18. Catatonic syndromes (stupor, agitation)
Catatonic syndromes are psychopathological disorders with a predominance of motor disorders in the form of stupor, agitation, or their alternation, occurring in both adults (up to 50 years old) and children. In most cases, these syndromes are observed in schizophrenia, but can also manifest themselves in organic or symptomatic psychoses. Catatonic stupor Expressed in complete immobility, and a person can freeze in a very unusual position: with his head raised above the pillow at a certain angle, standing on one leg, with uncomfortable outstretched arms, etc. However, in most cases, patients lie motionless in the so-called “fetal position” (with eyes closed, on one side with bent legs and arms pressed to the body). Such complete immobility is usually accompanied by either absolute silence (mutism) or passive/active negativism. With passive negativism, the patient does not react at all to any appeals, suggestions, requests. With active negativism, the patient, on the contrary, actively resists all requests, for example, when asked to show his tongue, he clenches his mouth even tighter, and when asked to open his eyes, he closes his eyelids even more tightly. Cataleptic stupor (stupor with waxy flexibility) is characterized by complete freezing of the patient for a sufficiently long time. long time in the position given to him, or in the position he himself adopted, even if it was extremely uncomfortable. During stupor, a person does not react to loud speech, but in conditions of complete silence he can spontaneously disinhibit, thereby becoming available for contact. Catatonic arousal Characterized by stereotypically repeated, chaotic, meaningless movements. Excitement is accompanied by characteristic shouts of individual words or phrases (verbigeration), or complete silence (mute excitation). A characteristic feature of excitation is that it occurs within limited spatial limits (patients can endlessly step from foot to foot, standing in the same place; jump in bed, while stereotypically waving their arms). Sometimes patients may experience copying movements (echopraxia) or the words of others (echolalia), without revealing spontaneous speech. Catatonic excitement is often combined with hebephrenic syndrome, which is characterized by non-infectious empty fun, giftedness, or mannerisms. Such patients meow, grunt, cackle, stick out their tongues, make faces, grimace; sometimes they can rhyme words meaninglessly, or mutter something inarticulate; copy the gestures and movements of others, extend a leg instead of a hand to greet, walk mincing, or throwing their legs high
19. Syndromes of switching off consciousness (stunning, stupor, coma)
Syndromes of switching off consciousness. Turning off consciousness - stunning - can have different depths, depending on which the terms are used: “nubilation” - fogging, cloudiness, “cloudy consciousness”; “stupefaction”, “doubtfulness” - drowsiness. This is followed by stupor - unconsciousness, insensibility, pathological hibernation, deep stupor; This circle of coma syndromes completes - the most profound degree of cerebral insufficiency. As a rule, instead of the first three options, a diagnosis is made “ precom" At the present stage of consideration of syndromes of switching off consciousness, much attention is paid to the systematization and quantification of specific conditions, which makes their differentiation relevant.
Stunning is determined by the presence of two main signs: an increase in the threshold of excitation in relation to all stimuli and depletion mental activity generally. At the same time, the slowdown and difficulty of all mental processes, the poverty of ideas, incompleteness or lack of orientation in the environment are clearly evident. Patients who are in a state of stunned, stupefied state can answer questions, but only if the questions are asked in a loud voice and repeated repeatedly, persistently. The answers are usually monosyllabic, but correct. The threshold is also increased in relation to other irritants: patients are not bothered by noise, they do not feel the burning effect of a hot heating pad, do not complain about an uncomfortable or wet bed, are indifferent to any other inconveniences, and do not react to them. At mild degree Stunned, patients are able to answer questions, but, as already noted, not immediately; sometimes they can even ask questions themselves, but their speech is slow, quiet, and their orientation is incomplete. Behavior is not impaired, mostly adequate. You can observe easily occurring drowsiness (doubtfulness), while only sharp, fairly strong stimuli reach consciousness. Drowsiness is sometimes classified as a mild degree of stunning.
upon awakening from sleep, as well as the nullification of consciousness with fluctuations in the clarity of consciousness: slight darkenings, obscurations are replaced by clarification. Average degree The severity of stunning is manifested by the fact that the patient can give verbal answers to simple questions, but he is not oriented in place, time and surroundings. The behavior of such patients may be inappropriate. A severe degree of stunning is manifested by a sharp increase in all previously observed signs. Patients do not answer questions, cannot fulfill simple requirements: to show where the hand, nose, lips, etc.
Sopor(from Latin sopor - unconsciousness), or soporous state, subcoma, is characterized by complete extinction of voluntary activity of consciousness. In this state, there is no longer responsiveness to external stimuli; it can only manifest itself in the form of an attempt to repeat a loudly and persistently asked question. The predominant reactions are of a passive-defensive nature. Patients resist when trying to straighten their arm, change their underwear, or give an injection. This kind of passive-defensive reaction should not be confused with negativism (resistance to any request or influence) in catatonic substupor or stupor, since in catatonia other very characteristic signs are observed: increased muscle tone, mask-like appearance of the face, uncomfortable, sometimes pretentious postures, etc. A. A. Portnov (2004) distinguishes between hyperkinetic and akinetic stupor. Hyperkinetic stupor is characterized by the presence of moderate speech excitation in the form of meaningless, incoherent, indistinct muttering, as well as choreo-like or athetoid-like movements. Akinetic stupor is accompanied by immobility with complete muscle relaxation, the inability to voluntarily change the position of the body, even if it is uncomfortable. In a soporous state, patients retain the reaction of the pupils to light, the reaction to painful stimulation, as well as the corneal and conjunctival reflexes.
