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Definitionen und Symptome

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Bewusstseinsstörungen und Enzephalopathien

Zusammenfassung

Die Frage der Entstehung von Bewusstsein, die die Menschheit seit Jahrhunderten beschäftigt, aktualisiert sich im medizinischen Alltag bei fraglichen Zuständen des Bewusstseinsverlusts oder einer prolongierten Bewusstseinsstörung. Dabei geht es um nichts Geringeres als die Grenze der spezifischen und individuellen menschlichen Existenz bei weitgehend intakt erhaltenen körperlichen Funktionen. In diesem Kapitel werden die Trennung in quantitative und qualitative Bewusstseinsstörungen sowie die klassischen Syndrome von Somnolenz, Sopor, Koma einerseits und anderseits die verschiedenen mit veränderter oder verringerter Reaktionsbereitschaft einhergehenden Zustände mit mehr oder weniger starker Bewusstseinstrübung wie etwa Delir oder apallisches Syndrom (vegetative state) definiert. Wichtige Differenzialdiagnosen wie das Locked-in-Syndrom und der akinetische Mutismus, aber auch der Zustand des Hirntods werden erläutert und die Syndrome in ihren typischen Manifestationsformen und ihrer Abfolge dargestellt.

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Notes

  1. 1.

    CBD, Corticobasale Degeneration PSP, Progressive supranukleäre Lähmung MSA, Multisystematrophie

Literatur

  • Bauer G, Gerstenbrand F, Rumpl E (1979) Varieties of the locked-in syndrome. J Neurol 221(2): 77–91

    Article  CAS  PubMed  Google Scholar 

  • Bauer G, Gerstenbrand F, Hengl W (1980) Involuntary motor phenomena in the locked-in syndrome. J Neurol 223(3): 191–8

    Article  CAS  PubMed  Google Scholar 

  • Bekinschtein T, Cologan V, Dahmen B, Golombek D (2009a). You are only coming through in waves: wakefulness variability and assessment in patients with impaired consciousness. Prog Brain Res 177: 171–89

    Google Scholar 

  • Bekinschtein TA, Shalom DE, Forcato C, Herrera M, Coleman MR, Manes FF, Sigman M (2009b) Classical conditioning in the vegetative and minimally conscious state. Nat Neurosci 12(10): 1343–9

    Article  CAS  Google Scholar 

  • Bonhoeffer KL (1917) Die exogenen Reaktionstypen. Archiv für Psychiatrie und Nervenkrankheiten 58: 50–70

    Google Scholar 

  • Bruno MA, Bernheim JL, Ledoux D, Pellas F, Demertzi A, Laureys S (2011) A survey on self-assessed well-being in a cohort of chronic locked-in syndrome patients: happy majority, miserable minority. BMJ 1(1): e000039

    Google Scholar 

  • Bruno MA, Ledoux D, Vanhaudenhuyse A, Gosseries O, Thibaut A, Laureys S (2012) Prognosis of Patients with Altered State of Consciousness . In: C Schnakers, S Laureys (Eds) Coma and Disorders of Consciousness, pp 11–23. Springer, London

    Google Scholar 

  • DIMDI (2012) www.dimdi.de/dynamic/de/klassi/downloadcenter/icd-10-gm/version2012/systematik/

  • Doble JE, Haig AJ, Anderson C, Katz R (2003) Impairment, activity, participation, life satisfaction, and survival in persons with locked-in syndrome for over a decade: follow-up on a previously reported cohort. J Head Trauma Rehabil 18(5): 435–44

    Article  PubMed  Google Scholar 

  • Fong TG, Jones RN, Marcantonio ER, Tommet D, Gross AL, Habtemariam D et al. (2012) Adverse outcomes after hospitalization and delirium in persons with Alzheimer disease. Ann Intern Med 156(12): 848–56

    Article  PubMed  Google Scholar 

  • Gerstenbrand F (1977) The Apallic Syndrome. Springer, Berlin Heidelberg New York

    Google Scholar 

  • Gerstenbrand F (1967) Das traumatische apallische Syndrom: Klinik, Morphologie, Pathophysiologie und Behandlung Springer, Berlin Heidelberg New York

    Google Scholar 

  • Gerstenbrand F, Rumpl E (1983) Das prolongierte Mittelhirnsyndrom traumatischer Genese. In: Neumärker KJ (Hrsg) Hirnstammläsionen, S 236–48. Enke-Verlag, Stuttgart

