Weiglein Tobias, Zimmermann Markus, Niesen Wolf-Dirk, Hoffmann Florian, Klein Matthias
Emergency Department, Hospital of the Ludwig-Maximilians-University (LMU) Munich, Munich; Department of Medicine III, Hospital of the Ludwig-Maximilians-University (LMU) Munich, Munich; Interdisciplinary Emergency Department, University Medical Center Regensburg, Regensburg; Department of Neurology, University Medical Center Freiburg, Freiburg; Kinderklinik und Kinderpoliklinik im Dr von Hauner Children's Hospital, Hospital of the Ludwig-Maximilians-University (LMU) Munich, Munich; Department of Neurology, Hospital of the Ludwig-Maximilians-University (LMU) Munich, Munich.
Dtsch Arztebl Int. 2024 Jul 26;121(15):508-518. doi: 10.3238/arztebl.m2024.0079.
Mortality in patients with acute onset of impaired consciousness is high: as many as 10% do not survive. The spectrum of differential diagnoses is wide, and more than one underlying condition is found in one-third of all cases. In this article, we describe a structured approach to patients with acute onset of impaired consciousness in the emergency department.
This review is based on pertinent articles retrieved by a selective search of PubMed and on the AWMF guidelines on the most common causes of impairment of consciousness.
Impairments of consciousness are classified as quantitative (reduced wakefulness) or qualitative (abnormal content of consciousness). Of all such cases, 45-50% have a primary neurological cause, and approximately 20% are of metabolic or infectious origin. Some cases are due to intoxications, cardiovas - cular disorders, or psychiatric disorders. Important warning signs ("red flags") in acute onset of impaired consciousness are a hyperacute onset, pupillomotor disturbances, focal neurologic deficits, meningismus, headache, tachycardia and tachypnea (with or without fever), muscle contractions, and skin abnormalities. Patients with severely impaired consciousness should be initially treated in the shock room according to the ABCDE scheme.
Acute onset of impaired consciousness is a medical emergency. Red flags must be rapidly recognized and treatment initiated immediately. Patients with severely impaired consciousness of new onset and uncertain cause, status epilepticus, lack of protective reflexes, or a new, acute neuro - logic deficit should be admitted via the resuscitation room.
急性意识障碍患者的死亡率很高：多达10%的患者无法存活。鉴别诊断范围广泛，三分之一的病例存在不止一种潜在病因。在本文中，我们描述了一种在急诊科针对急性意识障碍患者的结构化诊疗方法。
本综述基于通过选择性检索PubMed获取的相关文章以及德国医学专业协会（AWMF）关于意识障碍最常见病因的指南。
意识障碍分为定量性（清醒度降低）或定性性（意识内容异常）。在所有此类病例中，45%-50%有原发性神经病因，约20%源于代谢或感染。有些病例是由中毒、心血管疾病或精神疾病引起的。急性意识障碍的重要警示信号（“红旗征”）包括超急性起病、瞳孔运动障碍、局灶性神经功能缺损、颈项强直、头痛、心动过速和呼吸急促（伴或不伴发热）、肌肉收缩及皮肤异常。意识严重障碍的患者应首先在休克室按照ABCDE方案进行治疗。
急性意识障碍是一种医疗急症。必须迅速识别红旗征并立即开始治疗。新发且病因不明、存在癫痫持续状态、缺乏保护性反射或有新的急性神经功能缺损的意识严重障碍患者应通过复苏室收治。