Coma(from Greek ???? - deep dream), or coma, comatose syndrome - a state of deep depression of the functions of the central nervous system, characterized by complete loss of consciousness, loss of response to external stimuli and a disorder in the regulation of vital functions of the body.
According to the National Scientific and Practical Society of Emergency medical care, the frequency of coma in the prehospital stage is 5.8 per 1000 calls, and the mortality rate reaches 4.4%. The most common causes of coma are stroke (57.2%) and drug overdose (14.5%). This is followed by hypoglycemic coma - 5.7% of cases, traumatic brain injury - 3.1%, diabetic coma and drug poisoning - 2.5% each, alcoholic coma - 1.3%; Coma is diagnosed less frequently due to poisoning by various poisons - 0.6% of cases. Quite often (11.9% of cases) the cause of coma at the prehospital stage remained not only unclear, but not even suspected.
All causes of coma can be reduced to four main ones:
intracranial processes (vascular, inflammatory, volumetric, etc.);
hypoxic conditions as a result of somatic pathology (respiratory hypoxia - with damage to the respiratory system, circulatory - with circulatory disorders, hemic - with hemoglobin pathology), impaired tissue respiration (tissue hypoxia), a drop in oxygen tension in the inhaled air (hypoxic hypoxia);
metabolic disorders (primarily of endocrine origin);
intoxication (both exo- and endogenous).
Comatose states are an urgent pathology and require the use of resuscitation measures, since the severity of the subsequently developing psychoorganic syndrome depends on the duration of the coma. Leading in clinical picture any coma is a shutdown of consciousness with loss of perception of the environment and oneself. If in a soporotic state the reactions are of a passive-defensive nature, then with the development of coma the patient does not respond to any external stimuli (pricking, patting, changing the position of individual parts of the body, turning the head, speech addressed to the patient, etc.). There is no reaction of the pupils to light during coma, unlike stupor.
Sopor is a pathology related to non-productive types of impaired awareness. Stupor belongs to pathologically deep sleep; this manifestation can occur in a variety of situational moments; it is akin to precoma. Psychiatrists rarely encounter this manifestation; their consultation in the medical history of such a person is rather a formality. But resuscitation doctors encounter this pathology very often, so they are able to quickly distinguish this manifestation. Stupor is similar to most types of loss and loss of consciousness. All such states are quite similar to each other and have distinctive features only to the extent of loss of awareness.
Stupor - what is it?
In an adequate state, when a person is alert, she has a clear consciousness, while she adequately assesses the situation, maintains contact, assesses her life needs, is able to stand up for herself and adapt to changes around her. The level of work of the body and the synthesis of brain impulses is very different in different conditions, stress is activating, and activities with quiet rest are relaxing. A person has two brain hemispheres, but always with different intensity, depending on the leading hand, form of activity and level of load. But due to various pathological phenomena, people can experience states of blackout. All of them are characterized by a lack of consciousness, but with some differences that play an important diagnostic role.
The term stupor comes from Latin language and denotes deep sleep, sluggish stupor, subcomatose state. Domestic terminology differs from foreign ones, where it is believed that stupor is an abnormally deep sleep, but stupor is a subcoma, but here it is exactly the opposite.
Stupor is a pathological condition in which a person lies motionless. The state of stupor is serious signal, demonstrating abnormal brain function and subsequently leading to coma or worse pathologies. But stupor is physical immobilization, while the person is in clear consciousness (most often).
Deep stupor is a state approaching comatose; not even a facial or reflex reaction appears to all painful stimuli.
Stupor after a stroke develops due to damage to the blood vessels that penetrate the brain tissue. All this significantly disrupts his activities. You should be alarmed if there is even the slightest sign of a problem, since everything can end in massive neurological disorders, even coma.
Causes of stupor
Since stupor is an almost complete loss of consciousness, there are many reasons. They can come from completely different sources. A very significant etiological layer comes from neurology. Stupor after a stroke is quite common; a stroke with both hemorrhage and ischemia can often have a similar unfavorable outcome. This pathology is especially relevant when the superial parts are affected. brain stem. Skull injuries are also very relevant; they become the root cause of a considerable number of pathological processes, and stupor is no exception. If a person was in neurology with a bruise, then you already need to worry. But if there was a concussion, or hemorrhage, which is even worse, then it is imperative to do a comprehensive study in order to avoid such problems in the future.
When neoplasia is detected in brain tissue, there is a risk of swelling, which will invariably lead to stupor, but even tumors in other parts of the body have the ability to lead to such unfavorable outcome, due to metastasis and intoxication aspects.