    Google Scholar 

  • Giacino JT (2004). The vegetative and minimally conscious states: consensus-based criteria for establishing diagnosis and prognosis. NeuroRehabilitation 19(4): 293–8

    PubMed  Google Scholar 

  • Giacino JT, Ashwal S, Childs N et al. (2002) The minimally conscious state: definition and diagnostic criteria. Neurology 58: 349–53

    Article  PubMed  Google Scholar 

  • Girard TD, Ware LB, Bernard GR, Pandharipande PP, Thompson JL, Shintani AK et al. (2012) Associations of markers of inflammation and coagulation with delirium during critical illness. Intensive Care Med 38(12): 1965–73

    Article  CAS  PubMed  Google Scholar 

  • Gosseries O, Bruno MA, Chatelle C, Vanhaudenhuyse A, Schnakers C, Soddu A, Laureys S (2011) Disorders of consciousness: what’s in a name? NeuroRehabilitation 28(1): 3–14

    PubMed  Google Scholar 

  • Haig AJ, Katz RT, Sahgal V (1987) Mortality and complications of the locked-in syndrome. Arch Phys Med Rehabil 68(1): 24–7

    CAS  PubMed  Google Scholar 

  • Internationale statistische Klassifikation der Krankheiten und verwandter Gesundheitsprobleme, 10. Revision - German Modification (ICD-10-GM), herausgegeben vom Deutschen Institut für Medizinische Dokumentation und Information, DIMDI, in 50676 Köln

    Google Scholar 

  • Jellinger KA (2009) Funktionelle Pathophysiologie des Bewusstseins. Neuropsychiatrie 23, 115–33

    PubMed  Google Scholar 

  • Jennett B, Plum F (1972) Persistent vegetative state after brain damage. A syndrome in search of a name. Lancet 1: 734–7. URL: PM:4111204

    Google Scholar 

  • Kretschmer E (1940) Das Apallische Syndrom. Z Neurol Psychiat 169: 576–9

    Article  Google Scholar 

  • Landsness E, Bruno MA, Noirhomme Q, Riedner B, Gosseries O, Schnakers C, Massimini M, Laureys S, Tononi G, Boly M (2011) Electrophysiological correlates of behavioural changes in vigilance in vegetative state and minimally conscious state. Brain 134(Pt 8): 2222–32

    Article  PubMed  Google Scholar 

  • Laureys S, Boly M (2007) What is it like to be vegetative or minimally conscious? Curr Opin Neurol 20(6): 609–13

    Article  PubMed  Google Scholar 

  • Laureys S, Owen AM, Schiff ND (2004) Brain function in coma, vegetative state, and related disorders. Lancet Neurology 3: 537–46

    Article  PubMed  Google Scholar 

  • Laureys S et al. (2010) Unresponsive wakefulness syndrome: a new name for the vegetative state or apallic syndrome. BMC Medicine 8: 68 (http://www.biomedcentral.com/1741-7015/8/68)

  • Meagher DJ, Hanlon DO, Mahony EO, Casey PR, Trzepacz PT (2000) Relationship between symptoms and motoric subtype of delirium. J Neuropsychiatry Clin Neurosci 12: 51–6

    CAS  PubMed  Google Scholar 

  • Monti MM, Vanhaudenhuyse A, Coleman MR, Boly M, Pickard JD, Tshibanda L et al. (2010) Willful modulation of brain activity in disorders of consciousness. N Engl J Med 362(7): 579–89

    Article  CAS  PubMed  Google Scholar 

  • Moruzzi G, Magoun HW (1949) Brain stem reticular formation and activation of the EEG. Electroencephalogr Clin Neurophysiol. 1949 Nov;1(4):455–73

    CAS  PubMed  Google Scholar 

  • The Multi-Society Task Force on PVS (1994a) Medical aspects of the persistent vegetative state (1). The Multi-Society Task Force on PVS. N Engl J Med 330 (21): 1499–1508. URL: PM:7818633

    Google Scholar 

  • Multi-Society Task Force on PVS (1994b) Medical aspects of the persistent vegetative state (2). The Multi-Society Task Force on PVS. N Engl J Med 330 (22): 1572–9. URL: PM:8177248

    Google Scholar 

  • Owen AM, Coleman MR, Boly M, Davis MH, Laureys S, Pickard JD (2006) Detecting awareness in the vegetative state. Science 313(5792): 1402

    Article  CAS  PubMed  Google Scholar 

  • Plum F, Posner JB (1966) The diagnosis of stupor and coma. Philadelphia: FA Davis

