诊断昏迷的可逆原因的诊断
Jonathan A Edlow1, Alejandro Rabinstein2, Stephen J Traub3
1Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Rochester, MN, USA.
Lancet (London, England)
|April 29, 2014
概括
诊断昏迷需要一个结构化的方法来快速识别和治疗可逆性原因. 这涉及到患者稳定,病史,检查和有针对性的调查,如必要时进行脑成像.
科学领域:
- 神经学 神经学
- 紧急医疗 紧急医疗
背景情况:
- 昏迷呈现出不同的病因,需要系统的诊断策略.
- 了解昏迷的机制,包括结构性脑损伤,扩散神经元功能障碍和精神病因,至关重要.
研究的目的:
- 为快速诊断和治疗昏迷的可逆原因概述一个结构化,算法化的方法.
- 为了指导医生在关于诊断干预措施的决策中,如脑部成像.
主要方法:
- 患者的初始稳定处理危及生命的情况.
- 利用患者病史,体检和实验室发现进行诊断.
- 在怀疑有结构性病变时使用脑成像 (CT),并进行进一步的高级成像或针对非诊断性CT的特定检查清单.
主要成果:
- 一种结构化的方法优先考虑稳定,然后进行病因学调查.
- 脑部成像在创伤后昏迷或当结构性损伤可能出现时是适合的.
- 对于非诊断性CT,一个检查清单指导进一步评估可治疗的疾病,如中毒,感染,,内分泌病变或胺缺乏症.
结论:
- 一种系统的,算法化的方法对于及时诊断和管理昏迷至关重要.
- 通过有针对性的调查及时识别可逆原因可以改善患者的治疗结果.
- 当初始调查没有确定性时,定期重新评估和使用诊断检查清单至关重要.
相关概念视频
Hepatic Encephalopathy
53
DefinitionHepatic encephalopathy is a reversible neurologic syndrome that results from advanced liver dysfunction or portosystemic shunting. It leads to disturbances in cognition, behavior, and motor function due to the brain’s exposure to gut-derived toxins that the liver fails to detoxify.EtiologyThis condition develops either in the setting of acute fulminant hepatitis or progressively during chronic liver disease, such as cirrhosis and portal hypertension. Portosystemic...
53
Traumatic Brain Injury l: Introduction
25
DefinitionTraumatic brain injury, or TBI, is a disturbance of normal brain function induced by an external mechanical force, such as a direct blow to the head or a penetrating injury. It can affect both brain structure and function, producing a wide range of clinical outcomes. TBI is a heterogeneous condition, meaning its effects may differ based on the type, location, and severity of the injury.Basis of ClassificationTBI is classified based on severity, injury mechanism, or pathophysiology. In...
25
Seizures l: Introduction
42
Understanding seizures and epilepsy relies on key definitions that help in recognizing, classifying, and managing these disorders. These definitions provide a framework for recognizing, classifying, and managing seizure disorders.DefinitionsA seizure is a sudden, abnormal burst of electrical activity in the brain that can cause changes in awareness, movement, sensation, or behavior, depending on the area involved. Epilepsy is a chronic condition characterized by recurrent, unprovoked seizures,...
42
Seizures: Classification
2.5K
Epilepsy is primarily characterized by unpredictable seizures, either provoked by an identifiable factor, such as injury or illness, or unprovoked, occurring spontaneously without apparent cause.
Seizures are typically classified into two main categories: focal and generalized seizures.
Focal Seizures
Focal seizures originate from specific regions of the brain. These seizures are further sub-classified into two types:
Seizures are typically classified into two main categories: focal and generalized seizures.
Focal Seizures
Focal seizures originate from specific regions of the brain. These seizures are further sub-classified into two types:
2.5K
Dementia l: Introduction
35
Dementia is an acquired, progressive syndrome characterized by a decline in multiple cognitive domains severe enough to impair daily functioning and reduce independence. Although memory loss is a central feature, the diagnosis requires additional deficits involving language, executive function, visuospatial skills, judgment, calculation, or abstract reasoning. These cognitive impairments reflect underlying neurodegenerative or vascular processes that gradually disrupt neuronal networks...
35
Transient Ischemic Attack l: Introduction
18
A transient ischemic attack (TIA) is a brief episode of neurological dysfunction caused by a temporary, focal reduction in cerebral blood flow. Although symptoms resemble those of an ischemic stroke, the interruption in perfusion is short-lived and does not cause permanent infarction. TIAs are clinically important because they often serve as early warning events for future stroke.Mechanisms of Transient Cerebral IschemiaTransient cerebral ischemia may arise through several mechanisms. One...
18