Infectious pathology has always been famous for the danger of its complications, thus, infectious processes in brain tissue can lead to abscesses, which, increasing intracranial pressure, provoke stupor. Thus, tuberculosis, various viruses, herpes, prion pathology, and sometimes can even provoke stupor. In septic conditions, a person may also fall into stupor.
Rheumatological pathology, in the form of all kinds, lupus, due to inflammatory process in the vessels of brain tissue can also lead to severe precomatose states.
Deep stupor is often characteristic of childhood, especially in children with severe congenital pathology. , congenital pathology with an increased composition of fluid in the brain tissue, often complicated by stupor. Problems that originate from birth also include aneurysms; if there is a congenital one, then it can burst at any time, which will lead not only to stupor, but also to mortality, unfortunately. In newborns with severe hypoxia, for example, after asphyxia during childbirth, this condition is also possible.
Stupor also occurs in certain psychiatric pathologies, for example, epilepsy. In the case of severe epilepsy and its improper treatment, the person does not return to consciousness after an attack, but the attack is repeated again and again, this pathology is called status epilepticus. In this case, there is a high probability of cerebral edema, which in turn leads to stupor or even coma. It is important to remove a person from such a state at a pace and with effective methods in order to avoid permanent changes that can provoke death.
Endocrinological pathology always entails metabolic disruptions, which in turn causes problems with brain tissue. Incorrectly docked with or will invariably lead to complications. Ketoacidotic coma occurs when there is a lack of insulin, when pathological products of fat destruction accumulate in the body. In this case, coma has several stages. The first of them is just stupor; almost every diabetic at the beginning of the disease fell into such a state. When the thyroid gland becomes too low, stupor may also occur.
Failure in the body, especially the liver and kidneys, leads to the accumulation of dangerous metabolites, and uremia occurs, which poisons the body with its own waste products; excessive accumulation of proteins and sodium leads to swelling of brain tissue and provokes stupor. in its most severe manifestations also leads to this condition, when the heart is not able to adequately fill the brain tissue with blood, especially when it is complicated.
External factors can also play an unfavorable role in the occurrence of stupor. Hypothermia is especially dangerous; if a person is frozen and has not been found for a long time, and then is not warmed up properly, then stupor is more likely to occur. Sunstroke or heat received in hot working conditions can also provoke stupor, especially if the person had the prerequisites for this and a tendency to this condition.
Stupor can also be caused by toxic drugs, fumes, alcohol substitutes, many medications, barbiturate-type sleeping pills, narcotic drugs, and anesthetics.
Symptoms and signs of stupor
The state of stupor manifests itself as an insignificant reaction to external stimuli and, moreover, only to expressive ones. The personality will answer if you ask loudly and many times, but otherwise not. The response is always passive, but signs of nihilism are possible, especially in the case of an attempt to administer drugs; the person may not straighten his arms. Depending on the type of stupor, a person may react differently, with slightly different symptoms. In the hyperkinetic version, the person pronounces incoherent speeches that are completely devoid of meaning. With akinetic, there is complete immobility and the absence of any attempts to change one’s position. But still, stupor is less deep than coma and is not characterized by the absence of a reflex. Deep tendon reflexes are present with decreased muscle tone. The pupils react to light, as in a coma, but more sluggishly than in a healthy person. Pain will also set the personality in motion, coupled with the corneal ocular and conjunctival reflexes.
Stupor has its own expressive signs in the form of drowsiness with a reaction only to massive stimuli, for example, a sharp sound can force them to open their eyes. They are unable to carry out any tasks or orders, nor are they able to answer the simplest questions. Since stupor affects the cortex and subcortex of the brain, there is an expressive pyramidal insufficiency, which impairs the performance of the body.
Since stupor develops in the case of a number of dangerous reasons, then it makes a lot of sense to diagnose them. At brain injuries Often there are bruises around the eyes, which indicate a fracture of the base of the skull. Bruising may also appear behind the ears. A very ominous symptom is leakage of cerebrospinal fluid, brain fluid, from the nose and ears. A person may have a strong odor, which indicates poisoning with alcohol and its substitutes.
It is very important to look around, because you can find many characteristic things, packaging for poisons, medicines or toxic agents. A variety of syringes after drug use. The very appearance of a person can tell a lot; he may have tattoos indicating that he has diabetes or epilepsy. An epileptic has many tongue bites and other scars.
If there is a fever, rash, an infection may be suspected, then a test is performed to confirm lumbar puncture in sterile conditions, which will tell many facts. With tuberculosis in the punctate there is observed high level protein and little glucose, with viral infections There is not a lot of protein, but in bacterial cases, especially in advanced cases, there is real pus.
To make a correct diagnosis, an electroencephalogram is used, which will help to see all the pathological waves. MRI, CT and X-ray of the brain are an expensive necessity, without which in this case it's simply impossible to get by. After all, lesions, pathological tissues, areas of damage and injury, and volumetric structures will be found there. It makes sense to take a blood test, because it will demonstrate many pathological changes.
