Disorders of Consciousness Presented By: Joseph S. Ferezy, D.C

Disorders of Consciousness

Presented By:

Joseph S. Ferezy, D.C.

Levels of Consciousness

Clouding (Confusion) Irritable And Slow, But Accurate Hypoxic Increase BUN Encephalopathy

Levels of Consciousness

Delirium D.T.’s (2nd Most Common Alcoholic Encephalopathy) Like A Drunk Arousable Irritable Psychotic Confused Hallucinations

Levels of Consciousness

Obtundation One Step Worse Then Delirium

Levels of Consciousness

Stupor Like Deep Sleep (Different On EEG) Arousal Only With Deep Stimuli Organic Brain Dysfunction

Coma

Unarousable

Unresponsive

Glasgow Coma Scale

CNS vs Metabolic Coma

Syncope (Fainting, Vapors)

Common ComplaintBrief Loss of Consciousness and Muscle ToneRapidly Restored With Recumbency.Commonly Caused by Impaired Cerebral Circulation, Metabolism, or Psychosomatic.Seizures May Occur, Especially If the Patient Remains Erect.Associated With a Drop in Peripheral Blood Pressure (at Least to 75 Mm Hg) and a Slowed Heart Rate.

Syncope

Vasodepressor Commonest Precipitated by

Fear Anxiety Pain Other Psychological

Usually Occurs When Patient Is Standing Causative Stimuli

Sensory Emotional

Physiological Mechanisms

Fight or FlightTissue DamagePain (Deep)Reflex to Injury of Certain Areas (Testicles, Blood Vessels, Alimentary Canal)Blood Vessel StenosisReduced Blood VolumePeripheral VasodilatationAbnormal Blood Constituents

Prodroma

Motor WeaknessEpigastric DistressSympathetic Autonomic Activity Perspiration Pallor of Face Cold, Moist Extremities Lightheadedness Blurred Vision

EEG Changes After Onset of Unconsciousness

Treatment

Patient Must Remain Recumbent Until Well After Consciousness ReturnsRegular ExerciseGentle, Broad Contact, Thoracic AdjustmentsOccipital and Upper Cervical AdjustmentsAvoid Offending ActivityPsychological Evaluation If Recurrent

Carotid Sinus

Types Cardio Depressor (Vagal)

Pressure on the Carotid Sinus Causes Heart Rate Slowing and Subsequent Decrease in Blood Pressure.

Vasodilator (Vasomotor) Drop in Blood Pressure Without Decrease in Heart Rate.

Central (Cerebral) Loss of Consciousness Following Carotid Sinus Pressure Is

Not Associated With Fall in Blood Pressure. Pressure Below Receptors May Cause Syncope.

Treatment

Patient Education

Differentiate From Hysteria by Pressing Elsewhere on the Neck and Noting Symptoms

Occipital, Upper Cervical and Thoracic Adjustments

Orthostatic Hypotension

Characterized by Repeated Syncopal Episodes Associated With a Sudden Drop in Blood Pressure When the Patient Stands up After Sitting or Being Recumbent

Orthostatic Hypotension

Causes Prolonged Convalescence Faulty Postural Reflex Adaptation Sympathectomy Peripheral Venous Stasis Anxiety Anti-hypertensive Medication

Orthostatic Hypotension

Treatment Aerobic Exercise Patient Education Coordinate With MD Regarding Medications Brisk Specific Adjustments to Thoracic

Subluxations Elastic Stockings Abdominal Belt

Cardiac Problems

Various Cardiac Syndromes Resulting in Decreased Cerebral Perfusion May Result in Syncope, and a Cardiac Examination Is Essential for an Accurate Diagnosis. Some Are Listed Below:Stokes-Adams SyndromeReflex Heart BlockCoronary/myocardial InsufficiencyParoxysmal TachycardiaAortic StenosisCongenital Heart Disease

Impaired Brain Metabolism

Anoxemia

Anemia

Hypoglycemia

Acidosis

Drug Intoxication

Acute Alcoholism

Hyperventilation

Other Causes of Impaired Brain Circulation

Arteriosclerotic DiseasePost Head Injury With Abrupt Head MovementsHypertensive EncephalopathyMigraine (Rarely)Intracranial NeoplasmsA-V MalformationsMaturationCough

Hysteria

Usually a Repressed, Adolescent or Elderly Female. Look for Other Signs of Hysterical Illness.

Coma

Longer and More Profound Loss of Consciousness Than Syncope. Primitive or No Reaction to Painful Stimuli. Milder Grades Are Termed Semi Coma, and Even Lesser Grades As Stupor or Confusion.

Coma

Examination Motor Responses to Pain Respiration Pattern Pupil Size, Equality and Reactivity Fundoscopy Vestibulo-ocular Reflexes

Persistent Vegetative State (PVS)

Commonly, when coma lasts for a month or more, the individual's eyes may be open and may blink even though the person's stare is vacant, no purposeful responses occur, and no signs of awareness appear. At this state, most physicians will say that the individual is in a "persistent vegetative state" or PVS.

Persistent Vegetative State (PVS)

This term was developed by Drs. Brian Jennett and Fred Plum, an outstanding neurosurgeon and a well recognized neurologist respectively.

The intent was to describe a condition in which the vegetative or anatomic functions, such as breathing, maintaining a normal blood pressure, digesting and eliminating foods were maintained and would persist indefinitely in the absence of awareness.

Persistent Vegetative State (PVS)

Drs. Jennett and Plum, originators of the term PVS, to wait three months before making a determination.

Persistent Vegetative State (PVS)

Many physicians will solemnly announce to a family two or three days after onset of coma that their loved one is in a persistent vegetative state and declare unambiguously that nothing can be done, adding insult to injury and preventing treatment at the most treatable stage. Only brain death is untreatable in the spectrum of brain functions.