Early manifestations of disorder of consciousness The patient's sleep time is excessively prolonged, but he can be awakened. After waking up, he can barely cooperate with examinations and answer simple questions. After the stimulation is stopped, the patient continues to fall asleep.

➢Consciousness disorder that is more serious than drowsiness ➢The patient is in a deep sleep state and cannot be awakened by normal external stimulation. He must be awakened by loud calling or other strong stimulation. ➢The ability to respond to speech has not been completely lost. He can make vague, simple and incomplete answers, and falls asleep quickly after stopping stimulation.

It is the most serious disorder of consciousness. The patient has completely lost consciousness, cannot awaken from various strong stimuli, has no purposeful autonomous activities, and cannot spontaneously open his eyes.

Level three

➢Diminished attention and indifferent emotional response

➢Disorientation and reduced activity

➢Lack of coherence in language

➢Can respond to external stimulation, but below normal level

➢Acute high-level brain dysfunction: manifested as cognition, attention, orientation, slow thinking, delusions, hallucinations, etc.

➢Symptoms such as nervousness, fear, excitement, and even impulsive and aggressive behavior may occur

➢The condition often fluctuates, worsening at night and relieving during the day, often lasting for hours or days.

Definition: Decrease or loss of cortical function caused by extensive damage to the cerebral cortex on both sides, but subcortical function is still preserved

Performance:

posture

common in

definition

Performance

posture

1. There are no lesions in the cerebral hemispheres and their efferent pathways

2. There is a wake-sleep cycle, and you can look at the surrounding environment and people. You seem to be awake, but you can't speak.

3. Reduced muscle tone and fecal incontinence

4. There is no vertebral tract sign, and strong stimulation cannot change his or her state of consciousness.

5. Common in brainstem infarction

1. Severe impairment of brain function but preservation of brainstem function

2. Complete loss of cognitive functions of oneself and the outside world

3. Unable to communicate with the outside world

4. Open eyes spontaneously or reflexively, and occasionally find things to track

5. There can be meaningless wry smiles

6. There are primitive reflexes such as sucking, chewing and swallowing

7. Have wake-sleep cycle and incontinence

Persistent vegetative state refers to the vegetative state lasting for more than 12 months after craniocerebral trauma, and for more than 3 months due to other reasons.

Basal pontine lesions with bilateral involvement of corticospinal and cortico-brainstem tracts

The motor efferent pathway is completely damaged (below the pons), showing a motor state

Conscious, able to blink, eyeballs can move up and down, but unable to move left and right, unable to open mouth, quadriplegia

Can be caused by: cerebrovascular disease, infection, tumor, demyelinating disease

The patient is awake, has motor and sensory functions, and has normal memory function

No response to stimulation, no desire, severe apathy

May have frontal lobe release reflex

Mostly caused by bilateral frontal lobe lesions

Lack of response to external stimuli, silent, motionless, eating or drinking

Often accompanied by wax-like flexion, inflexibility, and reaction to emotional stimulation

Seen in catatonia, depression and reactive stupor

(1) Pupil

(2) Fundus

(3) Eyeball position

(4) Eye movement

Forcefully press the supraorbital rim and sternum to check the comatose patient's motor response to pain, which can help locate the level of brain dysfunction or determine the degree of coma.

Facial pain expression: facial paralysis

Unilateral or asymmetric postural reactions

cortical ankylosis

decerebrate ankylosing

No response to pain - pontobulbar disease

Facial paralysis

spontaneous movement of limbs

Drop test

Ciliary ridge reflex p103

corneal reflex

head-eye reflex

vestibular reflex

➢ Neck stiffness, Kernig sign, Brudzinski sign

➢ Meningeal irritation: meningitis, subarachnoid hemorrhage, encephalitis and increased intracranial pressure

➢ Accompanied by fever: central nervous system infection

➢ Afebrile and transient coma: subarachnoid hemorrhage

Inspection Method

➢ Malnutrition

➢ Lung or urinary tract infection

➢ Incontinence of urine and feces

➢ Pressure ulcers

➢ Stomatitis

➢ Conjunctivitis, keratitis, corneal ulcer

➢ Joint stiffness and limb contracture deformity