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DISORDERS OF CONSCIOUSNESS

Dr. Rini Andriani, SpS

Bagian Neurology

FK Untar

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Physiology of Consciousness

Depends on Intact andInteracting BrainstemReticular Formation and

Cereral !emis"er

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Physiology of consciousness

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Pathogenesis

Dys"unction o" t#eAscending Reticular

Formation in $#e $#alamusor Brainstem, and%or

Dys"unction o" Bot#Cereral !emis"er

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Pathogenesis

Supratentorial &esions

In"ratentorial &esions

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GLASGOW COMA SCALE

'ye (pening

)Spontaneously *

)$o Speec# +

)$o ain -

)None

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Glasgo Co!a Scale

/otor Response

) (eys Command 0

) &ocali1e ain 2

) Fle3ion 4it#dra5l *

) Fle3ion Anormal6Decorticate7 +

) '3tension 6Decererate7 -

) No Response

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Glasgo Co!a Scale

8eral Response

)(riented And Con9erses 2

)Disoriented*

) Inappropiate 4ords +

) Incompre#ensile Sounds -)No Response

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Classification of Le"els of

Consciousness

Normal Consciousness

Con"usion

Delirium

(tundation

Stupor

Coma

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Etiology

Supratentorial 62 :7 andIn"ratentorial 62:7 &esions

Brain !emorr#age6Intraparenc#ymal, Sudural,Suarac#noid7

Brain In"arction

8enous;sinus $#romosis

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Etiology

/eningo;encep#alitis

Brain Ascess

Brain $umor

!ead In

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Uncal an# t$anstento$ial he$niation

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Cent$al t$anstento$ial he$niation

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Uncal he$niation f$o! glio%lasto!a

!ultifo$!e

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Cau#al #is&lace!ent of the #ience&halon

an# !e#ial te!&o$al lo%e

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Du$et he!o$$hages

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Etiology

Di=use Brain Disturances 6>?:7

Metabolic:

!ypo3ia !yponatremia

!ypoglycemia

!yperglycemia

Uremia

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Etiology

&i9er "ailure

!ypocalcemia and#ypercalcemia

!ypot#yroid

$#iamine de@ciency

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'RAIN EDEMA()*

(2) Fishman, Robert. (1995). Brain Edema and Disorder of Intracranial Pressure. In Merritts Textbook of

Neurology. 9tEdition. Williams and Wilkins. USA : !2"1!

http://pathweb.uchc.edu/eAtlas/CNS/858b.htm

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EDEMA

MONROE KELLIE MODEL(3)

() ##. (2!!$). Monroe !ellie Model.A%ailable at : htt&:''snerosr*er+.om'

N(R/A& BRAIN 'D'/A

http://uscneurosurgery.com/http://uscneurosurgery.com/

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BRAIN EDEMA(6)

() htt&:''---.sneror*er+.om'

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+ASOGENI, C-.O.O,SI, IN.ERS.I.IAL

PATOGENESIS PENINGKATANPERMEAI!ITAS

KAPI!ER

PEMENGKAKANSE!"!AR

#AMATANASORSI CS$

!OKASI E%EMA S"STANSI A!A S"STANSI A!A%AN GRISEA

PERI&ENTRIKE!S"STANSI A!A

KOMPOSISI CAIRANE%EMA

PROTEIN P!ASMA AIR %AN NATRI"MSE!"!AR

CS$

&O!"ME CAIRANEKSTRASE!"!ER

MENINGKAT MEN"R"N MENINGKAT

PERMEAI!ITASKAPI!ER

MENINGKAT NORMA! NORMA!

MANI$ESTASI

K!INIK

T"MOR OTAK

TRA"MA OTAK

IN$ARK OTAK

#IPOKSIA

#IPO'OSMO!ARITAS

OSTR"KSI

#I%ROSE$A!"S

PER"A#AN EEG PER!AMATAN$OKA!

PER!AMATANGENERA!

NORMA!

PENGAR"# TERAPI

STEROI%

( ' )

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Manage!ent

Air5ay and Breat#ing

)Clear Air5ay Deli9ery o"

(3ygen)&ateral osition

)Remo9ed Secretions ySuctioning

) Intuated i" Necessary

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Manage!ent

Circulation

)'stalis#ed I8 &ine

)Dra5n Blood Sample 6lucose,Into3icating Drugs,'lectrolytes, &i9er Kidney

Function7)Nalo3one ?,2 /g I9 ForNarcotic (9erdose

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Manage!ent

For !ypoglycemia i9e -2 $o 2? /lo" a *?: or 2?: lucose Solutions,"ollo5ed y 2 : In"usion,

/ust e Supplemented 5it#$#iamine

I" t#e Diagnosis is Uncertain, Bot#S#ould e Administered

Correction o" t#e /etaolicDisturances

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Manage!ent

4it# t#e signs o" raisedintracranial pressure,manitol ?,2 to ,2 gr %g in a-?: solution s#ould egi9en i9 o9er ? to -? min

/onitoring t#e si1e o" t#elesions and degree o" edema

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Manage!ent

er"ormed lumar puncture, i"meningitis or suarac#noid#emorr#age is suspected

Con9ulsion s#ould e controlled

'3treme #ypot#ermia and

#ypert#ermia s#ould ecorrected

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Manage!ent

Decompression o" t#eladder

Insert nasogastric tue, "ormaintaining Euids andelectrolyte alance

roper positioning o" t#epatient

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Copyright 2007 dr. Rini Andriani, Sp.S.

.e$a&i Fa$!a/ologi(01)

(1) reenber*, /a%id0 Amino, ihael0 Simon, Ro*er. (199). "oma. In "linical Neurology #ndEdition.A&&lenton and3an*e. USA :291

O%at Dosis Se#iaan ,ete$angan

GLUCOCOR.ICOID

D'A/'$AS(N ?;??mg,dilan

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