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

Name: Plum and Posner's Diagnosis and Treatment of Stupor and Coma
Brand: OUP eBook
Price: 64.49 EUR
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Jerome B. MD Posner Clifford B. MD Saper Nicholas D. MD Schiff Jan MD Claassen(Autor*in)

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5. Auflage

Erschienen am 30. Juli 2019

480 Seiten

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Plum and Posner's Diagnosis and Treatment of Stupor and Coma, 5th edition, is a major update of the classic work on diagnosing the cause of coma, with the addition of completely new sections on treatment of comatose patients, by Dr. Jan Claassen, the Director of the Neuro-ICU at Columbia New York Presbyterian Hospital. The first chapter of the book provides an up-to-date review on the brain mechanisms that maintain a conscious state in humans, and how lesions that damage these mechanisms cause loss of consciousness or coma. The second chapter reviews the neurological examination of the comatose patient, which provides the basis for determining whether the patient is suffering from a structural brain injury causing the coma, or from a metabolic disorder of consciousness. The third and fourth chapters review the pathophysiology of structural lesions causing coma, and the specific disease states that result in coma. Chapter five is a comprehensive treatment of the many causes of metabolic coma. Chapter 6 review psychiatric causes of unresponsiveness and how to identify and treat them. Chapters 7 and 8 review the overall emergency treatment of comatose patients, followed by the treatment of specific causes of coma. Chapter 9 examines the long term outcomes of coma, including the minimally conscious state and the persistent vegetative state, and how they can be distinguished, and their implications for eventual useful recovery. Chapter 10 reviews the topic of brain death and the standards for examination of a patient that are required to make the determination of brain death. The final chapter 11 is by J.J. Fins, a medical ethicist who was invited by the other authors to write an essay on the ethics of diagnosis and treatment of patients who, by definition, have no way to approve of or communicate about their wishes. While providing detailed background for neurological and neurosurgical specialists, the practical nature of the material in this book has found its greatest use among Internists, Emergency Medicine, and Intensive Care specialists, who deal with comatose patients frequently, but who may not have had extensive neurological training.

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Jerome B. Posner, MD is a Professor Emeritus at Cornell Medical College and former Chairman of Neurology at Memorial-Sloan Kettering Cancer center in New York. He graduated from the University of Washington before moving to Cornell University Medical College. He was appointed to the New York Genome Center in 2016. Dr Posner has held many leadership positions throughout his long and distinguished tenure at Weill Cornell and Memorial Sloan-Kettering Cancer Center, including being President of the American Neurological Association. He is a member of the National Academy of Medicine and served on the advisory council of the National Institute of Neurological Diseases and Stroke (NINDS). Clifford B. Saper, MD, PhD is the James Jackson Putnam Professor of Neurology and Neuroscience at Harvard Medical School and Chairman of Neurology at Beth Israel Deaconess Medical Center in Boston. He received his degrees, and did his internship in internal medicine, at Washington University School of Medicine in St. Louis, before doing a neurology residency at Cornell University Medical Center- New York Hospital. He was previously on faculty at Washington University School of Medicine and the University of Chicago. Dr. Saper has received a Javits Neuroscience Investigator Award from the National Institutes of Health, and was elected to the National Academy of Medicine. He is the Editor-in-Chief of the Annals of Neurology. Nicholas D. Schiff, MD is the Jerold B. Katz Professor of Neurology and Neuroscience in the Feil Family Brain and Mind Research Institute at Weill Cornell Medical College. He is a graduate of Stanford University and the Cornell University Medical College and completed his residency in Neurology at the New York Hospital where he trained with Drs. Fred Plum and Jerome Posner He is an elected Fellow of the American Neurological Association and the recipient of several awards, including the 2007 Research Award for Innovation in Neuroscience from the Society for Neuroscience and the 2009 Bakken Pioneer Award from the Earl and Doris Bakken Heart-Brain Institute. Jan Claassen, MD is an Associate Professor of Neurology at Columbia University and Director of the NeuroICU at New York-Presbyterian Hospital. He received a degree in medicine from the University of Hamburg. He underwent post-doctoral research training and clinical training in neurology, electrophysiology, and neurocritical care at Columbia University, NY. His research characterizes physiologic changes following acute brain injury, focusing on novel treatment approaches to potentially improve patient outcomes. His laboratory focuses on the development and bedside integration of novel electrophysiological and imaging techniques study recovery of consciousness in the acute brain injury setting. Dr Claassen has been intimately involved with national and international guideline development for patients with acute brain injury.

