A disturbance of consciousness

A disorder of consciousness is a condition in which the normal processes and functions of consciousness are disrupted. Consciousness is a broad concept encompassing human perception, awareness, thinking and feeling. A disorder of consciousness can be caused by a variety of factors and have varying degrees of severity.

Here are some of the major types of disorders of consciousness:

1. Reduced Clarity Consciousness: This is a condition in which a person has difficulty understanding and recognizing the environment. There may be drowsiness, vague thoughts, and difficulty concentrating.
2. Stunned Consciousness: The person may feel stunned, as if "disconnected" from the world around them. This may be accompanied by a loss of sense of reality and a sense of alienation.
3. Loss of consciousness: In more serious cases, consciousness may be impaired to the point of unconsciousness. This may include fainting, coma and other forms of temporary loss of consciousness.
4. Psychosis: Psychosis is a severe disorder of consciousness in which a person loses touch with reality and may experience hallucinations, delusions, delusions and severe emotional disturbances.
5. Depersonalization and derealization: People with impaired consciousness may experience depersonalization (feeling disconnected from their body or identity) or derealization (feeling the environment is unreal).

Causes of the disorders of consciousness

Disorders of consciousness can be caused by a variety of reasons, and they can range from temporary and mild conditions to more serious and chronic conditions. Here are some of the common causes:

1. Intoxication: The use of alcohol, drugs, or other psychoactive substances can lead to impaired consciousness. This may include intoxication, poisoning, or overdose.
2. Head injuries: Head injuries, such as a concussion or head injury, can cause loss of consciousness or decreased clarity.
3. Medical conditions: Various medical conditions can affect consciousness. For example, hypoglycemia (low blood sugar), epileptic seizures, strokes, and other medical conditions can cause disturbances in consciousness.
4. Syncope: Syncope is a short-term fainting that can occur due to various factors such as lack of blood supply to the brain, such as orthostatic hypotension (a drop in blood pressure when standing up).
5. Mental disorders: Some mental disorders, such as schizophrenia or depression, can affect consciousness and perception of reality.
6. Sleep disorders: Sleep disorders such as narcolepsy or somnabulism (sleepwalking) can lead to disturbances of consciousness.
7. Psychoactive exposures: Exposure to psychotropic drugs or medications can cause changes in consciousness.
8. Stress and anxiety: Severe stress or anxiety can lead to decreased mental clarity, depersonalization or derealization.
9. Metabolic and endocrine disorders: Some metabolic or endocrine disorders, such as hypoglycemia, may affect consciousness.
10. Epilepsy: Epileptic seizures may cause brief changes in consciousness and behavior.
11. Toxic Substances: Exposure to toxic substances such as poisons or chemicals may cause unconsciousness or impaired function.
12. Other factors: Disturbance of consciousness can also be caused by other factors such as hyperthermia (overheating), hypoxia (lack of oxygen), infections, and others.

It is important to keep in mind that disturbances of consciousness can result from a variety of conditions and can vary in severity. For any disturbance of consciousness, especially if it is the first time it has occurred or has serious consequences, it is important to see a medical professional for evaluation and diagnosis.

Pathogenesis

The pathogenesis of disorders of consciousness is the developmental process and mechanisms that lead to disorders of consciousness. Pathogenesis may vary depending on the cause and type of disturbance of consciousness, but common factors may include the following:

1. Change in brain chemistry: Exposure of the brain to alcohol, drugs, toxins, or medications can change the chemical balance and functioning of neurons. This can lead to altered consciousness.
2. Decreased blood supply to thebrain: Dec reased oxygen and nutrient supply to the brain caused by factors such as syncope or stroke can lead to impaired brain function and consciousness.
3. Changes in electrical activity in the brain: Epileptic seizures and uncontrolled neuronal discharges can temporarily alter brain activity and cause impaired consciousness.
4. Inflammatory and infectious processes: Inflammation of brain tissue caused by infections can affect neural pathways and brain function, which can lead to impaired consciousness.
5. Mental factors: Severe stress, anxiety or mental disorders can cause changes in consciousness through a psychological mechanism such as depersonalization or derealization.
6. Head injuries: Head injuries can damage brain tissue and cause impaired consciousness.
7. Genetic and hereditary factors: Somegenetic factors may increase the risk of epilepsy or other conditions that can cause impaired consciousness.
8. Systemic diseases: Some systemic diseases, such as diabetes and thyroid disease, can cause metabolic changes that affect the brain and consciousness.
9. Toxic Substances: Exposure of the brain to poisons and chemicals can cause changes in consciousness.

