Disorders of Consciousness Presented By: Joseph S. Ferezy, D.C.

Levels of Consciousness Clouding (Confusion) Irritable And Slow, But Accurate Hypoxic Increase BUN Encephalopathy

Levels of Consciousness Delirium D.T.’s (2 nd Most Common Alcoholic Encephalopathy) Like A Drunk Arousable Irritable Psychotic Confused Hallucinations

Levels of Consciousness Obtundation One Step Worse Then Delirium

Levels of Consciousness Stupor Like Deep Sleep (Different On EEG) Arousal Only With Deep Stimuli Organic Brain Dysfunction

Coma Unarousable Unresponsive

Glasgow Coma Scale

CNS vs Metabolic Coma

Syncope (Fainting, Vapors) Common Complaint Brief Loss of Consciousness and Muscle Tone Rapidly Restored With Recumbency. Commonly Caused by Impaired Cerebral Circulation, Metabolism, or Psychosomatic. Seizures May Occur, Especially If the Patient Remains Erect. Associated With a Drop in Peripheral Blood Pressure (at Least to 75 Mm Hg) and a Slowed Heart Rate.

Syncope Vasodepressor Commonest Precipitated by Fear Anxiety Pain Other Psychological Usually Occurs When Patient Is Standing Causative Stimuli Sensory Emotional

Physiological Mechanisms Fight or Flight Tissue Damage Pain (Deep) Reflex to Injury of Certain Areas (Testicles, Blood Vessels, Alimentary Canal) Blood Vessel Stenosis Reduced Blood Volume Peripheral Vasodilatation Abnormal Blood Constituents

Prodroma Motor Weakness Epigastric Distress Sympathetic Autonomic Activity Perspiration Pallor of Face Cold, Moist Extremities Lightheadedness Blurred Vision EEG Changes After Onset of Unconsciousness

Treatment Patient Must Remain Recumbent Until Well After Consciousness Returns Regular Exercise Gentle, Broad Contact, Thoracic Adjustments Occipital and Upper Cervical Adjustments Avoid Offending Activity Psychological Evaluation If Recurrent

Carotid Sinus Types Cardio Depressor (Vagal) Pressure on the Carotid Sinus Causes Heart Rate Slowing and Subsequent Decrease in Blood Pressure. Vasodilator (Vasomotor) Drop in Blood Pressure Without Decrease in Heart Rate. Central (Cerebral) Loss of Consciousness Following Carotid Sinus Pressure Is Not Associated With Fall in Blood Pressure. Pressure Below Receptors May Cause Syncope.

Treatment Patient Education Differentiate From Hysteria by Pressing Elsewhere on the Neck and Noting Symptoms Occipital, Upper Cervical and Thoracic Adjustments

Orthostatic Hypotension Characterized by Repeated Syncopal Episodes Associated With a Sudden Drop in Blood Pressure When the Patient Stands up After Sitting or Being Recumbent

Orthostatic Hypotension Causes Prolonged Convalescence Faulty Postural Reflex Adaptation Sympathectomy Peripheral Venous Stasis Anxiety Anti-hypertensive Medication

Orthostatic Hypotension Treatment Aerobic Exercise Patient Education Coordinate With MD Regarding Medications Brisk Specific Adjustments to Thoracic Subluxations Elastic Stockings Abdominal Belt

Cardiac Problems Various Cardiac Syndromes Resulting in Decreased Cerebral Perfusion May Result in Syncope, and a Cardiac Examination Is Essential for an Accurate Diagnosis. Some Are Listed Below: Stokes-Adams Syndrome Reflex Heart Block Coronary/myocardial Insufficiency Paroxysmal Tachycardia Aortic Stenosis Congenital Heart Disease

Impaired Brain Metabolism Anoxemia Anemia Hypoglycemia Acidosis Drug Intoxication Acute Alcoholism Hyperventilation

Other Causes of Impaired Brain Circulation Arteriosclerotic Disease Post Head Injury With Abrupt Head Movements Hypertensive Encephalopathy Migraine (Rarely) Intracranial Neoplasms A-V Malformations Maturation Cough

Hysteria Usually a Repressed, Adolescent or Elderly Female. Look for Other Signs of Hysterical Illness.

Coma Longer and More Profound Loss of Consciousness Than Syncope. Primitive or No Reaction to Painful Stimuli. Milder Grades Are Termed Semi Coma, and Even Lesser Grades As Stupor or Confusion.

Coma Examination Motor Responses to Pain Respiration Pattern Pupil Size, Equality and Reactivity Fundoscopy Vestibulo-ocular Reflexes

Persistent Vegetative State (PVS) Commonly, when coma lasts for a month or more, the individual's eyes may be open and may blink even though the person's stare is vacant, no purposeful responses occur, and no signs of awareness appear. At this state, most physicians will say that the individual is in a "persistent vegetative state" or PVS.

Persistent Vegetative State (PVS) This term was developed by Drs. Brian Jennett and Fred Plum, an outstanding neurosurgeon and a well recognized neurologist respectively. The intent was to describe a condition in which the vegetative or anatomic functions, such as breathing, maintaining a normal blood pressure, digesting and eliminating foods were maintained and would persist indefinitely in the absence of awareness.

Persistent Vegetative State (PVS) Drs. Jennett and Plum, originators of the term PVS, to wait three months before making a determination.

Persistent Vegetative State (PVS) Many physicians will solemnly announce to a family two or three days after onset of coma that their loved one is in a persistent vegetative state and declare unambiguously that nothing can be done, adding insult to injury and preventing treatment at the most treatable stage. Only brain death is untreatable in the spectrum of brain functions.