions. The visions are frightening. Expressed aggression is directed towards people, animals and inanimate objects. A person suffering from twilight darkness is characterized by amnesia. The patient does not remember what he said and did during his seizures, and does not remember the hallucinations he saw.

Twilight consciousness occurs in several variants:

1. Outpatient automatism. This condition is not accompanied by delusions, hallucinations or aggressive behavior. Outwardly, the patient’s behavior is no different from his behavior in his normal state. A person automatically performs all usual actions. The patient may wander aimlessly along the street, following familiar routes.
2. Rave. The patient's behavior does not always change. This state is characterized by silence and an absent gaze. The patient may show aggression.
3. Oriented twilight stupefaction. The patient retains consciousness in fragments and is able to recognize close people. Delusions and hallucinations may be absent. The patient experiences fear or aggression.
4. Hallucinations. The visions that visit the patient during an attack are threatening. Patients see red or blood. Visions may include fictional characters or fantastic creatures that show aggression. The patient begins to defend himself, causing harm even to those closest to him.

At the first signs of twilight conditions, a person must be provided with pre-medical assistance, care and observation. The patient should not be left alone. If consciousness is not completely lost, contact can be maintained with it.

Sometimes familiar faces become the only reference point for someone who has lost touch with reality. You should not wait until the patient completely loses contact with the outside world. He needs urgent transport to the hospital.

First aid for impaired consciousness

During a patient's attack, people around him must take urgent measures. If consciousness is completely lost, you need to try to bring the person back to his senses: give him a sniff of ammonia, put a napkin soaked in cold water on his head.

You should also immediately call an ambulance, even if the person who has lost consciousness has managed to recover from the fainting state.

In case of partial loss of consciousness, the provision of first aid may be complicated by the patient’s inappropriate behavior. If there is an incomplete loss of contact with reality, it is necessary to conduct a constant dialogue with the person so that a complete break with reality does not occur.

The patient should not be left alone with himself. However, others need to remember that in such a state a person may be susceptible to various kinds of hallucinations. He is capable of harming those he loves.

Providing medical care

A person suffering from any type of mental disorder must be constantly monitored by a psychiatrist and undergo a medical examination on time. Since the causes of impaired consciousness may vary, treatment may also differ in each individual case.

For example, if a patient suffers from kidney failure, he is prescribed hemodialysis. In case of drug overdose Naloxone is required. Loss of consciousness caused by alcohol poisoning requires large doses of thiamine. In addition, in case of any poisoning, you must first rinse your stomach.

If during the next attack the patient lost consciousness for a long time, fell into a coma, a vegetative state or stupor, the doctor needs to assess vital functions and find out whether the patient’s body can independently support its vital functions.

(Tizercin, ) - drugs most often used in the treatment of disorders of consciousness, administered intramuscularly. To prevent the collaptoid state, Cordiamine is prescribed. If the first signs are present, the patient must be hospitalized. A nurse is assigned to the patient for care and constant monitoring.

Consciousness disorders are a group of mental illnesses and disorders that prevent the patient from providing self-help. The relatives and friends of a sick person have a huge responsibility.

They should not allow the patient to remain left to himself for a long time, and at the first signs of the onset of a seizure, they must be able to help him.

Clear consciousness implies the correct orientation of the patient in himself, in space and in time. The patient answers questions correctly and in a timely manner.

Impairment of consciousness has several degrees:

Stupor (stunning) is a state of stupor from which the patient can be brought out for a short time by talking to him. However, the patient is poorly oriented in the surrounding environment and answers questions slowly and late.

Stupor (indifferent, dull) – the patient is in a state of hibernation, does not respond to speech addressed to him or answers questions in monosyllables (“yes”, “no”), but responds to examination, palpation and percussion.

Coma (deep hibernation, complete loss of consciousness) is a complete loss of consciousness with a sharp decrease or complete absence of basic reflexes.

In therapeutic clinics, patients often experience clear consciousness.

Excited consciousness (delusions and hallucinations).

Delusions are mental disorders manifested in false judgments and conclusions.

