Plum and Posner's Diagnosis and Treatment of Stupor and Coma

 

Description:

Plum and Posner's Diagnosis and Treatment of Stupor and Coma, 5th edition, is a major update of the classic work on diagnosing the cause of coma, with the addition of completely new sections on treatment of comatose patients, by Dr. Jan Claassen, the Director of the Neuro-ICU at Columbia New York Presbyterian Hospital.

The first chapter of the book provides an up-to-date review on the brain mechanisms that maintain a conscious state in humans, and how lesions that damage these mechanisms cause loss of consciousness or coma.

The second chapter reviews the neurological examination of the comatose patient, which provides the basis for determining whether the patient is suffering from a structural brain injury causing the coma, or from a metabolic disorder of consciousness.

The third and fourth chapters review the pathophysiology of structural lesions causing coma, and the specific disease states that result in coma.

Chapter five is a comprehensive treatment of the many causes of metabolic coma.

Chapter 6 review psychiatric causes of unresponsiveness and how to identify and treat them.

Chapters 7 and 8 review the overall emergency treatment of comatose patients, followed by the treatment of specific causes of coma.

Chapter 9 examines the long term outcomes of coma, including the minimally conscious state and the persistent vegetative state, and how they can be distinguished, and their implications for eventual useful recovery.

Chapter 10 reviews the topic of brain death and the standards for examination of a patient that are required to make the determination of brain death.

The final chapter 11 is by J.J. Fins, a medical ethicist who was invited by the other authors to write an essay on the ethics of diagnosis and treatment of patients who, by definition, have no way to approve of or communicate about their wishes. While providing detailed background for neurological and neurosurgical specialists, the practical nature of the material in this book has found its greatest use among Internists, Emergency Medicine, and Intensive Care specialists, who deal with comatose patients frequently, but who may not have had extensive neurological training.

 

Table of Contents:

 

1. Pathophysiology of Signs and Symptoms of Coma

Altered States of Consciousness

Definitions

Consciousness

Acutely Altered States of Consciousness

Subacute or Chronic Alterations of Consciousness

Approach to the Diagnosis of the Comatose Patient

Physiology and Pathophysiology of Consciousness and Coma

The Ascending Arousal System

Behavioral State Switching

Relationship of Coma to Sleep

The Cerebral Hemispheres and Conscious Behavior

Structural Lesions that Cause Altered Consciousness in Humans

2. Examination of the Comatose Patient

Overview

History

General Physical Examination

Level of Consciousness

ABC: Airway, Breathing, Circulation

Circulation

Respiration

Pupillary Responses

Examine the Pupils and Their Responses

Pathophysiology of Pupillary Responses: Peripheral Anatomy of the Pupillomotor System

Pharmacology of the Peripheral Pupillomotor System

Localizing Value of Abnormal Pupillary Responses in Patients in Coma

Metabolic and Pharmacologic Causes of Abnormal Pupillary Response

Oculomotor Responses

Functional Anatomy of the Peripheral Oculomotor System

Functional Anatomy of the Central Oculomotor System

The Ocular Motor Examination

Interpretation of Abnormal Ocular Movements

Motor Responses

Motor Tone

Motor Reflexes

Motor Responses

False Localizing Signs in Patients with Metabolic Coma

Respiratory Responses

Pupillary Responses

Ocular Motor Responses

Motor Responses

Major Laboratory Diagnostic Aids

Blood and Urine Testing

Computed Tomography Imaging and Angiography

Magnetic Resonance Imaging and Angiography

Magnetic Resonance Spectroscopy

Neurosonography

Lumbar Puncture

Electroencephalography and Evoked Potentials

3. Structural Causes of Stupor and Coma

Compressive Lesions as a Cause of Coma

Compressive Lesions May Directly Distort the Arousal System

Compression at Different Levels of the Central Nervous System Presents in Distinct Ways

