Hypoxic encephalopathy: This usually the result of the conditions producing choking as choking, strangulation, aspiration in the respiratory tract, poisoning with carbon monoxide, respiratory paralysis secondary to syndrome Guillain-Barre Syndrome or polio and States appalled after a heart attack or heart arrest.
Mild degree of hypoxia cause neglect, errors in the trial and the confusion that are transient. Evere hypoxia more 3-5 minute long Ands produce permanent and serious injury in the brain leads to coma. This pupillary reflexes conditions presence, movement of the head of the intact doll eyes and other reflections of brainstem generally indicates a favorable prognosis. Head-eye wrist movement (Oculo-cephalic reflex) occurs by turning the head on the sides, when the eyes are seen to deviate in the opposite direction. This sign is absent in conscious individuals. Becomes psotive in the initial stages of coma, but lost, measure which deepens the comma. However, when absent brain stem with the absence of spontaneous breathing reflexes, suggests brain death.Absence of electrical activity in the EEG (EEG flat) confirms the diagnosis. less severe damage hypoxic, the patient can retrieve coma with some permanent as dementia, extrapyramidal disorders, choreoathetosis, ataxia and myoclonus neurological sequelae.
Diagnosis of hypoxic brain injury depends on the clinical setting of hypoxia and blood pressure of oxygen (PO2), less than 50 mmHg.El emergency treatment includes the provision of a clear airway, cardiopulmonary resuscitation, and oxygenation.Intravenous dexamethasone helps reduce cerebral edema.
Encephalopathy hypoglycemia: abnormal reduction in blood sugar leads to confusion, stupor, seizures or comma depending on the degree of hipoglicemia.Por generally, when the blood sugar is 30 mg/dl State confusion sets and when it is 10 mg/dL, the patient becomes comatose.
Causes
1. Accidental overdose of insulin or of a long-acting oral medication.
2. Tumors of the pancreas secretion of insulin.
3 Alcoholic fighting
4. A broad malignant disease as fibrosarcoma.
The effects of hypoglycemia are manifested more slowly than the hypoxia. According to progresses the status stage sets Medullary en This is characterized by deep, shallow breathing a dilated pupils coma. Administration of glucose before the appearance of the results of the Medullary phase complete reversal of neurological lesions.However, a time the Medullary stage sets, recovery may be delayed for months, or may even be incomplete.
Encephalopathy hyperosmolar: this may be due to hyperglycemia with Ketoacidosis or due to hyperosmolar coma-not.In both conditions, the patient becomes confused, stuporous and coma.
Eat liver: liver failure can lead to coma.It is likely that ammonia and other toxic metabolic products formed in the intestine and led to portal cicrculation passing the liver, or not be further metabolized by the cells of liver failure, arrive in cerebral circulation and damage the metabolism of brain and vital structures.
Hatching of coma can be precipitated by high protein, hematemesis electrolyte intake.Begins with the mental confusion, psychomotor activity increased and the progressive deterioration of the sensorium finally coma profundo.Durante initial stage, the patient exhibits tremors flutter (asterexis) and this can draw when hands are extended.Other signs of liver failure may be obvious.EEG reveals three-phase characteristic of waves.
Treatment involves administration of liver failure.Found l - dopa to improve the level of alertness in some casos.Con improved liver function, also improved neurological syndrome.
Hemolytic encephalopathy: acute and chronic renal failure can lead to confusion and estupor.Esto usually due to increased levels of nitrogen products toxic. Twitchings muscle, irregular blood muscle jerks, and occasional seizures predominate box clinico.La nature of kidney disease determines the outcome. in disease chronic renal irreversible condition does not improve without dialysis or transplant renal.Si seizures, anti-seizure must occur in small doses.
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