Hallucination is a deception of the senses, false perceptions that arise without appropriate stimulation.

4.Facial expressions. Specific types of faces and their characteristics.

Facial expression is a reflection of a person’s physical and mental state (calm, suffering, sly, and others).

For a number of diseases, facial expression is an important diagnostic sign (facial appearance).

1. “Mitral face” (facies mitralis) – characteristic of patients with mitral stenosis: cyanotic blush of the cheeks, cyanosis of the lips, tip and back of the nose, ears.

2. “Corvisar's face” – noted in patients with cardiac decompensation: yellowish-pale with a bluish tint, puffy, mouth half-open, cyanotic lips, dull eyes.

3. With infective endocarditis, there is a pallor of the face combined with a yellowish tint (“coffee with milk”).

4. “Face of Hippocrates” (facies Hyppocratica) – characteristic of agonizing patients or those suffering from serious diseases of the abdominal organs (generalized peritonitis, perforation of an ulcer, intestinal obstruction): a deathly pale, haggard face with a bluish tint, covered with cold sweat, sunken eyes, dull corneas, pointed nose.

5. “Feverish face” (facies febrilis) – at elevated body temperature, there is flushing of the facial skin, an excited expression, and sparkling eyes.

6. In case of lobar pneumonia (usually when the upper lobe is affected), a one-sided blush of the cheek on the affected side is detected, the wings of the nose are involved in the act of breathing.

7. The face with pulmonary tuberculosis is thin, pale with a bright blush on the cheeks, shiny eyes.

8. A puffy face is observed:

a) in case of kidney diseases – pale, swollen, especially in the area of ​​the upper and lower eyelids (facies nephritica);

b) with frequent attacks of suffocation and coughing as a result of local venous stagnation;

c) when the mediastinum is affected by a tumor process; in cases of compression of the lymphatic ducts (with significant effusion in the pleural cavity and pericardial cavity); with compression of the superior vena cava (“Stokes collar”).

9. The face of chronic alcoholism is reddened with dilated veins on the cheeks and nose, a blank look.

10. Face with tetanus (“sardonic smile”, risus sardonicus) – an open mouth, as in the diagram, and folds on the forehead, as in sadness.

11. “Wax doll” face - with Addison-Birmer anemia: slightly puffy, pale with a yellowish tint and seemingly translucent skin.

12. Red-cyanotic complexion of the skin of the face, especially the cheeks, the tip of the nose, lips, hyperemic conjunctiva of the eyes, dilated and engorged with blood, their vascular network, often telangiectasia on the cheeks, tip of the nose - are characteristic of Vaquez disease (erythremia).

13. The face with systemic scleroderma: mask-like, amicable, the skin is waxy, tense, does not fold, the eyes are half-open, the lips are thinned, there is a “pouch” around the mouth, telangiectasia on the skin.

14. Patients with dermatomyositis are characterized by dark purple erythema and periorbital edema on the face (symptom of “spectacles”).

15. With systemic lupus erythematosus, a “butterfly” is detected - erythematous rashes on the face in the area of ​​the cheeks, dorsum of the nose, and superciliary ridges.

16. “Lion face” - lumpy - nodular thickening of the skin under the eyes and above the eyebrows, a widened enlarged nose, observed in patients with leprosy (leprosy).

17. A face with a saddle-shaped nose and uneven pupils is characteristic of patients with syphilis.

18. “Parkinson’s” mask - an amicable face characteristic of patients with encephalitis.

19. “Distorted face” - asymmetry of movements of the facial muscles, remaining after a hemorrhage in the brain, or with neuritis of the trigeminal and facial nerves.

20. Face with Graves' disease (facies basedovica): wary, anxious, frightened, widened palpebral fissures, protruding shiny eyes, rich facial expressions.

21. “Myxedematous face” with hypothyroidism: puffy, with the presence of mucous edema, the eye areas are narrowed, swollen eyelids, enlarged lips and tongue, lack of hair on the lateral areas of the eyebrows.

