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Coma and Encephalopathy

  • M. V. Padma Srivastava
Chapter

Abstract

The term encephalopathy refers to a syndrome of global brain dysfunction that can be caused by a variety of different causes, each with a different prognosis and implication for diagnosis and management. The hallmark of encephalopathy is an altered mental state. The common neurological symptoms of encephalopathy are loss of cognitive function, subtle changes in personality, inability to concentrate, lethargy and depressed consciousness. The other neurological signs that may be present include myoclonus, asterixis, nystagmus, tremors, seizures and respiratory abnormalities, such as Cheyne–Stokes respiration, apneustic respiration and post-hypercapnic apnoea.

References

  1. 1.
    Plum F, Posner JB. The diagnosis of stupor and coma. 3rd ed. Philadelphia: Davis; 1980.Google Scholar
  2. 2.
    Brodal A. Neurological anatomy in relation to clinical medicine. 3rd ed. Oxford: Oxford University Press; 1981.Google Scholar
  3. 3.
    Jouvert M. The role of monoamines and acetyl choline containing neurons in the regulation of the sleep/wake cycle. Rev Physiol. 1972;64:166–307.Google Scholar
  4. 4.
    Defeudis FV. Cholinergic roles in consciousness. In: Defeudis FV, editor. Central cholinergic systems and behavior. London: Academic Press; 1974.Google Scholar
  5. 5.
    Tinuper P. Idiopathic recurring stupor. A case with possible involvement of the gamma aminobutyric acid (GABA) ergic system. Ann Neurol. 1992;31:503–6.CrossRefGoogle Scholar
  6. 6.
    Medical Research Council Brain Injuries Committee. A glossary of psychological terms commonly used in cases of head injury. MRC war memorandum. London: HMSO; 1941.Google Scholar
  7. 7.
    Jennett B, Plum F. Persistent vegetative state after brain damage. A syndrome in search of a name. Lancet. 1972;1:734–7.CrossRefGoogle Scholar
  8. 8.
    Teasdale G, Jennett B. Assessment of coma and impaired consciousness: a practical scale. Lancet. 1974;2:81–4.CrossRefGoogle Scholar
  9. 9.
    Cairns H. Disturbances of consciousness with lesions of the brain stem and diencephalon. Brain. 1952;75:109–46.CrossRefGoogle Scholar
  10. 10.
    Fisher CM. The neurological examination of the comatose patient. Acta Neurol Scand. 1969;45(Suppl 46):1–56.Google Scholar
  11. 11.
    Leigh RJ, Shaw DA. Rapid regular breathing in unconscious patients. Arch Neurol. 1976;33:356–61.CrossRefGoogle Scholar
  12. 12.
    Bates D. Defining prognosis in medical coma. J Neurol Neurosurg Psychiatry. 1991;54:569–71.CrossRefGoogle Scholar
  13. 13.
    Graves JR, Herlitz J, Bang A, et al. Survivors of out of hospital cardiac arrest: their prognosis, longevity and functional status. Resuscitation. 1997;35:117–21.CrossRefGoogle Scholar
  14. 14.
    Jorgensen EO. Course of neurological recovery and cerebral prognostic signs during cardio-pulmonary resuscitation. Resuscitation. 1997;35:9–16.CrossRefGoogle Scholar
  15. 15.
    Longstreth WT Jr. Neurological complications of cardiac arrest. In: Aminoff MJ, editor. Neurology and general medicine. 3rd ed. New York: Churchill Livingstone; 2001. p. 151–70.Google Scholar
  16. 16.
    Longstreth WT Jr, Dikmen SS. Outcomes after cardiac arrest. Ann Emerg Med. 1993;22:64–9.CrossRefGoogle Scholar
  17. 17.
    Snyder BD, Hauser WA, Loewenson RB, et al. Neurologic prognosis after cardiopulmonary arrest: III. Seizure activity. Neurology. 1980a;30:1292–7.CrossRefGoogle Scholar
  18. 18.
    Snyder BD, Loewenson RB, Hauser WA, et al. Neurologic prognosis after cardiopulmonary arrest: II. Level of consciousness. Neurology. 1980b;30:52–8.CrossRefGoogle Scholar
  19. 19.
    Zandbergen EG, de Haan RJ, Stoutenbeek CP, et al. Systematic review of early prediction of poor outcome in anoxic–ischemic coma. Lancet. 1998;352:1808–12.CrossRefGoogle Scholar
  20. 20.
    Edgren E, Hedstrand U, Kelsey S, et al. Assessment of neurological prognosis in comatose-survivors of cardiac arrest. BRCT I Study Group. Lancet. 1994;343:1055–9.CrossRefGoogle Scholar
  21. 21.
    Chen R, Bolton CF, Young B. Prediction of outcome in patients with anoxic coma: a clinical and electrophysiologic study. Crit Care Med. 1996;24:672–8.CrossRefGoogle Scholar
