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Intracranial dysfunctions: stupor and coma.
1Department of Clinical Studies, University of Pennsylvania School of Veterinary Medicine, Philadelphia.
The Veterinary Clinics of North America. Small Animal Practice
|November 1, 1989
Summary
Coma and stupor result from brain disease or toxicity. Early treatment focuses on managing intracranial pressure and avoiding complications, using physiological signs for diagnosis and specific therapies.
Area of Science:
- Neurology
- Critical Care Medicine
Background:
- Coma and stupor are pathological neural states stemming from cortical or brainstem disease or toxicity.
- Diagnosis and treatment often commence before the underlying cause is identified.
- Preventing intracranial crisis is paramount throughout patient management.
Purpose of the Study:
- To outline diagnostic physiological indicators in patients with altered consciousness.
- To detail general and specific treatment strategies for coma and stupor.
- To provide guidance on anesthetic and sedative choices in critically ill neurological patients.
Main Methods:
- Assessment of physiological derangements including arousability, pupil reactivity, reflexes, breathing patterns, and cardiovascular function.
- Implementation of treatments to reduce elevated intracranial pressure.
- Selection of anesthetic and sedative agents based on their effect on cerebral blood flow.
Main Results:
- Physiological parameters offer crucial diagnostic insights.
- Multifaceted treatment approaches are necessary, addressing both the underlying condition and intracranial pressure.
- Specific drug classes (e.g., thiopental, lidocaine, narcotics) are preferred for sedation to minimize cerebral blood flow increase.
Conclusions:
- Effective management of coma and stupor requires prompt diagnosis and careful treatment.
- Controlling intracranial pressure is a critical component of care.
- Judicious use of sedatives and anesthetics is essential to avoid exacerbating neurological conditions.