Consciousness and its disorders

Vigilance (quantitative)

 * wakefulness, ARAS + diencephalon

Causes of long-term impairment of consciousness

 * Types
 * somnolence
 * stupor
 * patient is not easily awoken, except to strong external stimuli (e.g. sternal rub) → returns back to sleep
 * Coma
 * unarousable for 2-4 weeks
 * decreased/absent reflex responses and motor activity
 * preserved circulatory function and breathing drive

Structural lesions

 * show pathological findings on imaging (CT, MRT) e.g. stroke, tumors, inflammations, trauma

Toxic-metabolic lesions

 * Imaging may be normal or diffuse
 * causes: toxic, physical, metabolic, endocrine, vascular causes....

Paroxysmal disorders (short-term)

 * are characterized by sudden onset, short, spont. recovery
 * Syncope
 * epileptic seizure
 * metabolic diseases (e.g. hypoglycemia)

Lucidity (qualitativ)

 * is defined as the clearness of consciousness, cerebral cortex

Qualitative disorders

 * wakefulness, altered state of consciousness
 * dysbalance/change in synthesis, release and/or inactivation of NTs, which influence cognition

Delirium

 * 20% of all inpatient patients
 * Risk factors
 * extracerebral (e.g. intoxication by medication, metabolic diseases) x cerebral (e.g. stroke, focal structural lesion)
 * Symptoms
 * Disorientation (time, place mostly)
 * visual hallucinations, delusions (e.g. "you want to kill me"), confabulations
 * impaired attention
 * behavior: can be hyperactive, but more commonly (esp. in eldery) hypoactive
 * altered responsiveness of ANS
 * subsequent amnesia (do not remember episode)
 * Complications
 * reduced delirium: aspiration, pneumonia, thromboembolism
 * hyperactive: harm themselves
 * Differential diagnosis
 * How do we treat delirium?
 * Nonpharmacological
 * it is self-limited. → bring to a calm environment, reorientation, support
 * Pharmacological
 * usually for hyperactive delirium e.g. haloperidol

Obnubilation

 * twilight state, no psychotic symptoms