The pathogenesis can be complex and depends on many factors. It is important to diagnose and treat consciousness based on the cause and type of consciousness. Medical research, neurophysiologic studies, examination with equipment (e.g., electroencephalography), and clinical observation can help determine the pathogenesis of a particular case of impaired consciousness.

Symptoms of the disorders of consciousness

Symptoms of disorders of consciousness can be varied and depend on the cause and severity of the disorder. Here are some common symptoms that may be observed:

1. Decreased mental clarity: The person may have difficulty concentrating, thinking, and understanding the environment.
2. Drowsiness: The affected person may feel drowsy and heavy in the head.
3. Sluggishnessor lethargy: The patient may be apathetic, lethargic, and unable to be active.
4. Loss of orientation in time and place: A person may not know what time of day, day of the week, or where they are.
5. Depersonalization: This is the feeling of disconnecting from one's own body or personality.
6. Derealization: The patient may experience a sense of unreality of the environment, as if they are in a different reality.
7. Hallucinations: Disturbances of consciousness may be accompanied by visual, auditory, or other hallucinations in which a person sees, hears, or feels objects or events that do not exist.
8. Delusions: The affected person may experience ridiculous and unrelated thoughts and beliefs.
9. Loss of consciousness: In some cases, disturbances of consciousness may result in fainting, loss of consciousness, or coma.
10. Memory loss: The patient may not remember events that occurred before or during the disturbance of consciousness.
11. Aggressive Behavior: Some people may become aggressive or irritable with disorders of consciousness.
12. Incoherent speech: A person's speech may become incoherent or incomprehensible.

Symptoms can be temporary and reversible, or long-lasting and associated with serious medical or psychiatric conditions. It is important to contact a medical professional immediately if you or someone you love is experiencing symptoms so that a diagnosis can be made and appropriate treatment can be prescribed.

Syndromes of impaired consciousness

They are certain clinical conditions or a set of symptoms that characterize changes in the functions of consciousness. These syndromes may have different causes and manifestations. The following are some of the most common syndromes of impaired consciousness:

1. Coma: This is a state of profound unconsciousness in which the patient is unresponsive to stimuli and unable to open his or her eyes. Coma can be caused by head trauma, stroke, intoxication, and other causes.
2. Subcoma: A condition close to coma in which the patient may respond slightly to stimuli but is largely unconscious.
3. Depression of consciousness: The patient may be conscious, but he or she is depressed, apathetic and has reduced activity. This condition may be associated with depression, anxiety, or other mental disorders.
4. Vague consciousness: The patient has difficulty orienting themselves in the environment, may be disoriented in time and place, and may have difficulty concentrating.
5. Dissociative syndrome: The patient may have a division of consciousness into two or more separate personalities or states. This condition may be associated with dissociative disorders.
6. Monkey Arm Syndrome: This syndrome is characterized by involuntary movements of the upper extremity that the patient cannot control. This condition may be associated with neurological disorders.
7. Agitated delirium: The patient may be agitated, aggressive, and experiencing delusions.
8. Brainstem irritation syndrome: The patient may have impaired consciousness, seizures and respiratory disturbances that may be associated with brainstem damage.
9. Hypoxic or ischemic syndrome: This syndrome is associated with inadequate oxygen supply to the brain and can occur in drowning, heart attack, or other conditions.
10. Personality Disorder Syndrome: Some psychiatric disorders, such as schizophrenia or bipolar disorder, may be accompanied by impaired consciousness.

These syndromes can have a variety of causes, including medical, psychiatric, and neurological conditions.

