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visiting hour essay help 2004;22:379-387. Doi:10.1016/j. Ncl.2003.12.007. Coma and other states of altered consciousness christopher robinson, do, ms eelco wijdicks, md, phd tabs t r ac t abnormal consciousness is caused by pathologies that speci cally alter the unction o a neuronal network responsible or causing awareness and alertness. Understanding o the basic concepts o this arousal system and the pathophysiologic mechanisms underlying its alteration are imperative in the diagnosis, treatment, and long-term management o coma. T is chapter will ocus on the de nition o consciousness, the physiology o arousal, the pathologies underlying coma, the neurologic examination o the comatose patient, management o coma, and assessment o prognosis. Each section is accompanied by a case to illustrate the di erent clinical scenarios in which coma can present. Background on altered states of consciousness c as e 36-1 a 57-year-old woman presented to the emergency department with acute loss o consciousness. She has no relevant past medical history. Her coworkers state she had complained o the worst headache in her li e 2 weeks ago that has since resolved. On observation, the patient’s eyes are closed and her respiratory pattern appears irregular. Blood pressure at the bedside is 180/90 mmhg, and heart rate is 54 beats per minute. General examination reveals neck sti ness and bilateral retinal hemorrhages. On neurologic examination, pupillary and corneal responses are present. The patient exhibits no eye opening or motor response to noxious stimuli. Her four score is 6. She is sent or emergent neuroimaging that reveals di use subarachnoid hemorrhage (sah) and obstructive hydrocephalus. 36 what are the general concepts o xt consciousness?. Consciousness is a state o ull awareness to both sel and environment, and is divided into two major categories:1 content de ned as the cognitive and a ective responses, which are mediated at a cortical level. Includes language, right and le orientation, reading, writing, behavior, and recognition o aces and colors. Linked closely with the arousal system to maintain the behavioral appearance o wake ulness. Di use damage o cortical structures (ie, alzheimer) can cause a reduced content consciousness. Arousal t e ascending arousal system is a di use network o a erent mesopontine and diencephalic neurons. Interneurons regulate the relationship between sleep/wake cycles and coordinate phase transition during sleep (ie, non-rem to rem). Ascending neurons target cortical structures, integrating the behavioral and cognitive components o consciousness. Focal or di use lesions o the arousal system (ie, in arction) can produce acute alterations in level o consciousness. What are the de nitions o the acutely xt altered states o consciousness?. Delirium.

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