Consciousness disturbances
Contents:
Description:
Stupefaction – the total disintegration of all mental activity consisting in a qualitative change of maintenance of consciousness, in its "perversion". Unlike switching off of consciousness reflection is present when obscuring, but its contents is not the objective reality, but the world of painful experiences of the patient.
Consciousness switching off – total disturbance of reflective activity which consists in reduction, up to total disappearance, volume and depth of all mental functioning with transition of level of reflection from the highest to the lowest.
Symptoms of Disturbances of consciousness:
Among stupefactions distinguish:
oneiric stupefaction – the psychotic state which is characterized by a kaleydoskopichnost of experiences in which in a whole merge real, illusory and hallucinatory. Singularity, irreality of the incidents and provisions endured by the patient, having usually menacing gloomy character is typical. Sometimes it is pictures of grandiose accidents. Usually the patient is an observer, but not the participant of events. At the same time full detachment from real events, catalepsy, passivity is noted.
delirious stupefaction – the leading symptoms – a disorientation in a real environment at preservation of orientation in own personality and true visual hallucinations. Patients are more often excited, disturbing. Development of acute sensual delirium is possible.
amental stupefaction (amentia) is a deep total disintegration of all mental activity that is shown by a full disorientation, the expressed disturbance of active attention with its sharp otvlekayemost accepting character of a hypermetamorphosis, and also the psychomotor excitement reaching quite often a chaotic throwing. The patient usually does not leave a bed. Excitement time is interrupted by an obezdvizhennost. This state develops against the background of heavy intoxications.
Distinguish the following types of switching off of consciousness:
devocalization – difficulty, simplification and considerable reduction of volume of all mental reflective activity. Orientation of patients is at a loss, gains fragmentary character, questions are perceived hardly, answers to them incomplete, inexact. After an exit – amnesia.
sopor – orientation is impossible in general, only reactions to strong irritants – pain stimulation, a loud call remain. The muscle tone is lowered, there are no tendon, periosteal, cutaneous reflexes.
coma – the deep disturbance of consciousness which is characterized by oppression of the TsNS functions, lack of reaction to external irritants, sensitivity, active movements, reflexes.
Reasons of Disturbances of consciousness:
Disturbance of consciousness is display of dysfunction of hemispheres, upper parts of a trunk of a brain, or and that and other area at the same time. So local defeat of supratentorial structures can have widespread character, or perhaps causing hypostasis, to displace brain structures, leading to a transtentorial gerniation, a prelum of diencephalic departments of a brain and dysfunction of the diencephalic activating system.
Primary subtentorial processes (brainstem and cerebellum) can squeeze or directly damage the reticular activating system between average departments of the varoliyevy bridge and the diencephalic area.
Metabolic or infectious diseases can make the oppressing impact on function of hemispheres and a trunk of a brain by means of the pathological maintenance of components of blood or direct toxic effect.
Disturbance of consciousness can be observed also at disturbance of cerebral circulation (syncopes and a heart attack) or at change of bioelectric activity of a brain (epilepsy). The inadequate brain blood stream and a chemical imbalance of blood can cause disturbance of electric activity of a brain also.
The concussion of the brain and psychological frustration cause disturbance of consciousness without visible structural changes of a brain.
Treatment of Disturbances of consciousness:
Obligatory inspections at consciousness disturbance (of course if the patient does not get in a serious condition to the intensive care care unit at once) will be – surveys of the neurologist, oculist, therapist, carrying out the electrocardiogram, an electroencephalography, computer tomography, magnetic and resonant therapy, biochemical inspections. Further tactics depends on the received results. The single syncope when overheating in the sun or orthostatic at a sharp night rising of special treatment does not demand. Neuro – circulator dystonia with faints demands observation and course treatment from the neurologist. At detection of a tumor of a brain of the patient will send to neurosurgical department. The brain stroke is treated in a neurology unit. The myocardial infarction, cardiac arrhythmias demand treatment and observation from the cardiologist. Epilepsy is treated at the neurologist, and with existence of disturbances of the personality at the psychiatrist – an epileptolog.