22. Face with acromegaly - enlarged protruding parts of the face (nose, chin, cheekbones, frontal tubercles, brow ridges), large lips and tongue.

23. “Moon-shaped face” - red, shiny, with developed hair in women, observed in Itsenko-Cushing’s disease.

24. With typhus - general hyperemia of the puffy face, the sclera of the eyes are injected (“rabbit eyes” according to F.G. Yanovsky).

There are many different diseases that lead to impaired consciousness. Before touching on the causes of disorders of consciousness, we should briefly dwell on the brain structures responsible for the state of clear consciousness.

A person is characterized by alternating periods of clear consciousness (wakefulness) and sleep. There is also an intermediate state - dormancy. The ascending reticular formation located in the upper parts of the brain stem (mainly in the midbrain) is responsible for controlling the cyclic sleep-wake rhythm - the formation of the brain that connects the cerebral hemispheres with the long brain.

Types and symptoms of consciousness disorders

Based on the depth of the disturbance of consciousness, coma, stupor and stupor are distinguished.

Coma- this is an extreme degree of impairment of consciousness:

• there are no reactions to irritations (speech,);
• there is no sleep-wake cycle;
• eyes closed.

Sopor(in foreign literature the term stupor is more often used) - a milder degree of impairment of consciousness compared to coma. For stupor:

• the patient cannot be completely awakened, but there is a reaction to pain (a non-directional protective motor reaction is preserved, for example, withdrawing a hand when painful stimulation is applied to it);
• the reaction to speech is either weak (with mild stupor) or absent;
• after a short awakening (with mild stupor), the patient quickly falls back into an unconscious state and does not remember the moments of awakening in the future.

Stun- a state of incomplete wakefulness, which is characterized by loss or disruption of varying degrees of severity of the coherence of thoughts and actions due to a gross disorder of attention, drowsiness.

Stunning should be distinguished from delirium (the most common cause of which is), in which stunning is combined with psychomotor agitation, delirium, hallucinations, activation of the sympathetic nervous system (increased blood pressure, sweating, tremors, tachycardia).

In coma and deep stupor, in addition to impaired consciousness, other symptoms are observed:

Disruption of the normal breathing rhythm; in severe cases, breathing becomes chaotic; Respiratory depression may even occur.

Impaired reaction of the pupils to light.

Disturbed eye movements (observed when lifting the eyelids): or floating movements, fixation of gaze.

A variety of pathological activity may be observed: epileptic seizures, muscle twitching (myoclonus), parakinesis (involuntary movements reminiscent of voluntary ones in nature - according to the popular expression: “before death”).

There may be a sharp increase in muscle tone or, conversely, a decrease (“atonic coma”).

Glasgow scale

Opening your eyes

Spontaneous - 4

Opening for speech - 3

Opening to pain - 2

Missing - 1

Motor response

Follows verbal command - 6

Localizes pain - 5

Withdrawals a limb with flexion in response to pain - 4

Pathological flexion of all limbs from pain (decorticate rigidity) - 3

Pathological extension of all limbs from pain (decerebrate rigidity) - 2

No movement - 1

Preservation of verbal responses

Oriented and talking - 5

Confused speech - 4

Says incomprehensible words - 3

Inarticulate sounds - 2

No speech - 1

The total score is the sum of the scores of the three groups. 15 points - clear consciousness, 14-13 - mild stun, 12-11 - severe stun, 10-8 - stupor, 7-6 moderate coma, 5-4 - deep coma, 3 - death of the pulp, extreme coma.

Diagnostics

It is important to establish not only the degree of impairment of consciousness, but also its cause. In addition to the medical history, which may remain unknown either in the absence of the patient’s relatives or due to their ignorance, additional research helps clarify the diagnosis.

Blood and urine tests - general analysis, analysis of glucose levels in the blood, urine, electrolytes, creatinine, calcium, phosphates in the blood, biochemical indicators of liver function, blood osmolality.

Screening of toxic substances (carried out in specialized toxicology laboratories).

Electrocardiography (ECG).