    Google Scholar 

  • Posner JB, Saper CB, Schiff ND, Plum F (2007) Plum and Posner’s Diagnosis of Stupor and Coma, 4th ed. Oxford University Press, New York

    Google Scholar 

  • Saczynski JS, Marcantonio ER, Quach L, Fong TG, Gross A, Inouye SK, Jones RN (2012) Cognitive trajectories after postoperative delirium. N Engl J Med 367(1): 30–9

    Article  CAS  PubMed  Google Scholar 

  • Schnakers C, Majerus S (2012) Behavioral Assessment and Diagnosis of Disorders of Consciousness. In: Schnakers C, Laureys S (Eds) Coma and Disorders of Consciousness, pp 1–10. Springer, London

    Google Scholar 

  • Searle JR (2000) Consciousness. Ann Rev Neurosci 23: 557–78

    Article  CAS  PubMed  Google Scholar 

  • Smith E, Delargy M (2005) Locked-in syndrome. BMJ 330(7488): 406–9

    Article  PubMed  Google Scholar 

  • Steiner LA (2011) Postoperative delirium. Part 1: Pathophysiology and risk factors. Eur J Anaesthesiol 28: 628–36

    Article  CAS  PubMed  Google Scholar 

  • Teasdale G, Jennett B (1974) Assessment of coma and impaired consciousness. A practical scale. Lancet 2(7872): 81–4

    Article  CAS  PubMed  Google Scholar 

  • Wieck HH (1956) Zur Klinik der sogenannten symptomatischen Psychosen. Dtsch Med Wochenschr 81: 1345–9

    Article  CAS  PubMed  Google Scholar 

  • Wijdicks EF, Bamlet WR, Maramattom BV, Manno EM, McClelland RL (2005) Validation of a new coma scale: The FOUR score. Ann Neurol 58(4): 585–93

    Article  PubMed  Google Scholar 

  • Wilson LM (1972) Intensive care delirium. The effect of outside deprivation in a windowless unit. Arch Intern Med 130(2): 225–6

    Article  CAS  PubMed  Google Scholar 

  • Witlox J, Eurelings LS, de Jonghe JF, Kalisvaart KJ, Eikelenboom P, van Gool WA (2010) Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. JAMA 304(4): 443–51

    Article  CAS  PubMed  Google Scholar 

  • Zeman A (2001) Consciousness. Brain 124: 1263–89

    Article  CAS  PubMed  Google Scholar 

  • Zschocke S, Hansen HC (2012) Entstehungsmechanismen des EEG. In: Zschocke S, Hansen HC. Klinische Elektroenzephalographie, 3. Aufl. Springer, Berlin Heidelberg New York

    Google Scholar 

Literatur zu AM

  • Mann MW, Degos JD (1988) Akinetic mutism in Wernicke-Korsakoff disease: a case report. J Neurol Neurosurg Psychiatry 51(4): 588–90

    Google Scholar 

  • Müller U, von Cramon DY (1994) The therapeutic potential of bromocriptine in neuropsychological rehabilitation of patients with acquired brain damage. Prog Neuropsychopharmacol Biol Psychiatry 18(7): 1103–20

    Article  PubMed  Google Scholar 

  • Naito K, Ueno H, Sekine M, Kanemitsu M, Ohshita T, Nakamura T, Yamawaki T, Matsumoto M (2012) Akinetic mutism caused by HIV-associated progressive multifocal leukoencephalopathy was successfully treated with mefloquine: a serial multimodal MRI Study. Int Med 51(2): 205–9

    Article  CAS  Google Scholar 

  • Otto A, Zerr I, Lantsch M, Weidehaas K, Riedemann C, Poser S (1998) Akinetic mutism as a classification criterion for the diagnosis of Creutzfeldt-Jakob disease. J Neurol Neurosurg Psychiatry 64(4): 524–8

    Article  CAS  PubMed  Google Scholar 

  • Rozen TD (2012) Rapid resolution of akinetic mutism in delayed post-hypoxic leukoencephalopathy with intravenous magnesium sulfate. NeuroRehabilitation 30(4): 329–32

    PubMed  Google Scholar 

  • Shetty AC, Morris J, O’Mahony P (2009) Akinetic mutism – not coma. Age Ageing 38(3): 350–1

    Article  PubMed  Google Scholar 

  • Schiff ND, Ribary U, Moreno DR, Beattie B, Kronberg E, Blasberg R et al. (2002) Residual cerebral activity and behavioural fragments can remain in the persistently vegetative brain. Brain 125(Pt 6): 1210–34

