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 both in adults (up to 50 years old) and in children. In most cases, these syndromes are observed in schizophrenia, but they can also manifest themselves in organic or symptomatic psychoses inconveniently outstretched arms, etc. However, in most cases, patients lie motionless in the so-called "embryonic position" (with closed eyes, 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 absolutely does not respond to any appeals to him, suggestions, requests. With active negativism, the patient, on the contrary, actively resists all requests, for example, when asked to show his tongue, he squeezes his mouth even tighter, and when asked to open his eyes, he closes his eyelids even tighter. Cataleptic stupor (stupor with waxy flexibility) is characterized by complete fading of the patient for quite a while. long time in a position given to him, or in a position adopted by him, even if it is extremely uncomfortable. During the course of a stupor, a person does not respond to loud speech, however, in conditions of complete silence, he can spontaneously disinhibit, thereby becoming available for contact Catatonic excitation It is characterized by stereotypically repeated, chaotic meaningless movements. Excitation is accompanied by characteristic cries of individual words or phrases (verbigeration), or complete silence (mute excitement). A characteristic difference of excitation is that it proceeds within limited spatial limits (patients can endlessly step from foot to foot, standing in the same place; bouncing in bed, while stereotypically waving their arms). Sometimes patients may copy movements (echopraxia), or the words of others (echolalia), without revealing spontaneous speech. Catatonic excitation is often combined with hebephrenic syndrome, which is characterized by non-contagious empty fun, daring, or mannerisms. Such patients meow, grunt, cackle, show their tongue, make faces, make faces; sometimes they can senselessly rhyme words, or mutter something inarticulate; copy the gestures and movements of those around them, for a greeting they stretch out a leg instead of an arm, walk with a seed, or toss their legs high
19. Syndromes of turning off consciousness (stunning, stupor, coma)
Syndromes of turning off consciousness. Turning off consciousness - stunning - can have a different depth, depending on which the terms are used: "obnubilation" - fogging, cloudiness, "cloudiness of consciousness"; "stunning", "drowsiness" - drowsiness. This is followed by sopor - unconsciousness, insensibility, pathological hibernation, deep stunning; completes this circle of coma syndromes - the most profound degree of cerebral insufficiency. As a rule, instead of the first three options, the diagnosis is " precoma". At the present stage of consideration of syndromes of turning off consciousness, much attention is paid to the systematization and quantification of specific states, 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 scarcity of ideas, the incompleteness or lack of orientation in the environment are clearly visible. Patients who are in a state of stupor, stunned, 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 raised in relation to other irritants: patients are not disturbed by noise, they do not feel the burning effect of a hot heating pad, they do not complain about an uncomfortable or wet bed, they are indifferent to any other inconveniences, they 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, orientation is incomplete. Behavior is not disturbed, mostly adequate. One can observe easily occurring drowsiness (somnolence), while only sharp, rather strong stimuli reach consciousness. Sleepy states are sometimes referred to as a mild degree of stunning.
upon awakening from sleep, as well as obnubilation of consciousness with fluctuations in the clarity of consciousness: slight blackouts, 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 inadequate. 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: show where the hand, nose, lips, etc. After leaving the state of stunning, the patient retains in his mind separate fragments of what was happening around.
Sopor(from lat. sopor - unconsciousness), or a soporous state, subcoma, is characterized by the complete extinction of voluntary activity of consciousness. In this state, there is no longer responsiveness to external stimuli; it can manifest itself only in the form of an attempt to repeat a loudly and persistently asked question. The prevailing reactions are passive-defensive. Patients resist when trying to straighten their arm, change their linen, and give an injection. Such passive-defensive reactions should not be confused with negativism (resistance to any request and influence) in catatonic substupor or stupor, since other very characteristic signs are observed in catatonia: increased muscle tone, masklike face, uncomfortable, sometimes pretentious postures, etc. AA 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 mumbling, as well as choreoid or athetoid-like movements. Akinetic sopor is accompanied by immobility with complete relaxation of the muscles, inability to voluntarily change the position of the body, even if it is uncomfortable. In the soporous state, patients retain the reaction of the pupils to light, the reaction to pain irritation, as well as the corneal and conjunctival reflexes.
Coma(from Greek ???? - deep dream), or coma, coma syndrome - a state of deep depression of the functions of the central nervous system, characterized by a complete loss of consciousness, loss of response to external stimuli and a disorder in the regulation of vital body functions.
