神经系统疾病常见症状与定位.ppt

第一节Disorders of consciousness Consciousness is the state of being aware of self and the environment. Disorders of consciousness is state of impaired consciousness in which the patient is not roused by external stimuli. Inattention ,confusion, stupor,and coma are terms describing progressive states of impaired consciousness [clinical classification] Severity degree of disorders of consciousness, range size\content\stem reflect of consciousness to be divided: 1.The descent of level of consciousness 2. Alteration of content of consciousness 3.special type 1.The descent of level of consciousness (1)somnolent The somnolent patient may be roused by various stimuli and will then make appropriate motor and verbal responses. When aroused, such a patient may be clear mentally but often is somewhat confused. Illusions, delusions, hallucinations or delirium is common in such patients. somnolent In somnolence, the patient generally drifts back to sleep when the stimulus ceases. Spontaneous movements and spontaneous speech or muttering are usual. + (2) sopor In stupor, the patient will often have considerable spontaneous movement. He will respond to pain, loud auditory stimuli or bright lights. Repeated and persistent stimuli will often rouse the patient to the point where he will respond briefly to questions. Spontaneous movement are common. Control of bowel and bladder is variable. + (3) coma The patient is unaware of self and the environment . Coma is the most degree of depressed of consciousness in which the patient is not roused by external stimuli. Deep coma patient makes no response to any stimulus . The muscle-stretch reflexes, Babinski sign, the corneal reflex and even the pupillary response tend to disappear. There are no spontaneous movements , and the musculature is flaccid,and incontinent of urine and feces. The pulse is