Acute disorders of consciousness are conditions in which a person's consciousness is altered or disturbed suddenly and usually requires medical attention. Depending on the cause and severity of the disturbance, acute disorders of consciousness can range from brief and mild to severe and life-threatening. Here are some of the most common acute disorders of consciousness:

1. Syncope (syncope): Syncope is often caused by a temporary drop in blood pressure and oxygen levels in the brain. They can be caused by stress, overexertion, standing for long periods of time, or even fear. Usually consciousness is recovered quickly after fainting.
2. Epileptic seizure: Epileptic seizures can cause temporary loss of consciousness and unusual motor behavior. After a seizure, the patient often experiences confusion or drowsiness.
3. Stroke: A stroke can cause acute loss of consciousness, paralysis, and other serious symptoms. It is an extremely dangerous condition that requires immediate medical attention.
4. Heart attack: In some cases, heart attacks can cause impaired consciousness, especially if they result in decreased blood flow to the brain.
5. Head trauma: Severehead trauma, including concussion or subdural hemorrhage, may cause loss of consciousness and other neurological symptoms.
6. Intoxication: Drug overdose, alcoholintoxication, or poisoning by other substances can lead to impaired consciousness.
7. Heatstroke: When the body overheats (heatstroke), unconsciousness may occur.
8. Diabetes mellitus: High or low blood sugar levels in diabetes can cause changes in consciousness.
9. Infections and sepsis: Severe infectious conditions such as sepsis can lead to impaired consciousness.
10. Neurologic diseases: Acute disturbance of consciousness may also be associated with neurologic diseases such as migraine, meningitis, or encephalitis.

The treatment of acute disorders of consciousness depends on the cause. In most cases, immediate examination and medical attention are necessary to find out the cause and take appropriate action.

A transient disturbance of consciousness (TDC) is a condition in which a person's consciousness is temporarily altered or impaired but recovers without lasting effects. TSC can have different causes and manifestations. Here are a few of the most common forms of TSC:

1. Syncope (syncope): Syncope usually occurs suddenly and may be caused by a drop in blood pressure or a temporary reduction in oxygen supply to the brain. The person loses consciousness for a short period of time and regains consciousness quickly after the cause stops.
2. Epileptic seizure: Epileptic seizures can cause a brief disturbance of consciousness and are accompanied by involuntary motor seizures. After a seizure, a person may experience drowsiness and confusion.
3. Hypoglycemia: Low blood sugar (hypoglycemia) can lead to CNS, manifested as loss of consciousness, weakness, and confusion. Consumption of rapidly absorbed carbohydrates or glucose injection can restore consciousness.
4. Orthostatic hypotension: This is a condition in which a person rapidly changes body position from horizontal to upright, which can lead to a drop in blood pressure and CNS.
5. Vasovagal reaction: In this reaction, the sympathetic nervous system responds to stress or fear, which can cause a drop in blood pressure and loss of consciousness.
6. Migraine with auras: In some people, migraine may be accompanied by auras, which may include brief disturbances of consciousness and visual or sensory changes.
7. Medication Reaction: Some medications can cause CNS as a side effect, especially if overused or misused.
8. Self-induced CNS: Some people may intentionally induce CNS by rapidly changing body position or holding their breath.

CNS is usually not a serious or long-term condition, and most people fully regain consciousness once the cause of the disorder stops. However, it is important to see a medical professional to find out the cause of CNS and rule out possible medical or neurological problems, especially if CNS becomes frequent or is accompanied by additional symptoms.

Severe impairment of consciousness is a condition in which the functions of consciousness are significantly impaired and the person is in a serious condition. It is a serious medical condition that requires urgent medical attention. Severe impairment of consciousness can have various causes and manifestations. Below are some of the most common causes and symptoms of severe impaired consciousness:

1. Head trauma: Severehead injuries such as concussion, subdural or epidural hemorrhage can cause loss of consciousness and impaired function.
2. Stroke: Stroke, especially stroke with impaired blood supply to the brain (infarct stroke) or brain hemorrhage (hemorrhagic stroke), can cause severe impairment of consciousness.
3. Status epilepticus: Status epilepticus is a condition in which a person has a series of epileptic seizures without regaining consciousness between them.
4. Intoxication: Poisoning from poisons, drugs, alcohol, or medications can cause severe impairment of consciousness.
5. Heart failure: Severe heart failure may result in decreased blood supply to the brain and loss of consciousness.
6. Sepsis: A severe infectious condition such as sepsis can cause decreased consciousness and organ function.
7. Hypoxia: Lack of oxygen to tissues and organs (hypoxia) can lead to impaired consciousness.
8. Neurologic diseases: Someneurologic diseases such as encephalitis, meningitis, or Parkinson's disease can cause severe impairment of consciousness.
9. Brainstem irritation syndrome: This is a condition in which there are disturbances of consciousness, seizures, and breathing problems that may be associated with brainstem damage.