According to the National Scientific and Practical Society of Emergency medical care, the frequency of coma at the prehospital stage is 5.8 per 1000 calls, and the mortality rate for them 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 often due to poisoning with various poisons - 0.6% of cases. Quite often (11.9% of cases), the cause of coma at the prehospital stage remained not only not clarified, 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).
Coma states are related to urgent pathology, 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 the turning off of consciousness with the loss of perception of the environment and oneself. If in the soporous state the reactions are passive-defensive in nature, then with the development of a coma, the patient does not respond to any external stimuli (prick, pat, change in the position of individual parts of the body, turn of the head, speech addressed to the patient, etc.). Pupillary reaction to light in coma, unlike stupor, is absent
Sopor is a pathology related to unproductive types of impaired awareness. Sopor belongs to a 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, therefore they are able to quickly distinguish this manifestation. Sopor 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.
Sopor - what is it?
In an adequate state, when a person is cheerful, she has a clear consciousness, while she adequately assesses the situation, maintains contact, evaluates 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, stresses are activating, and activities with a quiet rest are relaxing. The personality has two cerebral hemispheres, but always with different intensity, depending on the leading hand, the form of activity and the level of loads. But due to a variety of pathological phenomena, people can visit states of unconsciousness. All of them are characterized by the absence of consciousness, but with some differences that play an important diagnostic value.
The term sopor comes from Latin and denotes deep sleep, flaccid stupor, subcomatose state. Domestic terminology differs from foreign, where it is believed that stupor is an abnormally deep sleep, but stupor is a subcoma, and we have exactly the opposite.
Sopor is a pathological condition in which a person lies motionless. The state of the sopor is serious signal, demonstrating incorrect brain work and subsequently leading to coma or worse pathologies. But stupor is immobilization in the physical plane, while the person is in a clear mind (most often).
Deep stupor is a condition approaching coma, even not all pain stimuli have a mimic or reflex reaction.
Sopor after a stroke develops due to damage to the vessels penetrating the brain tissue. All this impressively disrupts his activities. You should be alarmed if there are already the slightest signs of a problem, since everything can end with massive neurological disorders, up to coma.
Causes of sopor
Since sopor is an almost complete shutdown of consciousness, there are many reasons. They can come from completely different sources. A very significant etiological layer comes from neurology. Sopor after a stroke is quite common, a stroke with both hemorrhage and ischemia can often have a similar adverse 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 sopor is no exception. If a person was lying in neurology with a bruise, then you already need to worry. But if there was a concussion, or a 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 the brain tissues, there is a risk of their edema, which will invariably lead to stupor, but even tumors in other parts of the body have the ability to lead to such poor outcome, due to metastasis and intoxication moments.
Infectious pathology has always been famous for the danger of its complications, thus, infectious processes in brain tissues can lead to abscesses, which, by increasing intracranial pressure, provoke controversy. So, tuberculosis, various viruses, herpes, prion pathology, and sometimes even can provoke stupor. In septic conditions, a person can also fall into stupor.
Rheumatological pathology, in the form of all kinds, lupus, due to inflammatory process in the vessels of the brain tissues can also lead to severe precomatose conditions.
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 tissues, often complicated by stupor. Problems that originate from birth 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 lethality, unfortunately. In newborns with severe hypoxia, for example, after asphyxia during childbirth, such a condition is also possible.
Sopor also occurs in certain psychiatric pathologies, for example, in epilepsy. In the case of a severe course of epilepsy and its incorrect treatment, the person does not return to awareness after an attack, but the attack repeats again and again, such a 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 irreversible changes that can provoke a fatal outcome.
Endocrinological pathology always entails metabolic disruptions, which in turn causes problems with brain tissues. Incorrectly docked with or invariably lead to complications. Ketoacidotic coma occurs when there is a lack of insulin, when pathological products of the destruction of fats accumulate in the body. In this case, the coma has several stages. The first of them is just sopor, almost every diabetic at the beginning of the disease fell into such a state. With a decrease in the work of the thyroid gland to a state, stupor may also occur.
Deficiency in the body, especially of 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 the brain tissues and provokes stupor. in the most severe manifestations, it 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 their unfavorable role in the occurrence of sopor. Hypothermia is especially dangerous, if a person is frozen and has not been found for a long time, and then it is also incorrectly warmed up, then the occurrence of stupor is more likely. Sunstroke or thermal, obtained in hot working conditions, can also provoke stupor, especially if a person had the prerequisites for this and a tendency to this condition.
The state of sopor can also be caused by toxic drugs, fumes, alcohol surrogates, many drugs, barbituric hypnotics, narcotic drugs, and anesthetics.