    Article  PubMed  Google Scholar 

  • Spiegel DR, Casella DP, Callender DM, Dhadwal N (2008) Treatment of akinetic mutism with intramuscular olanzapine: a case series. J Neuropsychiatry Clin Neurosci 20(1): 93–5

    Article  PubMed  Google Scholar 

  • Toledo Perdomo K, Navarro Cabello MD, Pérez Sáez MJ, Ramos Pérez MJ, Agüera Morales ML, Aljama García P (2012) Reversible acute encephalopathy with mutism, induced by calcineurin inhibitors after renal transplantation. J Nephrol. doi: 10.5301/jn.5000080

    Google Scholar 

  • Toyoda K (2012) Anterior cerebral artery and Heubner’s artery territory infarction. Front Neurol Neurosci 30: 120–2

    PubMed  Google Scholar 

Literatur zum Delir

  • Clegg A, Young JB (2011) Which medications to avoid in people at risk of delirium: a systematic review. Age and Ageing 40: 23–9

    Article  PubMed  Google Scholar 

  • Cunningham C, Campion S, Lunnon K, Murray CL, Woods JF, Deacon RM, Rawlins JN, Perry VH (2009) Systemic inflammation induces acute behavioral and cognitive changes and accelerates neurodegenerative disease. Biol Psychiatry 65(4): 304–12

    Article  CAS  PubMed  Google Scholar 

  • Ely EW, Shintani A, Truman B, Speroff T, Gordon SM, Harrell FE Jr, Inouye SK, Bernard GR, Dittus RS (2004) Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA 291(14): 1753–62

    Article  CAS  PubMed  Google Scholar 

  • Ely EW, Girard TD, Shintani AK, Jackson JC, Gordon SM, Thomason JW, Pun BT, Canonico AE, Light RW, Pandharipande P, Laskowitz DT (2007) Apolipoprotein E4 polymorphism as a genetic predisposition to delirium in critically ill patients. Crit Care Med 35(1): 112–7

    Article  CAS  PubMed  Google Scholar 

  • Kalisvaart KJ, Vreeswijk R, de Jonghe JFM, van der Ploeg T, van Gool WA, Eikelenboom P (2006) Risk factors and prediction of postoperativedelirium in elderly hip-surgery patients: implementation and validation of a medical risk factor model. J Am Geriatr Soc 54: 817–22

    Article  PubMed  Google Scholar 

  • Maclullich AM, Ferguson KJ, Miller T, de Rooij SE, Cunningham C (2008) Unravelling the pathophysiology of delirium: a focus on the role of aberrant stress responses. J Psychosom Res 65(3): 229–38

    Article  PubMed  Google Scholar 

  • Shehabi Y, Riker RR, Bokesch PM, Wisemandle W, Shintani A, Ely EW (2010) Delirium duration and mortality in lightly sedated, mechanically ventilated intensive care patients. Crit Care Med 38(12): 2311–8

    Article  PubMed  Google Scholar 

  • Weiner MF (2012) Impact of Delirium on the Course of Alzheimer Disease. Arch Neurol 17: 1–2

    Google Scholar 

  • Young J, Inouye SK (2007) Delirium in older people. BMJ 334(7598): 842–6

    Article  PubMed  Google Scholar 

Literatur zur Demenz

  • Barnes DE, Yaffe K (2011) The projected effect of risk factor reduction on Alzheimer’s disease prevalence. Lancet Neurol 10(9): 819–28

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Klinik für Neurologie und Psychiatrie, Friedrich-Ebert-Krankenhaus GmbH Neumünster, Friesenstr. 11, 24534, Neumünster, Deutschland

    H.-C. Hansen

  2. Klinik für Psychiatrie und Psychotherapie der TU München, Klinikum rechts der Isar, Ismaninger Str. 22, 81675, München, Deutschland

    H. Förstl

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  1. H.-C. Hansen
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  1. Klinik für Neurologie und Psychiatrie, Friedrich-Ebert-Krankenhaus Neumünster GmbH, Neumünster, Germany

    Hans-Christian Hansen

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Hansen, HC., Förstl, H. (2013). Definitionen und Symptome. In: Hansen, HC. (eds) Bewusstseinsstörungen und Enzephalopathien. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-36915-5_1

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  • DOI: https://doi.org/10.1007/978-3-642-36915-5_1

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