Treatment of stupor
Treatment of stupor is carried out simultaneously with the pathology that caused it. It is important that the person breathes normally; in some cases, this requires an intubation procedure. If the oxygen level is low, use an oxygen mask. In case of hypoglycemia, glucose is used with insulin to process it, and in case of hyperglycemia, insulin is used. If there is poisoning, especially with substances that suppress the respiratory center, then a universal antidote, Naloxone 3 ml, is used. If there is any injury to the spine, it becomes necessary to use a rigid collar - a retainer.
If there is a suspicion of any type of poisoning, it is important to rinse, which will help stop the absorption of toxins into the body. If a person has had significant blood loss, then it is necessary to compensate for this and normalize the pressure. For this, blood transfusions, blood products, Novoseven, Plasma, Reopoliglyukin, Reosorbilact, Saline are used. Also added is Thiamine, which helps nourish the brain, Piracetam, Cordarone, Magnesia.
If the state of stupor drags on, then it is important to maintain the individual’s body at a decent level. To prevent bedsores - turning over and wiping, as well as massage. To prevent stagnation during long-term therapy, antibiotic therapy is added: Carbopenem, Azalide, Flemoclav, Ceftriaxone, Meronem.
For epileptic genesis, anticonvulsants are used: Carbamozepine, Valprocom, Seduxen, Sibazon, Relanium. Feeding is done whenever possible naturally, but sometimes you have to use a probe, because It is important that a person has enough microelements.
Stupor after stroke treated with vascular drugs, and, sometimes, surgically, in the presence of a hematoma. At ischemic causes Streptokinase and Alteplase are used to relieve its effects and preserve some neurons. It is very important to prevent cerebral edema with Furosemide, Torasemide, Manitol, Mannitol, Hypothiazide, Papaverine. Glutargin 40%, Thiamine, Pyridoxine and other vitamin preparations are used for digging.
Prognosis and consequences of stupor
Stupor is an intermediate state between nullification and coma, so its outcome depends on the speed of first aid. If the person is not found or they think that he is just a “drunk”, as often happens, then coma and then death are inevitable. Well, if an experienced doctor identifies the causes and they turn out to be treatable, then the consequences can be minimized, but still, these conditions always leave an imprint on a person’s cognitive functions.
If the vital parts of the cerebral cortex are damaged, then the personality cannot be returned; while maintaining vital functions, it is possible to preserve the “vegetable”. But in case of infections and even some injuries it is possible to save normal functioning. After strokes, everything depends on the location of ischemia or hematoma; the most unfavorable places are in the cognitive zones and in the brain stem.
If a person has been diagnosed according to Glasgow and found low level points, the prognosis is disappointing, since this indicates irreversible damage to the cerebral cortex.
After cardiac arrest, the prognosis is more disappointing than with drug poisoning, in particular barbiturates. This is due to the depth of the soporous state. Deep stupor has a poorer prognosis and more often leads to coma.
At proper care using modern means support (nutrition, functional bed, vitamin complexes, exercise therapy, massages), having come out of this state, the person will be able to return to a typical life in a relatively short period of time. But when improper care, the consequences may be irreversible: contractures, paresis, infectious complications, nutrition problems.
It is very important for people after such conditions to adhere to a healthy life. Smoking and alcohol greatly reduce its duration and also lead to pathological intoxication. Moderate physical exercise and health improvement in sanatoriums are also indicated.
Distinguish the following types consciousness: clear, darkened, stupor, stupor, coma, delirium, hallucinations.
In therapeutic clinics, patients often experience clear consciousness. The patient is completely oriented in the environment and clearly answers questions.
Darkened (unclear) consciousness manifests itself in the patient’s indifferent, indifferent attitude towards his condition; He answers questions correctly, but late.
At stupor (stunning) the patient is poorly oriented in his surroundings, sluggishly, slowly answers questions, sometimes not to the point, and immediately begins to doze off, fall asleep: falls into a state of numbness.
Sopor- deep confusion of consciousness (dullness). In this case, the patient is in a state of “hibernation”. Only a loud shout, painful effects (injections, pinches, etc.) can bring him out of this state, but for a very short time; soon he “falls asleep” again.
Coma (deep hibernation)- complete loss of consciousness. The patient does not respond to shouting, painful stimulation or inhibition. In coma there are no reflexes. Coma indicates significant severity of the disease. It develops, for example, with severe diabetes mellitus, with renal and liver failure, in case of alcohol poisoning, etc.
In diabetes mellitus, in the case of metabolic disorders, mainly carbohydrates and fats, due to a lack of insulin in the body, a hyperglycemic (diabetic) coma occurs. It develops slowly. It is usually preceded by malaise, loss of appetite, headache, nausea, vomiting. Next, muscle tone decreases and dryness develops. skin, their turgor decreases, the face becomes pink, the eyeballs become soft, tendon reflexes partially or completely disappear, noisy breathing is noted (Kussmaul breathing), a characteristic smell of acetone (fruity) is felt in the exhaled air, the pulse slows down, and blood pressure drops.
