Classification of impaired consciousness

Classification of oppression of consciousness and coma

There are various classifications of impaired consciousness.

N.K. Bogolepov, one of the creators who described comatose states in the most detailed manner ("Comatose states", 1962), distinguishes 4 degrees of coma: light, pronounced, deep and terminal. This division is based primarily on assessing the degree of inhibition of cortical, subcortical and stem brain activity. F. Plum and J. Posner in the classic monograph "The Diagnosis of Stupor and Coma" (1986) avoid any division of the coma by the degree of inhibition of the brain, believing that this makes it difficult to diagnose the level and nature of the damage . Proceeding from the main questions facing the doctor when examining a comatose patient: "Functional or organic damage", "Local or diffuse damage", "Cause of coma," "Dynamics of the state," the authors propose to divide comatose states into the following main categories:

• caused by supratentorial bulk lesions that exert a secondary influence on deep diencephalic-stem structures;
• the subtitial destructive or compressive processes;
• metabolic disorders leading to widespread oppression or discontinuation of both supra- and sub-entorial structures;
• psychogenic states, reminiscent of who.

In the classification proposed by A.R. Shakhnovichem (1988), the degree of oppression of consciousness is determined on the basis of a combination of the most informative features that depend on the functional state of both supra- and subentorial structures (answers to questions, orientation, instructions, eyes on sound or pain, bilateral mydriasis, oculocephalic reflex , muscle atony). The informative nature of the signs is quantitative. According to this classification, mental disorders are subdivided into moderate, deep stunning, apallic state, to whom, to deep coma and transcendent coma. A similar three-step division of the coma is characteristic of other classifications (Konovalov AN et al., 1982). The designation of essentially similar coma states can be different [moderate, deep, terminal (atonic) coma; coma I, II, III]. In recent decades, one of the most common classifications of oppression of consciousness has become the Glasgow Coma Scale (Glasgo Coma Scale, 1974). The scale is based on a total scoring of 3 functions: speech, movements and eye opening. It allows the doctor or medical worker of any specialty to quickly determine the severity of the patient's condition.

The Glasgow Coma Scale

Opening the eyes

• Arbitrary - 4.
• On the converted speech - 3.
• On the pain stimulus - 2.
• Missing -1.

The motor reaction

• Executes commands - 6.
• Purposeful on pain stimulus - 5.
• Unspecified to pain stimulus - 4.
• Tonic flexion to the pain stimulus - 3.
• Tonic extension to the pain stimulus - 2.
• Not available - 1.

Verbal function (in the absence of intubation)

• Oriented and able to support the conversation - 5.
• Disoriented, can say - 4.
• Incoherent speech - 3.
• Inarticulate speech - 2.
• Not available - 1.

Verbal function (with intubation)

• Probably able to speak - 3.
• Doubtful ability to speak - 2.
• No reaction - 1.

The proposed score is correlated with descriptive classifications approximately as follows:

• 15 points - clear consciousness;
• 14-13 points - moderate stunning;
• 12-10 points - deep stunning;
• 9-8 points - sopor;
• 7 and less - coma.

Classification of the violation of consciousness allows to a certain extent to judge the degree and level of brain damage and justify the prognosis of the disease. Exit from a coma (moderate coma, coma I) is possible, while the normal operation of the brain can be completely restored. Deep coma (coma II) often ends with a lethal outcome or transition to a chronic condition. Extreme coma (atonic, coma III) is almost always irreversible.

[1], [2], [3], [4], [5]