Disturbance of Consciousness课件.ppt

Instruction Transient loss of consciousness Syncope Seizure Further differential diagnoses Cerebrovascular disease, Carotid sinus disease, Drop attacks Hyperventilation , Narcolepsy and cataplexy Coma Differnetial diagnosis Akinetic mutisum ,lock-in syndrome, persisent vegetative state, catatonic, non-convulsive status epilepticus Transient loss of consciousness A very common presenting problem No symptoms or physical signs, and subsequent investigations are normal It ‘s important to take the history carefully from the patient and the witness Recurrent loss of conciousness is usually due to epilepsy, synope, or cardiac arrhythmia Synope The conscious state is maintained by the cerebral cortex and brainstem renticular formation Synope is the transient loss of conciousness and posture that results from a global reduction in blood flow to the brain Vasovagal synope Peripheral vasodilatation ---the sudden drop in blood pressure Bradycardia result from vagal stimulation ----subsequent reduction in cardiac output Upright at onset of syncope Prodromal symptoms-last for several seconds to a few minutes light-headed ,gradual dimming of vision, ringing in the ears,salivation,sweating,nausea,vomiting Vasovagal synope The attack can be aborted if the patient assumes the supine position The patient is pale and clammy,the pulses almost imperceptible, the SBP drops to about 60mmHg, may be a convulsive movements Sphincter control is almost invariably maintained May be prolonged malaise afterward Micturition and cough syncope Micturition syncope occurs in men who get up during the night to pass urine A combination of Vasodilatation (which occurred with empting of the bladder) A degree of postural hypotension on standing Micturition and cough syncope Cough syncope Impair the venous return to the heart result from elevated the intrathoracic pressure Increased of the cerebrospinal fluid pressure Reduction of PCO2 Syncope following breath-