In case of adrenal insufficiency, as well as in case of insulin overdose and for a number of other reasons as a result sharp decline hypoglycemic coma occurs. It starts quickly. Sometimes it is preceded by a feeling of hunger, weakness, and sweating. With this disease, the skin becomes pale, moist, muscle rigidity, body tremors, convulsive twitching are noted, and the pupils dilate.
Due to severe diffuse liver damage as a result of complete failure of its function, hepatic coma develops. In this case, severe weakness and drowsiness appear, alternating with periods of excitement. The skin becomes jaundiced, scratching, spider veins, and hemorrhages are noted. Muscle twitching is also observed, and a sweetish (liver) odor is felt from the mouth. Breathing is noisy (Kussmaul), pupils are motionless, dilated, blood pressure is reduced, urine is dark yellow, feces are discolored.
In patients with chronic disease kidneys, accompanied by severe functional insufficiency, uremic coma occurs. Its initial signs are general weakness, headaches, nausea, vomiting (especially in the morning, before meals), general anxiety, insomnia. Then comes loss of consciousness. The skin becomes pale yellowish, dry, with traces of scratching and hemorrhages. The mucous membranes of the oral cavity also become pale and dry, breathing is like Cheyne-Stokes, less often - Kussmaul, muscle tone increases, an ammonia smell is felt from the mouth (smell of urine).
For the sick alcoholic coma Characterized by a cyanotic face, dilated pupils, hyperemic sclera of the eyes, shallow, hoarse breathing, the smell of alcohol on the breath, Cheyne-Stokes type breathing, a small rapid pulse, low blood pressure.
In the case of an anemic coma, there is a “dead” pallor, clammy sweat, muffled heart sounds, thready pulse, decreased blood pressure blood.
In some diseases (especially infectious diseases with severe intoxication), poisoning with alcohol, sleeping pills and other drugs, patients experience excitation of the central nervous system, i.e., a state opposite to those described above. Such patients are restless and agitated.
In addition, there may be a disturbance in consciousness leading to delirium. Rave- this is an objectively false, absolutely uncorrectable judgment. With violent delirium, patients are extremely excited, jump out of bed, run somewhere, and experience hallucinations.
Hallucinations There are auditory, visual, tactile (the feeling of worms, insects, microbes crawling over the body, etc.).
During auditory hallucinations, the patient talks to himself or to an imaginary interlocutor.
At visual hallucinations patients see something that is not really there, for example, mice that rush at them, devils, etc. This often happens with alcoholism.
Quiet delirium is also characterized by unrealistic ideas, hallucinations, only patients behave outwardly calmly, often in a state of stupor or stupor, muttering something, uttering incomprehensible and incoherent phrases.
Stupor is a depression of consciousness preceding coma (subcoma, pre-coma), i.e. pre-coma state. In a state of stupor, a person is able to react to loud sounds, repeatedly repeated questions, the pupils weakly, but still react to light, and the body - to painful stimuli (pinches, slaps). However, such stimuli can only bring a person out of stupor for a short time.
Stupor should be distinguished from another medical concept - “stupor”. Both of them are similar in external manifestations, but stupor is a pathology of neurological etiology, while stupor is of mental etiology. In foreign sources these concepts are differentiated differently. “Stupor” means “deep sleep,” and depression of consciousness, on the contrary, is called stupor.
IN international classification diseases of the 10th revision (ICD-10), stupor is classified in subparagraph R40.1.
Causes of subcoma
Stupor can occur for many reasons. Internal reasons are divided into two groups: neurological and metabolic. External factors can also influence the development of depressed consciousness.
Neurological causes include:
- Acute cerebrovascular accident (ACVA), including; falling into stupor is especially typical when affected upper sections brain stem as a result of hemorrhagic stroke;
- traumatic brain injuries resulting in brain contusion, concussion, hemorrhage, or hematoma;
- abscesses, hemorrhages, brain tumors with swelling, edema, displacement of segments;
- dropsy of the brain (hydrocephalus);
- dysfunction of nerve structures as a result of inflammation of the capillaries (vasculitis);
- inflammatory processes in the brain caused by infections (meningitis, encephalitis);
- status epilepticus, in which epileptic seizures occur every half hour; the patient does not have time to fully recover between attacks, which causes dysfunction of the nervous system and internal organs are growing;
- subarachnoid hemorrhage due to rupture of a cerebral aneurysm.
Metabolic factors:
- Abnormal blood glucose levels due to diabetes;
- self-poisoning of the body with uremia due to the accumulation of protein metabolic products;
- hypothyroidism (hormone deficiency thyroid gland);
- a sharp drop in sodium levels in the blood;
- hepatic-renal failure;
- hypoxia (lack of oxygen), asphyxia (excess carbon dioxide);
- severe hypertensive crisis;
- severe heart failure;
- blood poisoning (sepsis).
Stupor can be triggered by external factors:
- Overheating of the body (sunstroke or heatstroke);
- hypothermia (hypothermia);
- poisoning by toxins (carbon monoxide, methyl alcohol, a number of medications, for example, barbiturates).
