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Altered Mental Status and Coma,[object Object],意識不清與昏迷,[object Object],Adapted from Rosen's Emergency Medicine, 7E,[object Object],Chapter e14 Depressed Consciousness and Coma,[object Object]
Glasgow Coma Scale (Teasdale & Jennett, 1977),[object Object]
意識之成分,[object Object],喚醒度(Arousal):意識之原動力,[object Object],臨床現象:外表上呈醒的狀態,[object Object],(能主動睜眼或對外界刺激有睜眼反應),[object Object],是腦幹之網狀系統(RAS)活動的表現,[object Object],主為腦幹之功能,[object Object],覺察能力(Awareness):意識之內容,[object Object],綜合認知和情感之腦功能,[object Object],臨床現象:有意義的動作和語言,[object Object],主為大腦半球的功能,[object Object]
Brainstem RAS (Mid-Pons Rostrally) and Its Projections to the Hemispheres,[object Object]
Anatomic basis of coma (results from lesions that affect either the RAS or both hemispheres),[object Object]
Mnemonic for Treatable Causes of AMS (AEIOU-TIPS),[object Object],A	Alcohol,[object Object],E	Endocrine	Electrolytes	Encephalopathy,[object Object], I	Insulin,[object Object],O	O2,[object Object],		Opiates,[object Object],U	Uremia,[object Object],T	Trauma,[object Object],I	Infection 	,[object Object],		Intra-cranial,[object Object],P	Poisoning,[object Object],S	Seizure,[object Object],		Stroke,[object Object],		Sepsis,[object Object],		Shock,[object Object]
Reversible cause of altered mental status,[object Object],Hypoglycemia, narcotic overdose, hypoxia, hypercarbia should be quickly investigation and treatment,[object Object],If structural lesion etiology is indicated non-contrast head CT,[object Object]
Delirium,[object Object],Diffuse metabolic and multifocal cerebral lesion, generalized impairment of brain functions or at least a bilateral involvement ,[object Object],limbic structure,[object Object]
Major brainstem reflexes used in coma examination,[object Object],2進3出,[object Object],5進7出,[object Object],8進6出,[object Object]
Pupils in comatose patients,[object Object]
Caloric Test for Vestibular Function  (30-100 cc ice water for oculovestibular reflexes in comatose patients),[object Object]
Brainstem pathways mediating conjugate horizontal eye movements,[object Object]
Oculocephalogyric (caloric) responses to various central nervous system pathologic conditions. MLF, medial longitudinal fasciculus,[object Object]
Oculocephalic and Oculovestiblar reflexes in comatose patients with:,[object Object],Brainstem intact (doll’ head eye phenomenon),[object Object],Bil. MLF involvement,[object Object],Low brainstem lesion,[object Object]
   Motor responses to ,[object Object],   noxious stimulation   ,[object Object],   in acute cerebral ,[object Object],   dysfunction.,[object Object],   A = Rt hemisphere,[object Object],   B = Diencephalon,[object Object],   C = Mibrain/Pons,[object Object],   D = Medulla,[object Object]
Sudden weakness or numbness of arm or leg especially on one side of the body,[object Object],Sudden trouble in walking or dizziness, vertigo, loss of balance or coordination.,[object Object],Facial Weakness/Numbness,[object Object],Sudden severe headaches,[object Object],Altered consciousness,[object Object]

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