Plum and Posner's Diagnosis and Treatment of Stupor and Coma

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PLUM AND POSNER’S DIAGNOSIS AND TREATMENT OF STUPOR AND COMA
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Contents
Preface to the Fifth Edition
1. Pathophysiology of Signs and Symptoms of Coma
	Altered States of Consciousness
	Definitions
		Consciousness
		Subacute or Chronic Alterations of Consciousness
	Approach to the Diagnosis of the Comatose Patient
	Physiology and Pathophysiology of Consciousness and Coma
		The Ascending Arousal System
		Structural Lesions that Cause Altered Consciousness in Humans
2. Examination of the Comatose Patient
	Overview
	History
	General Physical Examination
	Level of Consciousness
	ABC: Airway, Breathing, Circulation
		Respiration
	Pupillary Responses
		Examine the Pupils and Their Responses
		Metabolic and Pharmacologic Causes of Abnormal Pupillary Response
	Oculomotor Responses
		Motor Tone
		Motor Responses
	False Localizing Signs in Patients with Metabolic Coma
		Respiratory Responses
	Major Laboratory Diagnostic Aids
		Blood and Urine Testing
3. Structural Causes of Stupor and Coma
	Compressive Lesions as a Cause of Coma
	Compressive Lesions May Directly Distort the Arousal System
		Compression at Different Levels of the Central Nervous System Presents in Distinct Ways
	Herniation Syndromes: Intracranial Shifts in the Pathogenesis of Coma
		False Localizing Signs in the Diagnosis of Structural Coma
	Destructive Lesions as a Cause of Coma
4. Specific Causes of Structural Coma
	Introduction
	Supratentorial Compressive Lesions
	Epidural, Dural, and Subdural Masses
		Epidural Hematoma
		Dural and Subdural Tumors
	Subarachnoid Lesions
		Subarachnoid Hemorrhage
		Subarachnoid Infection
	Intracerebral Masses
		Intracerebral Hemorrhage
		Brain Abscess and Granuloma
	Infratentorial Compressive Lesions
	Epidural and Dural Masses
		Epidural Hematoma
	Subdural Posterior Fossa Compressive Lesions
		Subdural Empyema
		Subdural Tumors
	Subarachnoid Posterior Fossa Lesions
	Intraparenchymal Posterior Fossa Mass Lesions
		Cerebellar Hemorrhage
		Pontine Hemorrhage
	Supratentorial Destructive Lesions Causing Coma
	Vascular Causes of Supratentorial Destructive Lesions
		Carotid Ischemic Lesions
		Vasculitis
	Infections and Inflammatory Causes of Supratentorial Destructive Lesions
		Viral Encephalitis
		Acute Disseminated Encephalomyelitis
	Concussion and Other Traumatic Brain Injuries
		Delayed Encephalopathy After Head Injury
	Infratentorial Destructive Lesions
	Brainstem Vascular Destructive Disorders
		Brainstem Hemorrhage
		Posterior Reversible Leukoencephalopathy Syndrome
	Infratentorial Inflammatory Disorders
	Infratentorial Tumors
	Central Pontine Myelinolysis
5. Metabolic and Diffuse Encephalopathies: Disruption of the Internal Milieu
	Part 1: Distinguishing Metabolic from Structural Coma
		Key Features of the Neurological Examination in Metabolic Encephalopathies
	Part 2: The Internal Milieu: An Overview of Cerebral Metabolism and the Environment Necessary to Maintain Normal Neuronal Function
		Cerebral Blood Flow, Oxygen, and Glucose Utilization
		Synaptic Environment in the Brain and Seizures
	Part 3: Disorders of the Internal Milieu: Lack of Substrate
		Cerebral Hypoxia and Ischemia
	Part 4: Disorders of the Internal Milieu: Ionic and Osmotic Environment
		Hyperglycemic Hyperosmolar State
	Part 5: Disorders of the Internal Milieu: Hormonal and Temperature
		Hypothyroidism
		Hyperthermia
	Part 6: Disorders of the Internal Milieu: Electrical Environment
		Seizure Disorders
		Cortical Spreading Depression
	Part 7: Disorders of the Internal Milieu: Abnormal CSF Pressure or Constituents
	Part 8: Disorders of Endogenous Toxins
		Hypercarbia
		Autoimmune Disorders: Specific Antibodies
	Part 9: Disorders of Exogenous Toxins
6. Psychogenic Unresponsiveness
	Conversion Reactions
	Catatonia
	Psychogenic Seizures
	Cerebellar Cognitive Affective Syndrome
	“Amytal Interview”
7. Initial Management of Patients with Stupor and Coma
	A Clinical Regimen for Diagnosis and Management
	Algorithm and Principles of Emergency Management
	History, Exam, and Basic Diagnostics
		Skeletal Muscle Tone
	Emergent Treatment for All Patients with Stupor or Coma
		Hypoglycemia or Hyperglycemia
		Protect the Eyes
	More Definitive Diagnosis and Treatment of Specific Etiologies of Stupor and Coma
8. Management of Frequently Encountered Causes of Unconsciousness
	Structural Lesions: Supratentorial or Infratentorial Compressive/​Destructive Etiologies
		Aneurysmal Subarachnoid Hemorrhage
		Brain Abscess
	Nonstructural Lesions: Metabolic, Diffuse, or Multifocal Coma
		Central Nervous System Infections
		Metabolic Coma
	General Management Considerations Applying to All or Most Brain-​Injured patients
	Goals of Care
	A Final Word
9. Prognosis in Coma and Related Disorders of Consciousness and Mechanisms Underlying Outcomes
	Introduction 380
	Prognosis in Coma 381
		Traumatic Brain Injury
	Prognosis in Disorders of Consciousness 398
		Vegetative State
	Mechanisms Underlying Outcomes of Coma: Investigational Studies of Disorders of Consciousness 405
		Functional Imaging of the Vegetative State
10. Brain Death
	Determination of Brain Death
	Clinical Signs of Brain Death
		Brainstem Function
11. Disorders of Consciousness in Clinical Practice: Ethical, Legal and Policy Considerations
	Professional Obligations and Clinical Discernment 450
	An Emerging Nosology and Ethic of Care 450
	Brain States 452
	Neuroethics of Covert Consciousness 459
	Capacity, Competence, and Surrogate Decision-​Making 462
		Decision-​Making Capacity
		Mosaic Decision-​Making
	Communication Strategies 464
		Goals of Care
	Institutional Context of Care 467
		Rehabilitation and Long-​Term Care
	Neuropalliative Care 470
	Rights Come to Mind 472
Index