What is the difference between coma and stupor
Stupor is a state of depression of consciousness moderate severity. It may be preceded by more light form depression of consciousness - deafness.
Coma is a more severe form, in which consciousness is lost altogether. Stupor can develop into a coma. With stupor, reflex reactions persist, while with coma they are practically absent. In both cases, reflexes slow down, but in coma the degree of slowing is much greater.
In a soporotic state, a person is not able to answer the question, but one can be sure that he hears it to some extent. For example, by speaking loudly to him several times, you will receive a reaction in the form of opening your eyes. By pinching the hand, you can notice from the facial expressions that the person in stupor feels pain. In a coma, all this is completely impossible. Even a weak reaction to external stimuli does not occur. Breathing during coma also weakens due to depression of respiratory function.
How long does the stuporous state last?
Depending on the reasons for which it arose, the stuporous state can last from a few seconds or minutes to several months. Then the person either leaves it or plunges even deeper into unconsciousness - into a coma.
How to properly bring a person out of stupor
It is impossible to bring a patient out of stupor without the help of doctors. He may automatically open his eyes when there is a sharp clap or scream, but immediately closes them. Later, having finally woken up, the patient does not remember anything, because... stupor is most often accompanied by amnesia.
If you notice signs of depressed consciousness in a person, you should immediately call an ambulance.
Signs of a soporous state
Stupor resembles a state of deep, good sleep. The man does not move, his body is relaxed, his eyes are closed. Inhibitory functions predominate in the patient’s brain. At loud sound By patting his cheeks, he can open his eyes for a few seconds. If you pinch or slap your hand, pull it back and hit back. Breathing, swallowing, and corneal reflex remain normal. With the hyperkinetic form of stupor, abrupt mutterings and movements occur, but it is still impossible to establish contact with the patient.
Usually, along with signs of stupor, symptoms of the disease that caused the development of this condition appear. If stupor is caused by a traumatic brain injury, dark blue circles around the eyes may be a sign. This indicates possible fracture base of the skull.
Diagnostics
When diagnosing, it is important to correctly determine the degree of depression of the patient’s consciousness, i.e. soporous state with stunning and coma. The measures taken for further treatment will depend on this.
It is necessary to identify the cause-and-effect relationship of stupor with other diseases or pathological conditions. Treatment will be effective only if the disease that caused the depression of consciousness is eliminated.
To determine the cause of stupor, the doctor needs full information about the circumstances that preceded it. To do this, a survey is conducted of the patient’s relatives or those accompanying him during the onset of stupor. The ambulance team usually examines the room in which the patient is located. Found bottles of alcohol, packaging of medicines, syringes can lead to conclusions about poisoning of the body with alcohol, drugs, medicines due to their overdose. Traces of a fight, blood on things can indicate a traumatic brain injury, injury received from a fall due to a stroke, fainting and other circumstances. Medical records and certificates that shed light on the presence of existing diseases are studied.
The patient's body is examined to identify skin rashes, bruises, hemorrhages, injection marks, and the smell of alcohol. The patient's body temperature, blood pressure, and blood glucose levels are measured. Auscultation (listening) of the heart and ECG are performed. Blood is taken for general and biochemical analyzes. An MRI or CT scan of the brain, urine screening and blood tests for the presence of toxins, and a lumbar puncture may also be performed. The list of emergency examinations depends on the existing diseases and circumstances on the basis of which the causes of stupor can be suspected.
Treatment of stupor
Treatment for stupor should begin as quickly as possible. The patient must be taken to the hospital's intensive care unit. He must be under round-the-clock supervision of medical workers, under the control of equipment.
The choice of treatment method depends entirely on the cause of the depression of consciousness. Stupor is not a separate disease. This is just one of the symptoms in the clinical picture of stroke, poison intoxication, severe hypertensive crisis and other acute conditions.
The main component of therapy is measures aimed at preserving the nervous tissue of the brain. As a rule, medications such as furosemide, mannitol, torasemide, papaverine and some others are used for this. The choice of drug remains with the doctor.
If the treatment is approached incorrectly, brain tissue cells will die, which will lead to even more disastrous consequences. To prevent this from happening, you need to ensure good blood supply to the brain and prevent tissue swelling. Depending on the cause of the stupor, doctors treat hepatic or renal failure, restore heart rhythm, adjust blood sugar levels, stop bleeding (as appropriate). Treatment measures supplemented by the introduction of microelements missing in the body. If stupor appears against the background of an infectious disease, antibacterial drugs. Each etiology requires specific treatment.
In case of poisoning, the stomach and intestines are washed to stop further absorption of toxins into the blood. In case of bleeding with significant blood loss, a blood infusion is given. Blood products, saline, and plasma may also be administered. To improve the nutrition of brain cells, the doctor may prescribe thiamine, piracetam, cordarone, and magnesium preparations.