Inhalt

1. Pathophysiology of Signs and Symptoms of Coma ALTERED STATES OF CONSCIOUSNESS DEFINITIONS Consciousness Acutely Altered States of 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 Behavioral State Switching Relationship of Coma to Sleep The Cerebral Hemispheres and Conscious Behavior 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 Circulation Respiration PUPILLARY RESPONSES Examine the Pupils and Their Responses Pathophysiology of Pupillary Responses: Peripheral Anatomy of the Pupillomotor System Pharmacology of the Peripheral Pupillomotor System Localizing Value of Abnormal Pupillary Responses in Patients in Coma Metabolic and Pharmacologic Causes of Abnormal Pupillary Response OCULOMOTOR RESPONSES Functional Anatomy of the Peripheral Oculomotor System Functional Anatomy of the Central Oculomotor System The Ocular Motor Examination Interpretation of Abnormal Ocular Movements MOTOR RESPONSES Motor Tone Motor Reflexes Motor Responses FALSE LOCALIZING SIGNS IN PATIENTS WITH METABOLIC COMA Respiratory Responses Pupillary Responses Ocular Motor Responses Motor Responses MAJOR LABORATORY DIAGNOSTIC AIDS Blood and Urine Testing Computed Tomography Imaging and Angiography Magnetic Resonance Imaging and Angiography Magnetic Resonance Spectroscopy Neurosonography Lumbar Puncture Electroencephalography and Evoked Potentials 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 The Role of Increased Intracranial Pressure in Coma The Role of Vascular Factors and Cerebral Edema in Mass Lesions HERNIATION SYNDROMES: INTRACRANIAL SHIFTS IN THE PATHOGENESIS OF COMA Anatomy of the Intracranial Compartments Patterns of Brain Shifts That Contribute to Coma Clinical Findings in Uncal Herniation Syndrome Clinical Findings in Central Herniation Syndrome Clinical Findings in Dorsal Midbrain Syndrome Safety of Lumbar Puncture in Comatose Patients False Localizing Signs in the Diagnosis of Structural Coma DESTRUCTIVE LESIONS AS A CAUSE OF COMA DIFFUSE, BILATERAL CORTICAL DESTRUCTION DESTRUCTIVE DISEASE OF THE DIENCEPHALON DESTRUCTIVE LESIONS OF THE BRAINSTEM 4. Specific Causes of Stupor and Coma INTRODUCTION SUPRATENTORIAL COMPRESSIVE LESIONS EPIDURAL, DURAL, AND SUBDURAL MASSES Epidural Hematoma Subdural Hematoma Epidural Abscess/Empyema Dural and Subdural Tumors SUBARACHNOID LESIONS Subarachnoid Hemorrhage Subarachnoid Tumors Subarachnoid Infection INTRACEREBRAL MASSES Intracerebral Hemorrhage Intracerebral Tumors Brain Abscess and Granuloma INFRATENTORIAL COMPRESSIVE ESIONS EPIDURAL AND DURAL MASSES Epidural Hematoma Epidural Abscess Dural and Epidural Tumors SUBDURAL POSTERIOR FOSSA OMPRESSIVE LESIONS Subdural Empyema Subdural Tumors SUBARACHNOID POSTERIOR FOSSA LESIONS INTRAPARENCHYMAL POSTERIOR FOSSA MASS LESIONS Cerebellar Hemorrhage Cerebellar Infarction Cerebellar Abscess Cerebellar Tumor Pontine Hemorrhage SUPRATENTORIAL DESTRUCTIVE LESIONS CAUSING COMA VASCULAR CAUSES OF SUPRATENTORIAL DESTRUCTIVE LESIONS Carotid Ischemic Lesions Distal Basilar Occlusion Venous Sinus Thrombosis Vasculitis INFECTIONS AND INFLAMMATORY CAUSES OF SUPRATENTORIAL DESTRUCTIVE LESIONS Viral Encephalitis Acute Disseminated Encephalomyelitis CONCUSSION AND OTHER TRAUMATIC BRAIN INJURIES Mechanism of Brain Injury During Closed Head Trauma Mechanism of Loss of Consciousness in Concussion Delayed Encephalopathy After Head Injury INFRATENTORIAL DESTRUCTIVE LESIONS BRAINSTEM VASCULAR DESTRUCTIVE DISORDERS Brainstem Hemorrhage Basilar Migraine Posterior Reversible Leukoencephalopathy Syndrome INFRATENTORIAL INFLAMMATORY DISORDERS INFRATENTORIAL TUMORS CENTRAL PONTINE MYELINOLYSIS 5. Metabolic and Diffuse Encephalopathies: Disruption of the Internal Milieu DISTINGUISHING FEATURES OF METABOLIC ENCEPHALOPATHY Mental status testing, delirium, and grading level of