Chest X-ray

X-ray of the skull (if TBI is suspected)

CT and MRI of the brain, revealing the presence of stroke, consequences of TBI (brain contusion, subdural hematoma, epidural hematoma, confusion of brain structures), encephalitis.

Lumbar puncture followed by examination of the cerebrospinal fluid if meningitis or subarachnoid hemorrhage is suspected.

Electroencephalography (EEG), which makes it possible to distinguish coma from mental “reactivity (with hysteria, catatonia).

Causes

Impaired consciousness (coma, stupor) can be caused by various causes: neurological, metabolic (diabetes mellitus, hypothyroidism, adrenal insufficiency, uremia, hyponatremia, liver failure), poisoning, hypoxia (asphyxia, severe heart failure), sunstroke and heat stroke.

Neurological causes of impaired consciousness:

• with damage to the reticular substance of the midbrain and associated subcortical formations (primarily the optic thalamus);
• with extensive lesions of the cortex;
• with combined damage to the cerebral cortex and midbrain.
• TBI: concussion or contusion of the brain, hematoma, traumatic intracerebral hemorrhage, diffuse axonal damage;
• stroke;
• brain tumors (impaired consciousness can be caused by blockade of the cerebrospinal fluid pathways, hemorrhage into the pituitary tumor, which increases with compression of the brain stem),
• status epilepticus,

Diabetic coma

Hypoglycemic and diabetic (ketoacidotic) comas occur with diabetes mellitus. The first one occupies 3rd place, and the second coma takes 5th place in the structure of coma. Hypoglycemic coma most often occurs in type 1 diabetes on insulin therapy (and in those patients with type 2 diabetes receiving insulin) with fasting blood glucose at a level of 3 mmol/l.

Provoking factors:

• insulin overdose,
• skipping meals or not eating enough,
• excessive alcohol intake

Taking medications can also cause a hypoglycemic state. These include: adrenergic blockers, sulfonamides, salicylates, anabolic hormones, tetracycline, lithium carbonate, monoamine oxidase inhibitors, calcium-containing drugs.

Symptoms develop quickly (usually within minutes, less often within hours). The first symptoms include profuse sweating, pale skin, a feeling of extreme hunger, trembling hands, weakness, and sometimes dizziness. Inappropriate behavior, psychomotor agitation (sometimes with aggression), impaired coordination of movements, later confusion, development of coma, and sometimes convulsions appear quite quickly.

At the first signs of hypoglycemia, the patient should eat a lump of sugar (a tablespoon of granulated sugar) or candy and drink a cup of very sweet tea. Comatose states are stopped by intravenous jet injection of 60 ml of 40% glucose, no more than 10 ml per minute. Then 5% glucose is administered intravenously (up to 1.5 liters per day) under blood glucose control.

Diabetic (most often ketoacidotic) coma when taking insufficient doses of glucose-lowering drugs or skipping insulin due to unauthorized withdrawal of medications and non-compliance with the diet. Provoking factors may include physical activity, alcohol abuse, and taking certain medications (steroids, oral contraceptives, calcitonin, saluretics, adrenergic blockers, diphenin, lithium carbonate, diacarb). Diabetic hyperglycemic coma develops more slowly than hypoglycemic coma.

With moderate ketoacidosis, asthenia and thirst increase; dyspepsia, weight loss, and the smell of acetone in the exhaled air. Subsequently, a precomatous state occurs, characterized by stunning, an increase in dyspeptic symptoms (anorexia, vomiting, abdominal pain), shortness of breath, decreased muscle tone and eye turgor, and dry skin. On examination, the tongue has a brown coating, decreased pressure and temperature, and absence of tendon reflexes.

Diagnosis is helped by laboratory data: hyperglycemia and glycosuria, increased blood ketone bodies, acidosis.

In the precoma stage, the glucose level reaches 28 mmol/l, in the coma stage - 30 mmol/l or more.

Necessary emergency measures for diabetic coma include the elimination of dehydration (dehydration), hypovolemia (reduction in circulating blood volume) and the prevention of possible hemorrhagic complications and the normalization of glucose and blood levels.

