Brinar V, Matijević V
Neuroloska klinika KBC Rebro i Medicinskog fakulteta Sveucilisa u Zagrebu.
Lijec Vjesn. 1995 Jun;117 Suppl 2:50-3.
Seventy-nine patients admitted in the neurological Intensive care unit because of severe disturbances of consciousness has been evaluated. Protocol based on previous experiences in evaluation of unconsciousness patients was used. Forty-four patients died and thirty-five survived. In 46 patients cause of illness was intracerebral hemorrhage. In 44 of them the cause of hemorrhage was arterial hypertension and in two of them rupture of a-v malformation. The majority of patients actually 41 of them showed hemispheral localization of intracerebral hematoma and five subtentorial. Pontien hemorrhages was found in three and cerebellar in two patients. In majority of 24 patients with hemispheral localization of intracerebral hematoma who showed progressive deterioration of consciousness the signs of descendent transtentorial herniation were found. The symptoms of uncal herniation were rare. In three patients with subtentorial localization of intracerebral hematoma who died signs of upward transtentorial herniation were observed. In 16 patients with ischemic cerebrovascular accident who showed disturbances of the consciousness at the admittance or soon after, nine patients died and seven survived. The cause of their condition were great hemispheral, smaller brain stem ischemic lesion, or deterioration of consciousness was related to the somatic illness. Patients with great ischemic lesions showed similar course of consciousness deterioration as it was observed in patients with hemispherical intracerebral hematomas with difference that biphasic course of illness characterized with temporary stagnation or even slight improvement of patients condition and than secondary progression of deterioration was seen only in patients with intracerebral hematoma, probably because of secondary ischemic complications. Ten patients were admitted because of subarachnoidal and two of them because of intraventricular hemorrhage. Six of them died and four survived. These patients has rupture of great sacular aneurysm with fast development of high intracranial pressure. In two of them the cause of death was rerupture of aneurysm. Stuporous patient with hemispheral neoplasm showed development of descendent transtentorial herniation which was stopped by anti oedematous and corticosteroid therapy. Comatose patient with brisk response on oculocephalic stimulation and normal papillary light reflexes was suspected on intoxication rather than structural brain lesion. He recovered by diuretics and forced rehydratation. After becoming conscious barbiturate intoxication was confirmed. Three patients were admitted in coma because of poisoning with CO, two patients died. Two patients admitted in epileptic status showed late diencephalic state of coma and they survived after anti epileptics and antioedematous treatment.
对79名因严重意识障碍入住神经重症监护病房的患者进行了评估。采用了基于以往昏迷患者评估经验的方案。44名患者死亡，35名患者存活。46名患者的病因是脑出血。其中44名患者的出血原因是动脉高血压，2名患者的出血原因是动静脉畸形破裂。实际上，大多数患者（41名）脑内血肿位于半球，5名位于幕下。3名患者发现脑桥出血，2名患者发现小脑出血。在24名脑内血肿位于半球且意识逐渐恶化的患者中，大多数发现了下行性小脑幕切迹疝的体征。钩回疝的症状很少见。在3名脑内血肿位于幕下且死亡的患者中，观察到了上行性小脑幕切迹疝的体征。16名因缺血性脑血管意外入院且入院时或入院后不久出现意识障碍的患者中，9名患者死亡，7名患者存活。他们病情的原因是大脑半球、较小的脑干缺血性病变，或者意识障碍与躯体疾病有关。有严重缺血性病变的患者意识恶化过程与脑内血肿位于半球的患者相似，不同之处在于，疾病的双相病程表现为患者病情暂时停滞甚至略有改善，而只有脑内血肿患者出现继发性恶化进展，这可能是由于继发性缺血并发症所致。10名患者因蛛网膜下腔出血入院，其中2名因脑室内出血入院。他们中有6名死亡，4名存活。这些患者患有巨大囊状动脉瘤破裂，颅内压迅速升高。其中2名患者的死亡原因是动脉瘤再次破裂。患有半球肿瘤的昏睡患者出现了下行性小脑幕切迹疝，通过抗水肿和皮质类固醇治疗得以阻止。对眼头刺激反应活跃且瞳孔光反射正常的昏迷患者，怀疑是中毒而非结构性脑损伤。他通过利尿剂和强制补液后康复。清醒后证实为巴比妥类药物中毒。3名患者因一氧化碳中毒昏迷入院，2名患者死亡。2名因癫痫持续状态入院的患者出现了晚期间脑昏迷状态，经抗癫痫和抗水肿治疗后存活。