unresponsiveness Distinguishing metabolic encephalopathy from focal causes of coma Distinguishing metabolic encephalopathy from diffuse or multifocal causes of coma Key features of the neurological exam in metabolic encephalopathy THE INTERNAL MILIEU: AN OVERVIEW OF CEREBRAL METABOLISM AND THE ENVIRONMENT NECESSARY TO MAINTAIN NORMAL NEURONAL FUNCTION Cerebral blood flow, glucose, and oxygen utilization Acid-base balance and osmolality Ionic environment in the brain and spreading depression Synaptic environment in the brain and seizures DISORDERS OF THE INTERNAL MILIEU: LACK OF SUBSTRATE Cerebral hypoxia Hypoperfusion (global ischemia, multifocal vascular compromise) Hypoglycemia Lack of metabolic cofactors (thiamine) Mitochondrial disorders DISORDERS OF THE INTERNAL MILIEU: IONIC AND OSMOTIC ENVIRONMENT Hyponatremia Hypernatremia Hypercalcemia Metabolic acidosis Hyperglycemia, hyperosmolar state Hypo-osmolar state DISORDERS OF THE INTERNAL MILIEU: HORMONAL AND TEMPERATURE Hypothyroidism Hyperthyroidism Adrenal insufficiency Hypothermia Hyperthermia DISORDERS OF THE INTERNAL MILIEU: ELECTRICAL ENVIRONMENT Seizure disorders Spreading depression DISORDERS OF THE INTERNAL MILIEU: ABNORMAL CSF PRESSURE OR CONSTITUENTS Intracranial hypertension Intracranial hypotension Subarachnoid hemorrhage Acute bacterial meningitis Chronic bacterial or fungal meningitis Viral meningitis vs. encephalitis Carcinomatous meningitis DISORDERS OF ENDOGENOUS TOXINS Hypercarbia Hepatic encephalopathy Renal failure Pancreatic encephalopathy Systemic septic encephalopathy Auto-immune disorders: specific antibodies Auto-immune disorders: acute disseminated encephalomyelitis DISORDERS OF EXOGENOUS TOXINS Sedative/hypnotic drugs and anesthetics (GABA-A receptor enhancers) Ethanol, methanol, and propylene glycol (including withdrawal) Ketamine, phencyclidine (NMDA receptor antagonists) Antidepressants Neuroleptics Opiates Aspirin and acetaminophen Overdose of unknown type 6. Psychogenic Unresponsiveness CONVERSION REACTIONS CATATONIA PSYCHOGENIC SEIZURES CEREBELLAR COGNITIVE AFFECTIVE SYNDROME ''AMYTAL INTERVIEW'' 7. Approach to Management of the Unconscious Patient A CLINICAL REGIMEN FOR DIAGNOSIS AND MANAGEMENT ALGORITHM AND PRINCIPLES OF EMERGENCY MANAGEMENT SUPPORT VITAL SIGNS: AIRWAY, BREATHING, AND CIRCULATION Ensure Oxygenation, Airway, and Ventilation Maintain the Circulation HISTORY, EXAM, AND BASIC DIAGNOSTICS Emergency Examination of the Comatose and Stuperous Patient Emergent Treatment that Should be Considered for All Patients with Stupor or Coma More Definitive Treatment of Etiologies of Stupor and Coma 8. Management of Frequently Encountered Causes of Unconsciousness MANAGEMENT OF FREQUENTLY ENCOUNTERED CAUSES OF UNCONSCIOUSNESS STRUCTURAL LESIONS: SUPRATENTORIAL OR INFRATENTORIAL COMPRESSIVE/DESTRUCTIVE ETIOLOGIES Aneurysmal Subarachnoid Hemorrhage Intracerebral Hemorrhage Traumatic Brain Injury Subdural and Epidural Hematoma Arterial Ischemic Stroke Venous Sinus Thrombosis Brain Tumor Brain Abscess NONSTRUCTURAL LESIONS: METABOLIC, DIFFUSE, OR MULTIFOCAL COMA Central nervous system infections Autoimmune causes of coma Hypoxic Brain Injury / cardiac arrest Metabolic coma GENERAL MANAGEMENT CONSIDERATIONS APPLYING TO ALL OR MOST BRAIN INJURED PATIENTS GOALS OF CARE FINAL WORD 9. Prognosis in Coma and Related Disorders of Consciousness and Mechanisms Underlying Outcomes 10. Brain Death - Joseph J. Fins DETERMINATION OF BRAIN DEATH CLINICAL SIGNS OF BRAIN DEATH Brainstem Function Confirmatory Laboratory Tests and Diagnosis Diagnosis of Brain Death in Profound Anesthesia or Coma of Undetermined Etiology Pitfalls in the Diagnosis of Brain Death Brain Death versus Prolonged Coma Management of the brain dead patient

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