The Role of Increased Intracranial Pressure in Coma

The Role of Vascular Factors and Cerebral Edema in Mass Lesions

Herniation Syndromes: Intracranial Shifts in the Pathogenesis of Coma

Anatomy of the Intracranial Compartments

Patterns of Brain Shifts that Contribute to Coma

Clinical Findings in Uncal Herniation Syndrome

Clinical Findings in Central Herniation Syndrome

Clinical Findings in Dorsal Midbrain Syndrome

Safety of Lumbar Puncture in Comatose Patients

False Localizing Signs in the Diagnosis of Structural Coma

Destructive Lesions as a Cause of Coma

Diffuse, Bilateral Cortical Destruction

Destructive Disease of the Diencephalon

Destructive Lesions of the Brainstem

4. Specific Causes of Structural Coma

Introduction

Supratentorial Compressive Lesions

Epidural, Dural, and Subdural Masses

Epidural Hematoma

Subdural Hematoma

Epidural Abscess/Empyema

Dural and Subdural Tumors

Subarachnoid Lesions

Subarachnoid Hemorrhage

Subarachnoid Tumors

Subarachnoid Infection

Intracerebral Masses

Intracerebral Hemorrhage

Intracerebral Tumors

Brain Abscess and Granuloma

Infratentorial Compressive Lesions

Epidural and Dural Masses

Epidural Hematoma

Epidural Abscess

Dural and Epidural Tumors

Subdural Posterior Fossa Compressive Lesions

Subdural Empyema

Subdural Tumors

Subarachnoid Posterior Fossa Lesions

Intraparenchymal Posterior Fossa Mass Lesions

Cerebellar Hemorrhage

Cerebellar Infarction

Cerebellar Abscess

Cerebellar Tumor

Pontine Hemorrhage

Supratentorial Destructive Lesions Causing Coma

Vascular Causes of Supratentorial Destructive Lesions

Carotid Ischemic Lesions

Distal Basilar Occlusion

Venous Sinus Thrombosis

Vasculitis

Infections and Inflammatory Causes of Supratentorial Destructive Lesions

Viral Encephalitis

Acute Disseminated Encephalomyelitis

Concussion and Other Traumatic Brain Injuries

Mechanism of Brain Injury During Closed Head Trauma

Mechanism of Loss of Consciousness in Concussion

Delayed Encephalopathy After Head Injury

Infratentorial Destructive Lesions

Brainstem Vascular Destructive Disorders

Brainstem Hemorrhage

Basilar Migraine

Posterior Reversible Leukoencephalopathy Syndrome

Infratentorial Inflammatory Disorders

Infratentorial Tumors

Central Pontine Myelinolysis

5. Metabolic and Diffuse Encephalopathies: Disruption of the Internal Milieu

Part 1: Distinguishing Metabolic from Structural Coma

Key Features of the Neurological Examination in Metabolic Encephalopathies

Part 2: The Internal Milieu: An Overview of Cerebral Metabolism and the Environment Necessary to Maintain Normal Neuronal Function

Cerebral Blood Flow, Oxygen, and Glucose Utilization

Ionic Environment in the Brain and Cortical Spreading Depolarization

Synaptic Environment in the Brain and Seizures

Part 3: Disorders of the Internal Milieu: Lack of Substrate

Cerebral Hypoxia and Ischemia

Hyperoxia

Hypoglycemia

Cofactor Deficiency

Mitochondrial Disorders

Part 4: Disorders of the Internal Milieu: Ionic and Osmotic Environment

Hyponatremia

Hypernatremia

Hypercalcemia

Hypocalcemia

Metabolic Acidosis (Disorders of Systemic Acid–-Base Balance)

Hyperglycemic Hyperosmolar State

Part 5: Disorders of the Internal Milieu: Hormonal and Temperature

Hypothyroidism

Hyperthyroidism

Adrenal Gland

Hypothermia

Hyperthermia

Part 6: Disorders of the Internal Milieu: Electrical Environment

Seizure Disorders

Cortical Spreading Depression

Part 7: Disorders of the Internal Milieu: Abnormal CSF Pressure or Constituents

Intracranial Hypertension

Intracranial Hypotension

Subarachnoid Hemorrhage

Acute Bacterial Meningitis

Chronic Bacterial or Fungal Meningitis

Viral Meningitis Versus Encephalitis

Acute Viral Encephalitis

Carcinomatous Meningitis

Part 8: Disorders of Endogenous Toxins

Hypercarbia

Hepatic Encephalopathy

Renal Failure

Pancreatic Encephalopathy

Systemic Septic Encephalopathy

Autoimmune Disorders: Specific Antibodies

Part 9: Disorders of Exogenous Toxins

Sedative/Hypnotic Drugs and Anesthetics (GABA A Receptor Enhancers)

Intoxication with “Endogenously Produced” Benzodiazepines

Ethanol Intoxication and Ethanol Withdrawal

Ketamine, Phencyclidine (NMDA Receptor Antagonist Drugs)

Antidepressants

Neuroleptics

Opiates

Intoxication with Antipyretic/Analgesic Medications

Intoxication with Drugs of Abuse

Intoxication with Drugs Causing Metabolic Acidosis

6. Psychogenic Unresponsiveness

Conversion Reactions

Catatonia

Psychogenic Seizures

Cerebellar Cognitive Affective Syndrome

“Amytal Interview”