Intensive infusion therapy is carried out - saline solution 1 l/hour (up to 5-7 l) under the control of blood pressure, pulse rate, diuresis. If necessary, oxygen therapy and warming are carried out. To prevent thrombosis, 500 units of heparin (preferably low molecular weight heparin) is administered intravenously. Insulin therapy is carried out with blood glucose control.

Coma due to sunstroke

Often they encounter a coma that occurs in previously healthy people as a result of sunstroke (or heatstroke). Sunstroke can occur during heavy physical work under the scorching sun with your head uncovered, or during prolonged sunbathing on the beach. A risk factor is excessive alcohol intake. Symptoms can occur not only directly during exposure to the sun, but also several hours after exposure. In relatively mild cases (without loss of consciousness) and in a precomatous state, redness of the facial skin, increased sweating, increased body temperature (in severe cases up to 41 ° C), tachycardia, and shortness of breath occur. Subsequently, tachycardia gives way to bradycardia, breathing becomes arrhythmic, convulsions, delirium and impaired consciousness may occur.

Immediate measures for sunstroke include:

• placing the patient in a cool atmosphere;
• a cold compress (or an ice pack) on the patient’s head and wrapping the body with a sheet soaked in cold water;
• intravenous administration of 500 ml of saline, subcutaneous administration of 1-2 ml of 10% caffeine, 1-2 ml of cordiamine.

The development of heat stroke is associated with general overheating of the body, which appears when staying in a hot and humid room, during intensive work in stuffy conditions, during long hikes (military, tourist) in the heat.

Apaleic syndrome

What differs from coma is such a special state of impaired consciousness as apalic syndrome (synonyms: vegetative state, chronic persistent vegetative state, “waking” coma). The apalic state is a total disorder of the function of the cerebral cortex with preserved functioning of the brainstem (including the midbrain), which is characterized by:

• as in coma - lack of consciousness, reactions to pain, sound stimulation;
• in contrast to coma, the alternation of wakefulness and sleep is preserved (but their change is chaotic); during wakefulness, there is no fixation of gaze on any object and monitoring of others.

Some patients may then have a partial (and in the case of apallic syndrome of traumatic origin, sometimes quite good) restoration of consciousness. During the transitional stage, gaze fixation and monitoring of others, primitive emotional reactions and purposeful movements occur.

Isolation syndrome

“Isolation” syndrome (synonyms: “locked up” syndrome) is sometimes perceived by the patient’s relatives as a gross violation of consciousness and intellect. This syndrome occurs with extensive infarctions of the base of the brain stem. It is characterized by:

• total immobility (tetraplegia - paralysis of arms and legs);
• lack of speech as a result of anarthria;
• preservation of consciousness and intellect;
• preservation of voluntary eye movement and blinking, with the help of which communication with the patient is possible (for example, using Morse code, which is taught to the patient and the person caring for him).

Impaired consciousness in the form of coma and stupor should be differentiated from some mental states that outwardly resemble coma: conversion (hysterical) and catatonic (in schizophrenia) stupor. With a psychogenic disorder of consciousness, there are no involuntary slow movements of the eyeballs, the eyes are often open, there are no changes in muscle tone and changes in the EEG.

First aid for impaired consciousness

A general practitioner who finds a patient in a coma must:

• call an ambulance in order to hospitalize the patient as quickly as possible;
• find out anamnestic data from relatives or friends of the patient to make a preliminary presumptive diagnosis;
• measure blood pressure, pulse rate, breathing rate, measure body temperature, and if you have a glucometer, blood glucose;
• pay attention to the skin, turgor of the eyeballs and muscles of the limbs, the size of the pupils, reaction to light;
• administer intravenously 60 ml of 40% glucose (not dangerous even if the patient has a hyperglycemic coma) with 100 mg of vitamin B1.