  22. 22.
    Bassetti C, Bomio F, Mathis J, et al. Early prognosis in coma after cardiac arrest: a prospective clinical, electrophysiological, and biochemical study of 60 patients. J Neurol Neurosurg Psychiatry. 1996;61:610–5.CrossRefGoogle Scholar
  23. 23.
    Berek K, Lechleitner P, Luef G, et al. Early determination of neurological outcome after prehospital cardiopulmonary resuscitation. Stroke. 1995;26:543–9.CrossRefGoogle Scholar
  24. 24.
    Wijdicks EFM, Hijdra A, Young GB, et al. Practice parameter: prediction of outcome in comatose survivors after cardiopulmonary resuscitation (an evidence-based review): report of the quality standards Subcommittee of the American Academy of neurology. Neurology. 2006;67:203–10.CrossRefGoogle Scholar
  25. 25.
    Roine RO, Raininko R, Erkinjuntti T, et al. Magnetic resonance imaging findings associated with cardiac arrest. Stroke. 1993;24:1005–14.CrossRefGoogle Scholar
  26. 26.
    Sorenson K, Thomassen A, Wernberg M. Prognostic significance of alpha frequency EEG rhythm in coma after cardiac arrest. J Neurol Neurosurg Psychiatry. 1978;41:840–2.CrossRefGoogle Scholar
  27. 27.
    Dinsdale HB. Hypertensive encephalopathy. Stroke. 1982;13:717–9.CrossRefGoogle Scholar
  28. 28.
    Chester EM, Agamanolis DP, Banker BQ, et al. Hypertensive encephalopathy: a clinico-pathologic study of 20 cases. Neurology. 1978;28:928–39.CrossRefGoogle Scholar
  29. 29.
    Paulson OB, Strandgaard S, Edvinsson L. Cerebral autoregulation. Cerebrovasc Brain Metab Rev. 1990;2:161–92.PubMedGoogle Scholar
  30. 30.
    Healton EB, Brust JC, Feinfeld DA, et al. Hypertensive encephalopathy and the neurologic manifestations of malignant hypertension. Neurology. 1982;32:127–32.CrossRefGoogle Scholar
  31. 31.
    Spetzler RF, Wilson CB, Weinstein P, et al. Normal perfusion pressure breakthrough theory. Clin Neurosurg. 1978;25:651–72.CrossRefGoogle Scholar
  32. 32.
    Sanders TG, Clayman DA, Sanchez–Ramos L, et al. Brain in eclampsia: MR imaging with clinical correlation. Radiology. 1991;180:475–8.CrossRefGoogle Scholar
  33. 33.
    Hauser RA, Lacey DM, Knight MR. Hypertensive encephalopathy. Magnetic resonance imaging demonstration of reversible cortical and white matter lesions. Arch Neurol. 1988;45:1078–83.CrossRefGoogle Scholar
  34. 34.
    Hinchey J, Chaves C, Appignani B, et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med. 1996;334:494–500.CrossRefGoogle Scholar
  35. 35.
    Ahn KJ, You WJ, Jeong SL, et al. Atypical manifestations of reversible posterior leukoencephalopathy syndrome: findings on diffusion imaging and ADC mapping. Neuroradiology. 2004;46:978–83.CrossRefGoogle Scholar
  36. 36.
    Trommer BL, Homer D, Mikhael MA. Cerebral vasospasm and eclampsia. Stroke. 1988;19:326–9.CrossRefGoogle Scholar
  37. 37.
    Rowland L. Merritt’s neurology. 10th ed. Philadelphia: Lippincott Williams and Wilkins; 2000.Google Scholar
  38. 38.
    Shah SM, Kelly KM. Emergency neurology: principles and practice. Cambridge: Cambridge University Press; 1999.Google Scholar
  39. 39.
    Victor M. Adams and Victor’s principles of neurology. 7th ed. New York: McGraw-Hill; 2001.Google Scholar
  40. 40.
    Hoffman RS, Goldfrank LR. The poisoned patient with altered consciousness. Controversies in the use of a ‘coma cocktail. JAMA. 1995;274:562–9.CrossRefGoogle Scholar
  41. 41.
    Young GB, Bolton CF, Austin TW. The encephalopathy associated with septic illness. Clin Invest Med. 1990;13:297–304.PubMedGoogle Scholar
  42. 42.
    Freund HR, Ryan JA, Fischer JE. Amino acid derangements in patients with sepsis: Treatment with branched chain amino acid rich transfusions. Ann Surg. 1978;188:423–30.CrossRefGoogle Scholar
  43. 43.
    Brain L, Jellinek EH, Ball K. Hashimoto’s disease and encephalopathy. Lancet. 1966;2:512.CrossRefGoogle Scholar

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© The Author(s) 2019

Authors and Affiliations

  • M. V. Padma Srivastava
    • 1
  1. 1.Department of NeurologyAll India Institute of Medical SciencesNew DelhiIndia

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