7. Initial Management of Patients with Stupor and Coma

A Clinical Regimen for Diagnosis and Management

Algorithm and Principles of Emergency Management

Support Vital Signs: Airway, Breathing, and Circulation

Ensure Oxygenation, Airway, and Ventilation

Maintain the Circulation

History, Exam, and Basic Diagnostics

Emergency Neurological Examination of the Comatose or Stuporous Patient

Verbal Responses

Respiratory Pattern

Eye Opening

Pupillary Reactions

Eye Position at Rest

Spontaneous Eye Movement

Oculocephalic Responses

Caloric Vestibulo-Ocular Responses

Corneal Responses

Motor Responses

Tendon Reflexes

Skeletal Muscle Tone

Emergent Treatment for All Patients with Stupor or Coma

Hypoglycemia or Hyperglycemia

Thiamine

Antidotes

Infections

Intracranial Pressure

Seizures

Hypo- and Hyperthermia

Acid–Base Abnormalities

Control Agitation

Protect the Eyes

More Definitive Diagnosis and Treatment of Specific Etiologies of Stupor and Coma

8. Management of Frequently Encountered Causes of Unconsciousness

Structural Lesions: Supratentorial or Infratentorial Compressive/Destructive Etiologies

Aneurysmal Subarachnoid Hemorrhage

Intracerebral Hemorrhage

Traumatic Brain Injury

Subdural and Epidural Hematoma

Arterial Ischemic Stroke

Venous Sinus Thrombosis

Brain Tumor

Brain Abscess

Nonstructural Lesions: Metabolic, Diffuse, or Multifocal Coma

Central Nervous System Infections

Acute Disseminated Encephalomyelitis

Hypoxic Brain Injury/Cardiac Arrest

Metabolic Coma

General Management Considerations Applying to All or Most Brain-Injured patients

Goals of Care

A Final Word

9. Prognosis in Coma and Related Disorders of Consciousness and Mechanisms Underlying Outcomes

Introduction

Prognosis in Coma

Prognosis by Disease State

Traumatic Brain Injury

Nontraumatic Coma

Vascular Disease

Central Nervous System Infection

Autoimmune Encephalitis and Encephalomyelitis

Hepatic Coma

Prolonged Hypoglycemia

Depressant Drug Poisoning

Prognosis in Disorders of Consciousness

Vegetative State

Minimally Conscious State

Locked-In State

Mechanisms Underlying Outcomes of Coma: Investigational Studies of Disorders of Consciousness

Functional Imaging of the Vegetative State

Atypical Behavioral Features in PVS

Isolated Neuroimaging of Cortical Responses in PVS Patients

Functional Neuroimaging of Minimally Conscious State

Conceptualizing Patterns of Restoration of Cerebral Network Activity in Disorders of Consciousness Following Coma

Functional Imaging of Recovery of Consciousness: Linked Roles of the Anterior Forebrain Mesocircuit and Default Mode Network/Posterior Medial Complex

Cognitive Motor Dissociation

Assessments of Patients with Chronic Disorders Of Consciousness: An Empirical Guide to Time-Limited Pharmacologic Trials

10. Brain Death

Determination of Brain Death

Clinical Signs of Brain Death

Brainstem Function

Confirmatory Laboratory Tests and Diagnosis

Diagnosis of Brain Death in Profound Anesthesia or Coma of Undetermined Etiology

Pitfalls in the Diagnosis of Brain Death

Brain Death Versus Prolonged Coma

Management of the Brain Dead Patient

11. Disorders of Consciousness in Clinical Practice: Ethical, Legal and Policy Considerations

Professional Obligations and Clinical Discernment

An Emerging Nosology and Ethic of Care

Brain States

Coma

Brain Death

Vegetative State

Unresponsive Wakefulness Syndrome

The Minimally Conscious State

Neuroethics of Covert Consciousness

Normative Significance of Covert Consciousness

Ancillary Care Obligations

Translating Research to Practice

Capacity, Competence, and Surrogate Decision-Making

Decision-Making Capacity

Surrogate Decision-Making

Reemergent Agency

Mosaic Decision-Making

Communication Strategies

Time Delimited Communication

Goals of Care

Institutional Context of Care

Intensive Care

Discharge Planning

Rehabilitation and Long-Term Care

Neuropalliative Care

Pain and Suffering

Withholding and Withdrawing Life-Sustaining Therapy

Family Burden and Bereavement

Rights Come to Mind

Index

 

An aparitie	25 Oct. 2019
Autor	Jerome B. Posner MD, Clifford B. Saper MD PhD, Nicholas D. Schiff MD
Dimensiuni	25.65 x 3.05 x 17.53 cm
Editura	Elsevier
Format	Hardcover
ISBN	9780190208875
Limba	Engleza
Nr pag	464