In cases where stupor was preceded by epileptic seizures, anticonvulsants: sibazon, carbamozepine, seduxen, valprocom, relanium. After a stroke, vascular drugs are used in therapy. If a cerebral hematoma has formed, it may be necessary to emergency surgery. The doctor may prescribe antibiotics, the purpose of which is to prevent congestion in the tissues if the patient has to lie down for a long time. After all, stupor can last for months.
If stupor lasts for a long time, the patient will require special care. To prevent bedsores from forming, the person needs to be turned over, wiped with water, and the muscles massaged. In addition, he will have to be spoon-fed. If this is not possible, feeding will have to be done through a tube.
Forecast and consequences
The prognosis when a person falls into a state of stupor is very ambiguous. The reasons why it arose and the degree of depression of consciousness play a big role. It is also important how quickly treatment is started.
If the processes affect vital areas of the cerebral cortex, the patient may completely lose his personal qualities. While maintaining vital functions a person may emerge from stupor disabled. Such a person will require lifelong support and care. He will no longer be able to take care of himself.
For prognosis, doctors use the Glasgow scale diagnostics. If the score is determined to be low, then it will most likely not be possible to return the person to their previous life.
With a slight degree of depression of consciousness and proper treatment a quick recovery is possible. However, being in a pre-coma state in any case leaves a mark on the cognitive abilities of the brain. To minimize the risks of relapse and the development of new diseases, a person who has suffered stupor urgently needs to reconsider his lifestyle. You need to set yourself up for a healthy life and eliminate any bad habits.
Full consciousness of a person is manifested by wakefulness and the absolute implementation of cognitive functions (thinking, speech, the ability to remember). If we talk about anatomical and physiological features, normal consciousness is maintained through the relationship of the cerebral hemispheres with the reticular formation - a system that receives nerve impulses from all organs and systems, which transmits them further to all parts of the main organ of the central nervous system. 
Against the background of pathological conditions, proper brain activity may be disrupted. Stupor is one of the options for depression of consciousness, in which the reflex activity of the human body is preserved, but its ability to develop behavioral reactions is sharply reduced. More details about the characteristics of the condition, principles of diagnosis and treatment are described later in the article.
There are several degrees of impairment of consciousness, among which stupor (subcoma, stupor) occupies an intermediate place:
- Stunning is a decrease in the level of consciousness, which is manifested by limited speech contacts, an increase in the threshold of perception of stimuli external character, behavioral disorders. Stunning may manifest itself as delusions, hallucinations, rapid heartbeat and increased blood pressure.
- Coma is a complete absence of consciousness, which, depending on its manifestations, is divided into several degrees of severity.
- Moderate coma - some reflex reactions and the response of the pupils to light stimuli are preserved, a number of deep reflexes are normal.
- Deep coma - absence of reflexes, severe hypotension, breathing, as well as the functioning of the heart and blood vessels are severely impaired.
- Coma of an extreme degree is manifested by dilation of the pupils, lack of reactions to irritations, and a sharp disruption of all vital functions.
The state of coma is assessed using a specific scale (Glasgow), in which each of the reactions has a certain digital designation. Qualified specialists evaluate eye opening (from 1 to 4 points), motor response to irritation (from 1 to 6 points) and speech of a sick person (from 1 to 4 points).
Important! The highest score is assigned to an adequate answer, the lowest – to its absence. The coma state is confirmed if the score is 8 points or less.
The soporous state is an intermediate option between stunning and coma.
Causes
There are a number of pathologies against which the condition of stupor occurs. They are divided into several large groups because they have different development mechanisms.
Neurological disorders
This group includes the following diseases and pathologies:
- cerebrovascular accident of an ischemic or hemorrhagic nature - appears due to changes in the functioning of the upper parts of the brain stem;
- traumatic injuries accompanied by the formation of hematoma, hemorrhage, destruction of nerve tissue;
- tumor processes;
- formation of a brain abscess;
- pathological accumulation of fluid;
- severe course of epilepsy with the appearance of epistatus.
Changes in metabolic processes
Another group of reasons that provoke the occurrence of stupor in humans. Its representatives are considered diabetes, hypofunction of the thyroid gland, liver and kidney failure. An important reason is uremia. It is characterized by accumulation in the bloodstream large quantity metabolites of protein metabolism.
Oxygen deficiency
It can occur against the background of asphyxia (suffocation, as a result of which the human body does not receive the required amount of oxygen, in parallel with which the level of carbon dioxide in the tissues increases).
The second reason for hypoxia and the development of a soporous state against its background is heart disease associated with severe failure and congestive processes.
Stupor due to stroke
The main reason for the development of a stuporous state during a stroke is a disruption of the functioning of the cerebral vessels. Pathology can have varying degrees of damage to the brain functions of a sick person, up to the death of brain cells.
Unfortunately, stupor can develop not only during the period of acute manifestations, but also during rehabilitation measures. Ignoring pathological condition leads to the transition of stupor to coma.
The most severe form is observed with a hemorrhagic stroke, which is manifested by the presence of hemorrhage in the patient’s brain. Experts confirm that in most cases the outcome of the pathology is unfavorable.