Symptoms may include loss of consciousness, drowsiness, lack of response to stimuli, breathing problems, and other serious symptoms.

Disturbance of consciousness in children

This condition can be caused by both medical and non-medical factors. It is important to note that children may differ in their reactions to a disturbance of consciousness and may not always accurately describe how they feel. Here are some of the possible causes and symptoms of impaired consciousness in children:

1. Syncope (syncope): Fainting in children is quite common and can be caused by a temporary drop in blood pressure, stress, fear, standing for long periods of time, or hunger. Usually consciousness is recovered quickly after fainting.
2. Epileptic seizures: Children may experience epileptic seizures, which may include loss of consciousness and involuntary motor seizures.
3. Hypoglycemia: Low blood sugar can cause unconsciousness, weakness, and irritability in children.
4. Head Injury: Blows to the head, concussion or other head injury.
5. Infections: Severe infectious diseases such as meningitis or sepsis.
6. Heart problems: Children rarely have heart problems.
7. Intoxication: The ingestion of poisons, drugs, alcohol, or medicines into the body.
8. Other medical conditions: Certain medical conditions such as epilepsy, allergic reactions, or diseases of the nervous system.

Symptoms may include loss of consciousness, drowsiness, involuntary movements, seizures, loss of coordination, and other neurological symptoms. If a child has lost consciousness or has a disturbance of consciousness, it is important to see a doctor or call an ambulance immediately. Diagnosis and treatment of disorders of consciousness in children will depend on their cause and characteristics, and only a medical professional will be able to determine further action.

Stages

There is a system for classifying degrees of impaired consciousness that helps to determine the severity of the patient's condition and to select the appropriate treatment. The Glasgow Coma Scale (GCS) is commonly used, which evaluates the patient's responses to stimuli and assigns scores based on the responses. The Glasgow Scale assesses the following parameters:

1. Eye Opening: This part of the assessment evaluates whether the patient is able to open the eyes on command, to a painful stimulus, or is unable to open them at all. Scores are assigned from 1 to 4.
2. Verbal response: It is assessed whether the patient is able to express himself/herself verbally, what words or sounds he/she makes, or whether he/she does not express himself/herself verbally. Scores are assigned from 1 to 5.
3. Motor Response: Evaluates whether the patient is able to perform motor commands to a command or painful stimulus, what movements the patient makes or is unable to make movements. Scores are assigned from 1 to 6.

The scores for each parameter are added up and the total score on the Glasgow scale ranges from 3 (lowest state of consciousness) to 15 (fully preserved consciousness). The degree of impaired consciousness can be categorized as follows:

1. Severe impairment of consciousness (GCS 3-8): This is a condition in which the patient is critically ill, unable to open his or her eyes, not responding verbally, and has limited motor responses.
2. Moderately severe impairment of consciousness (GCS 9-12): Patient has limited responses to stimuli but can open eyes and/or give verbal responses.
3. Mild disturbance of consciousness (GCS 13-15): The patient may be conscious but have some symptoms of disorientation or confusion.

This classification system helps medical professionals determine how severe the disturbance of consciousness is and what steps should be taken to treat and care for the patient. It is important to recognize that the assessment of consciousness is only one part of the overall clinical examination and should always be accompanied by other diagnostic and assessment methods.

Diagnostics of the disorders of consciousness

Diagnosis of disorders of consciousness requires a comprehensive approach and may include the following steps:

1. PhysicalExam: The doctor will perform an initial physical examination of the patient, including taking the patient's pulse, blood pressure, respiratory rate, and assessing the patient's general condition. This will help determine if there are physical problems such as infections, injuries, or heart problems that could be the cause of impaired consciousness.
2. History: The doctor will ask the patient or parents questions about medical and family history, symptoms, and the circumstances under which the disturbance of consciousness occurred. This will help identify possible causes and risk factors.
3. Laboratory tests: Performing laboratory tests on blood and urine can help detect the presence of infections, electrolyte imbalances, diabetes, and other medical conditions.
4. Educational tests: Depending on the clinical presentation and age of the patient, the physician may perform educational tests to assess level of consciousness and cognitive function.
5. Neurological Examination: A neurological examination includes evaluation of reflexes, motor function, sensitivity, and other neurological signs to help identify abnormalities in the nervous system.
6. Educational studies: If epilepsy or other neurologic conditions are suspected, additional educational studies such as electroencephalogram (EEG) or magnetic resonance imaging (MRI) may be performed.
7. Cardiac exam: If heart problems are suspected, cardiac tests including ECG and echocardiography may be performed.
8. Intoxication testing: If poisoning is suspected, tests may be done to check for poisons, drugs, or alcohol in the body.
9. Vascular examinations: Additionalvascular studies, such as angiography, may be performed to detect abnormalities in the blood supply to the brain.
10. Screening for infections: If symptoms suggesting infectious disease are present, tests for infections such as meningitis or sepsis may be performed.