Syndromes of disorder of consciousness: types and characteristics of confusion

In psychiatry, the definition of clear (normal) consciousness usually means the normal status of a mentally healthy person in a state of wakefulness. The main criteria for a clear consciousness of an individual are:

Nullification
It is the mildest form of quantitative shifts. The individual resides, as it were, in a “foggy”, “veiled” world. The person perceives reality poorly. All types of reactions to external stimuli occur at a low speed.
Motor activity is significantly slower. The subject can “freeze” in one position for a long time, fixing his gaze on one object. There are no purposeful and meaningful eye movements.
First of all, the speech function suffers: the individual has difficulty perceiving the question put to him and giving an answer after a certain time interval. There are often reservations and errors in answers. The patient becomes inattentive, uncollected, and absent-minded. In some cases, there is a careless mood, foolishness, and a tendency to make inappropriate jokes.

The state of numbing can last for several minutes, after which the person becomes enlightened. However, if the patient suffers from a psychoorganic disease of syphilitic origin - progressive paralysis at the initial stage, this form of depression of consciousness can exist for a long time.
If a patient has a benign or malignant brain tumor, obnubilation almost always turns into more severe forms of depression of consciousness. With severe intracranial pathology and metabolic disorders, the patient's condition may worsen, even to the development of coma.

Stun
It implies a pathological mental status in which the individual has a significantly increased threshold of sensitivity to all stimuli originating from the environment. At the same time, there is a significant deterioration in all cognitive abilities. The patient is in a drowsy state and indifferent to what is happening.
The speed of thought processes slows down, the quality of thinking deteriorates. A person loses the ability to form associative connections between phenomena.
During deafening, the possibility of establishing verbal contact with the patient is preserved. However, he does not immediately perceive the questions addressed to him. In this case, the patient can only perceive relatively simple requests. A significant depletion of the vocabulary is recorded. The individual’s statements are characterized by vagueness and lack of brightness. The patient gives short, often monosyllabic answers. Meaningless repetition of the same words may be recorded. Difficulties in memorizing and reproducing information are established.
Self-orientation is preserved. The patient names his personal information correctly. However, the patient has poor orientation in time and space.
Stunning in most cases develops as a result of severe cerebrovascular accidents. Also, this type of depression of consciousness can occur as a result of complex damage to various brain structures. Many or all of the events that happen to a person during a stunned episode are not remembered.

Represents a half-asleep state of a person. There is practically no physical activity. The individual is almost always in a lying position. He makes no attempt to change position. There are no forms of non-verbal communication observed. The eyes are most often closed.
The subject loses the ability to fully perceive the phenomena of reality. A person reacts only to the influence of strong stimuli.
There is no spontaneous speech, the patient does not provide any information on his own initiative. However, he is able to correctly perceive very simple questions, to which he gives correct answers after a while. The patient does not understand complex commands and calls.

Sopor
Represents a pathological dream. The patient is in a supine position. He is motionless. Eyes closed. There are no facial movements observed on the face.
The subject's mental activity is manifested at a minimal level. The ability to perform voluntary activities is completely lost. The ability to carry out reflex motor acts is preserved.
It is not possible to establish full verbal contact with an individual. Intense stimuli, such as bright lighting, sharp sound, impact on pain receptors, lead to the appearance of stereotypical protective motor and vocal reactions.
As the state of stupor deepens, the subject is completely deprived of clarity of consciousness, and an unconscious state occurs - coma.

Coma
A comatose state involves a complete loss of lucidity. The subject has no reactions to all stimuli, regardless of the strength of their influence. The individual cannot be brought out of the coma state even with intense external stimulation. More than 65% of comatose states are associated with a wide range of metabolic disorders, both endogenous and exogenous. About 35% of all clinically recorded coma states are the result of destructive changes in various parts of the body.

