Henry Thomas R, Ezzeddine Mustapha A
Department of Neurology, University of Minnesota, Minneapolis.
Neurol Clin Pract. 2012 Sep;2(3):179-186. doi: 10.1212/CPJ.0b013e31826af1be.
Evaluating transient impairment of consciousness is critical to diagnose epileptic seizures, syncope, parasomnias, organic encephalopathies, and psychogenic nonepileptic seizures. Effective evaluation of episodic unconscious events demands interactive interviewing of the patient and witnesses of the events, with judgment as to historians' observational abilities. When generalized tonic-clonic seizures have been witnessed by medical staff or other reliable observers, a search for concomitant nonconvulsive events and for comorbid illnesses often elucidates diagnoses unsuspected by the referring physician. Consultation for stupor-coma should not miss a potentially reversible acute severe encephalopathy, particularly when reversibility requires timely therapy. Perspicacious analyses of complex cognitive-motor phenomena support judicious application of diagnostic procedures, including brief or prolonged EEG and video-EEG, EKG tilt-table testing, EKG loop monitoring, and brain imaging.
评估意识的短暂损害对于诊断癫痫发作、晕厥、异态睡眠、器质性脑病和精神性非癫痫性发作至关重要。有效评估发作性无意识事件需要对患者及其事件目击者进行交互式访谈，并对病史提供者的观察能力作出判断。当医务人员或其他可靠观察者目睹全身性强直阵挛发作时，寻找伴随的非惊厥性事件和合并疾病往往能明确转诊医生未怀疑的诊断。对于木僵-昏迷的会诊不应遗漏潜在可逆的急性重症脑病，尤其是当可逆性需要及时治疗时。对复杂认知运动现象的敏锐分析有助于明智地应用诊断程序，包括短程或长程脑电图和视频脑电图、心电图倾斜试验、心电图环路监测以及脑成像。
