Impairment of consciousness

Consciousness is a complex philosophical concept used in a wide range of areas of knowledge (for example, legal, historical consciousness, etc.). In medicine, the concept of consciousness is one of the fundamental. Disturbances of consciousness can be a manifestation of a wide variety of diseases and pathological conditions, so doctors face many specialties. Most often, questions related to diagnosis, differential diagnosis and treatment of disorders of consciousness have to be addressed by a neurologist.

Under the normal consciousness (clear consciousness) means an adequate perception of the surrounding world and one's own self (complete orientation in space, time, self), the ability to interact productively with the outside world and cognitive activities.

Consciousness is the result of integrative activity of the entire brain, so the spectrum of changes and disturbances from the normal state of consciousness to its absence (coma) is extremely wide and depends to a large extent on the "point of application" of the damaging factor.

When characterizing the state of consciousness, it is necessary to distinguish two main aspects: the level of wakefulness and the content, cognitive (cognitive) component of consciousness. The state of wakefulness is provided mainly by the activating function of the reticular formation of the brainstem and the limbic system, while cognitive activity is a function of the cerebral hemispheres. Both these components are closely interconnected, however it is obvious that adequate cognitive activity is impossible without a sufficient level of wakefulness provided by older mechanisms and therefore much less dependent on mental activity. The main criterion of wakefulness, or "awakening", of the patient is considered to be the reaction of opening the eyes to sound or painful irritation (safety of reactions at the level of the midbrain). With the preservation of this reaction, the patient's condition can not be qualified as unconscious. In pathological conditions, a variety of combinations of the depth and structure of wakefulness and cognitive impairment are possible, which creates objective difficulties in the classification of disorders of consciousness and explains the multiplicity of terms used for their characterization, which sometimes contradict each other. Thus, a patient with coarse aphathic disturbances may be in a state of active wakefulness, but his cognitive activity and interaction with the surrounding world is undoubtedly limited. Nevertheless, it is difficult to qualify such a patient as a patient with a violation of consciousness. On the contrary, some patients after leaving the coma, that is, a state in which the wakefulness (awakening) and the perception of the external world are lacking, talk about what was happening around them. The latter fact is currently being confirmed by carrying out a functional MRI in patients in a coma state, by which the activation of certain cortical areas is recorded upon presentation of appropriate stimuli. Nevertheless, the condition of such a patient must be regarded as unconscious.

Disorders of consciousness are distinguished by etiology, developmental speed (acute, gradually increasing, wavy), duration (acute, subacute, chronic), depth, content (productive and unproductive).

The disturbance of consciousness is understood as a breakdown of the reflection of the environment, objects, phenomena and their connections, manifested by the total impossibility or impermanence of perception of the environment, disorientation in time, place, surrounding persons, self, incoherence of thinking. Both primary cerebral diseases and secondary CNS lesions can develop into consciousness disorder, which develop when cerebral circulation is impaired (transitory disorders due to vasospasm, as well as cerebral hemorrhage or ischemia), pathology of internal organs or exogenous intoxication. Violations of consciousness conditionally divided into two groups - oppression and change of consciousness.

• Oppression of consciousness - unproductive forms, characterized by a deficiency of mental activity, a decrease in the level of wakefulness, oppression of intellectual functions and motor activity. These include stunning, sopor and coma (with some reservations - and stupor). At the expressed oppression of consciousness vital functions are broken.
• Changes in consciousness develop against the background of wakefulness and are characterized by a disturbance of mental functions, a perverted perception of the environment and one's own personality.

Assessment of the state of consciousness is the first element of a general examination conducted by a doctor.

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Classification of oppression of consciousness

Distinguish the following types of oppression of consciousness.

• Stupor - numbness; When you leave this state, the patient does not answer meaningfully.
• Stun is a form of obscuration of consciousness, characterized by an increase in the threshold of all external stimuli, slowing and obstructing the course of mental processes, scant representations, incompleteness or lack of orientation in the surrounding environment.
• Sopor is a deep stage of stunning, in which there are no reactions to verbal circulation and only responses to pain stimuli are preserved.
• Coma is a state of deep depression of the central nervous system, characterized by complete loss of consciousness, loss of reactions to external stimuli, and a disturbance in the regulation of vital body functions.

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Forecast

The outcome in patients with impaired consciousness, especially those in a state of coma, depends on so many factors. The accuracy of the prognosis is due primarily to the etiology of the lesion and the degree of depression of consciousness, so it is advisable to discuss the prognosis and outcome of the disease only in connection with the specific condition of the patient. In general, besides the cause of coma development, the age of the patient, the speed and volume of medical care are of great importance.

A patient with a violation of consciousness, especially in a coma, requires quick decisions, since with a timely diagnosis and adequate therapy, coma can be reversible, and delay in some cases can be fatal.

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