The unconscious patient

Question 1

What 3 main categories can the causes of disorders of consciousness be divided into?

Answer 1

-Traumatic brain injury
-Non-traumatic brain injury
-Progressive brain damage

Question 2

What examples of traumatic brain injury can cause LOC?

Answer 2

-Falls
-RTAs
-Assault

Question 3

What examples of non-traumatic brain injury can cause LOC?

Answer 3

-Neurological eg stroke, TIA, seizure
-MI / arrhythmia
-SAH
-Meningitis, encephalitis
-Drug overdose
-Poisoning
-Uraemia
-Electrolyte imbalance
-DKA / low BG
-Dehydration
-Massive blood loss
-Near drowning, suffocation, smoke inhalation

Question 4

What forms of progressive brain damage can cause LOC?

Answer 4

-Alzheimer’s
-Parkinson’s
-Brain tumours

Question 5

How might you investigate someone with a disorder of consciousness?

Answer 5

Depends on the cause
-Head imaging
-EEG
-ECG and echo
-CXR
-LP
-Toxicology
-Full bloods
-BP

Question 6

How is syncope defined?

Answer 6

-A transient loss of consciousness caused by transient global cerebral hypo perfusion characterised by rapid onset, short duration and spontaneous complete recovery
-The term excludes seizures, coma, shock or other states of altered consciousness

Question 7

What causes syncope?

Answer 7

-Neurally mediated ie reflex syncope:
–vasovagal syncope
–situation syncope eg defection, cough
–glossopharyngeal neuralgia
-Postural hypotension
-Cardiac arrhythmias
-Structural cardiac / cardiopulmonary disease
-Substance abuse / alcohol intoxication
-Psychogenic

Question 8

What investigations would you carry out for someone with LOC?

Answer 8

-Lying/Standing BP
-ECG
-FBC if anaemia or bleeding is suspected
-BG

Question 9

How should you manage syncope?

Answer 9

-Neurally mediated - education and reassurance
-PH - try to stop drugs causing / exacerbating, avoid alcohol, encourage fluid intake, education re slow standing
-Cardiac - treat underlying cause
-Psychogenic - CBT