Diagnosing disorders of consciousness can be complex and multifaceted, so it is important to perform all necessary tests and specialist consultations to determine the cause and choose the most effective treatment. Doctors can use evidence from different areas of medicine to make an accurate diagnosis and prescribe appropriate treatment.

Treatment of the disorders of consciousness

First aid for unconsciousness can save a person's life and help prevent possible complications. Here is what you should do if you encounter a situation where someone has lost consciousness:

1. Check the safety of the area: Make sure the area where the casualty is is safe for you and the casualty. If there is a danger, e.g. From moving vehicles, move the victim to a safe place.
2. Call anambulance: Immediately call the ambulance service (112 or other appropriate number in your area) and report the incident. Verify the address and provide all relevant information.
3. Check breathing and pulse: Check if the casualty is breathing. If he is not breathing or breathing is irregular, start CPR and cardiopulmonary resuscitation (CPR). If there is no pulse, start cardiac massage combined with CPR.
4. Address the causes if it is safe to do so: If it is known that impaired consciousness was caused by certain factors, such as suffocation, allergic reaction, or trauma, try to address these causes if it is safe for you and the victim to do so.
5. Support the head and neck: If you think the victim may have a head, neck or back injury, support their head and neck in a stationary position to prevent possible spinal injuries.
6. Pay attention to burns and bleeding: If the casualty has burns or bleeding that require first aid, pay attention to them after ensuring breathing and circulation.
7. Provide warmth and comfort: The victim may be cold. Try to cover him/her with a warm blanket or clothing.
8. Do not give the casualty a drink: Refrain from giving fluids to the casualty as this may cause suffocation, especially if the casualty has lost consciousness due to intoxication.
9. Stay close: Try to stay close to the casualty and provide support and monitoring of their condition until medical help arrives.

It is important to remember that providing first aid for unconsciousness can be dangerous and you should proceed with caution without putting yourself or the victim in further danger. If you are in doubt or unsure how to proceed, wait for the arrival of emergency medical professionals and follow their advice.

Forecast

The prognosis of impaired consciousness depends on many factors, including the cause of the impairment, the speed and quality of first aid, and the timeliness and effectiveness of treatment. Prognosis can vary for different types of disorders of consciousness and for specific clinical situations. Here are some general considerations:

1. Syncope: In cases of syncope that are caused by a temporary drop in blood pressure or other non-serious causes, the prognosis is usually favorable. The victim often regains consciousness and feels better after a short period of time.
2. Epileptic seizures: The prognosis for most people with epilepsy who receive adequate treatment can be good. With medication and management of epileptic seizures, most patients can achieve a stable condition.
3. Cardiac and vascular disorders: The prognosis depends on the severity of the problem and the timeliness of treatment. For example, in the case of cardiac arrest, immediate resuscitation and defibrillation are important. The sooner help is given, the better the prognosis.
4. Head infections and injuries: The prognosis depends on the severity of the infection or injury and the speed of diagnosis and treatment. In some cases, such as meningitis or severe head injuries, impaired consciousness may be associated with serious consequences.
5. Intoxication: The prognosis depends on the type and dose of the substance that caused the intoxication and the speed of medical attention. Severe poisoning can lead to serious complications and even death.

The prognosis may also depend on the general health of the victim and the presence of any underlying medical conditions. It is important to remember that in the event of impaired consciousness, it is important to call an ambulance immediately and provide first aid if necessary to improve prognosis and minimize risks to the victim. Treatment and rehabilitation can also have a significant impact on the long-term prognosis.

Literature used

Bagnenko, Miroshnichenko, Khubutia: Emergency Medical Care. National manual. GEOTAR-Media, 2021.