Important! On the background ischemic stroke a person’s consciousness is not so disturbed; more often it does not reach the point of stupor. The main manifestation is stunning.
Other reasons
Stupor can occur against the background of the following diseases and pathologies:
- severe degree of hypertensive crisis;
- significant hypothermia or, conversely, aggressive exposure to direct rays of the sun;
- influence of toxic and poisonous substances;
- reproduction of pathological microorganisms in the blood.
Infectious diseases are dangerous because they can provoke the formation of abscesses in the brain tissue. An important place among the etiological factors is occupied by Koch's bacillus (the causative agent of tuberculosis), meningococcus, virus herpes simplex, toxoplasma. In some cases, even helminths can cause stupor.
Alcohol intoxication is an important provoking factor of the pathological condition. Manifestations of disorders of the central nervous system depend on the degree of intoxication.
Symptoms and signs of stupor
Signs of impaired consciousness appear in parallel with the symptoms of the disease that caused the change in brain processes. The specialist diagnoses the following points:
- Reactions in response to irritations are reduced, as is the pupillary response, but the processes of swallowing, breathing and the corneal reflex are preserved.
- Uncontrolled movements and constant muttering appear (not always, it occurs in some clinical cases).
- Possible seizures, tension muscular apparatus neck.
- Changes in the sensitivity of the skin, paralysis of the upper and lower limbs, the occurrence of weakness of certain muscle groups - if the violations affected the pyramidal system.
An important symptom of the development of stupor is pathological drowsiness. When examining a sick person, it seems that he is sleeping and cannot answer the questions asked. Only a loud or painful stimulus can force him to open his eyes or make any movement. At the same time, the patient opens his eyes, swears, mutters something, and tries to move aside the place that is exposed to the irritant. 
In parallel with the symptoms of depression of consciousness, signs of a disease appear that provoked a change in brain reactions. Associated symptoms can be:
- bruises around the eyes;
- discharge of blood or cerebrospinal fluid from the ears;
- the presence of a sharp pathological odor from the patient (for example, when alcohol intoxication, uremia or hyperglycemic ketoacidosis);
- the presence of a significant number of scars on the body, tongue bites;
- increase in body temperature.
Diagnostics
The pathological condition of the patient is assessed by clarifying blood pressure, pulse rate, checking reflexes, muscle tone and reaction to painful stimuli. The presence of the following points is specified:
- mechanical damage;
- hemorrhages;
- presence of the smell of alcohol;
- rashes;
- injection marks.
Experts are studying medical documentation the patient, examine his personal belongings, check with relatives whether the patient has any diseases that could provoke the development of the condition (for example, epilepsy, diabetes, liver or kidney pathology). 
They examine the patient’s blood and urine, assess blood sugar levels, conduct toxicological studies, electroencephalography, CT and MRI of the brain. Heart function is assessed by auscultation and ECG. If the doctor suspects the development infectious process, carry out bacteriological culture of blood and cerebrospinal fluid.
Treatment of stupor
The principles of therapy include not only the inpatient stage of treatment of the condition, but also the provision of first aid. If the development of stupor occurs at home, work or another place, the following measures should be taken:
- Call a team of qualified specialists.
- Place the patient on his side, control the position of the tongue.
- Measure vitally important indicators(blood pressure, pulse, breathing rate).
- Assess condition eyeballs, their response to light stimuli.
- If possible, thiamine and glucose solution should be injected into a vein.
Important! Activities should be carried out before the arrival of qualified ambulance.
Further assistance is provided to the patient in the intensive care unit. First of all, oxygen therapy is carried out. At mechanical damage The neck area is fixed with special splints and collars. Doctors monitor changes in blood pressure, pulse, respiration, changes in blood oxygen saturation and water and electrolyte balance.
It is necessary to eliminate the development of stupor as soon as possible, since the progression of changes in the body’s brain reactions can provoke a transition to a coma. In such a case, the consequences for the human body will be much more serious.
In parallel with the provision of assistance, they prescribe treatment for the main cause of the brain disease, use antibiotics, decongestant therapy, and carry out detoxification measures. 
Since the duration of the pathological state of the brain and the level of its severity can be different, from the very beginning of treatment it is necessary to prevent the development of pressure sores. It is necessary to change the position of the patient's body on the couch every few hours.
Deep brain pathology requires feeding the patient through a tube or through parenteral administration of nutritional mixtures.
Forecast and consequences
As a rule, the outcome of the pathological state of the brain depends on the speed of providing assistance to a person. Most people who abuse alcohol end up dying because they have an antisocial lifestyle and do not seek help.
The level of change in brain function is assessed using the Glasgow scale throughout the entire period of stupor. Low numbers confirm deep violations from the tissues and cells of the main organ of the central nervous system, which indicates the possibility of loss of a number of cognitive functions if the patient can be brought to his senses.
The issue of preventing the development of subcoma is important. It includes maintaining healthy image life, cessation of alcohol abuse and drug use, regular medical examinations, annual health improvement.
Hepatic coma- terminal (last) stage of progressive failure...
brain - death of brain cells...
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