Qualitative disturbances: variants of clouding of consciousness
Qualitative disorders are also called productive or psychotic disorders. Despite the existence of various variants of clouding of consciousness, all these pathological conditions are characterized by the presence of a number of similar symptoms:

He does not comprehend the patient’s appeals addressed to the individual; his answers do not correspond to the questions asked. With delirious syndrome, the ability to navigate the environment is impaired. However, most often the individual is adequately oriented and perceives his own “I” fully.
A person who has suffered a full-blown form of delirium retains fragmentary memories of the experiences that took place. He can reproduce details of hallucinations, illusions, and delusions. In certain variants of the course of delirious syndrome, complete loss of memory for the events that occurred is observed.
Delirium develops with drug addiction and chronic alcoholism. This type of disorder of consciousness may be a consequence of intoxication of the body. The cause of depression of consciousness may be an acute infectious disease of bacterial or viral origin. Common provocateurs of delirium are vascular pathologies, destructive brain injuries, traumatic effects in areas of the skull of varying severity.

Oneiroid
Oneiric syndrome is characterized by the sudden, involuntary appearance of fantastic ideas in the patient. The emerging scenes represent significantly modified elements of previously seen, read, listened to information or personally experienced experience.
Such fragments of the past are unusually intertwined with a perverted interpretation of actually present details in the environment. The scenes perceived by the subject resemble absurd, “animated” dreams. The plots of the paintings follow each other sequentially, which looks as if a person is watching a film.
For oneiroid, the constant symptoms are various depressive symptoms, combined with irritability and unreasonable fear, or manic states reaching a degree of ecstasy.

Affective disorders are accompanied by severe sleep disturbances. The patient's eating behavior changes. Psychogenic cephalgia and pain in the heart area occur.
As the oneiroid becomes aggravated, the patient enters a period of delusional mood. The individual perceives the environment as an incomprehensible, ominous and dangerous situation. He foresees an imminent catastrophe. Subsequently, delusions of staging arise: the subject is convinced that he is a participant or witness to some kind of theatrical production. Verbal illusions and auditory hallucinations occur. Psychomotor agitation sharply turns into motor retardation and emotional devastation.
Oneiroid is fixed in metal-alcohol psychoses. It may be a consequence of severe infectious diseases when a microbial agent has affected the structures of the nervous system. Oneiric syndrome may indicate vascular pathologies. This type of impairment of consciousness is determined in severe skull injuries.
The duration of oneiroid syndrome is variable - from half an hour to a week. Memories of experienced sensations are fragmentary and scarce. Delayed amnesia often develops: immediately after the end of the oneiroid, the subject remembers the essence of his sensations, and subsequently he completely loses memories of the contents of the oneiroid.

Amentive syndrome is characterized by incoherence and illogical thinking of the patient. The person has severe motor impairment. The subject spends almost all the time in bed in the fetal position, making a variety of chaotic and illogical movements.
Confusion and helplessness are recorded. It is not possible to establish verbal contact with the patient. The statements of people in a state of amentia are represented by indistinct sounds, broken syllables, and primitive words. The patient most often speaks quietly and in a singsong voice: his messages are devoid of any intonation coloring. He often repeats the same words several times.
The emotional status is unstable. A person can be sad and depressed one moment, and the next moment he will be ecstatic and joyful. Hallucinations in amentia syndrome occur in isolated cases. From time to time, the patient may experience fragmentary delirium.
The duration of the amentia period can reach several weeks. The subject's memory leaves no trace of the experience. Amentive syndrome most often develops in various forms of psychoses of infectious, intoxication, traumatic, and vascular origin. - .

Twilight stupefaction
This condition is characterized by a spontaneous and short-term loss of the ability to function normally. The disorder has an acute and sudden onset. Symptoms develop at lightning speed. Twilight stupefaction ends after several hours.
With this variant of consciousness impairment, the subject does not completely perceive the phenomena of reality; he is completely detached from events in the surrounding world. The perception of reality is distorted and fragmentary. He is disoriented in his own “I”.
The emotional state is dominated by irrational fears, aggressiveness, and sad mood. Vivid visual hallucinations occur. Painful ideas, reasoning and conclusions that do not correspond to reality appear, characteristic of secondary sensory delusions. Typical automated actions are retained in full.
At the end of the episode of stupefaction, the subject loses partial or complete memory of the events that occurred.

There are several separate forms of twilight stupefaction:

Read more detailed information about the causes and symptoms of certain forms of depression of consciousness in subsequent reviews.