Symptoms and signs of stupor
The state of stupor manifests itself as an insignificant response to external stimuli and, moreover, only to expressive ones. The personality will answer if you ask loudly and many times, otherwise not. The reaction is always passive, but there may be signs of nihilism, especially in the case of an attempt to administer drugs, the person may not extend his arms. Depending on the type of sopor, a person may react differently, with slightly different symptoms. With the hyperkinetic variant, the person makes incoherent speeches that are completely devoid of semantic load. With akinetic, there is complete immobility and the absence of any attempts to change one's position. But still, the sopor is less deep than the 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, along with the corneal ocular and conjunctival reflexes.
Sopor has its own expressive signs in the form of drowsiness with a reaction only to massive stimuli, for example, a sharp sound can make them open their eyes. They are not able to perform any tasks and orders, as well as answer the simplest questions. Since sopor affects the cortex and subcortex of the brain, there is an expressive pyramidal insufficiency which impairs the performance of the organism.
Since stupor develops in the case of a series 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 formidable symptom is streaks of cerebrospinal fluid, cerebral fluid, from the nose and ears. A pungent odor may come from a person, which indicates poisoning with alcohol and its surrogates.
It is very important to look around, because you can find many characteristic things, packages of 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 that tell that he has diabetes or epilepsy. The epileptic has many tongue bites and other scars.
If there is a temperature, a rash, an infection can be suspected, then for confirmation, lumbar puncture in sterile conditions, which will tell a lot of facts. With tuberculosis in the punctate is observed high level protein and low glucose viral infections there is not much protein, but with bacterial ones, especially in advanced cases, there is real pus.
For the correct diagnosis, an electroencephalogram is used, which will help to see all the pathological waves. MRI, CT and X-ray of the brain is an expensive necessity, without which this case it's simply impossible to get by. After all, there will be found lesions, and pathological tissues, and areas of damage and injury, and three-dimensional structures. It makes sense to take a blood test, because it will demonstrate many pathological changes.
Sopor treatment
Treatment of the stupor condition is carried out simultaneously with the pathology due to which it arose. It is important that the person breathes normally, in some cases this requires an intubation procedure. If the oxygen level is too low, use an oxygen mask. In hypoglycemia, glucose is used with insulin to process it, and in hyperglycemia, insulin is used. If there is poisoning, especially with substances that suppress the respiratory center, then the universal antidote, Naloxone 3 ml, is used. In the presence of any injuries in the spine, it becomes necessary to use a rigid collar - a fixator.
If any type of poisoning is suspected, it is important to flush, which will help stop the absorption of toxins into the body. If a person had a significant loss of blood, then it is necessary to compensate for this and normalize pressure. For this, blood transfusion, blood products, Novoseven, Plasma, Reopoliglyukin, Reosorbilact, Physiological solution are used. Thiamine is also added, which contributes to the nutrition of the brain, Piracetam, Cordarone, Magnesia.
If the state of stupor drags on, then it is important to maintain the body of the individual at a decent level. To prevent bedsores - turning over and wiping, as well as massage. To prevent congestion during long-term therapy, antibiotic therapy is added: Carbopenem, Azalide, Flemoklav, Ceftriaxone, Meronem.
In epileptic genesis, anticonvulsants are used: Carbamozepine, Valprokom, 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 trace elements.
Sopor after a stroke it is treated with vascular preparations, and, sometimes, surgically, in the presence of a hematoma. At ischemic causes Streptokinase, Alteplase is used to remove its effects and preserve part of the neurons. It is very important to prevent cerebral edema with Furosemide, Torasemide, Manita, Mannitol, Hypothiazid, Papaverine. For digging, Glutargin 40%, Thiamine, Pyridoxine and other vitamin preparations are used.
Forecast and consequences of sopor
Sopor is an intermediate state between obnubilation and coma, so its outcome depends on the speed of first aid. If a person is not found or they think that this is just a "drunk", as often happens, then a coma, and then death, is inevitable. Well, if an experienced doctor identifies the causes and they turn out to be stopped, then the consequences can be minimized, but nevertheless, these conditions always leave an imprint on the cognitive functions of a person.
If the vital parts of the cerebral cortex have been damaged, then the personality cannot be returned; while maintaining life, it is possible to save the “vegetable”. But with infections and even some injuries, it is possible to save normal life. 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 was diagnosed in Glasgow and identified low level points, then 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 worse prognosis and is more likely to lead to coma.
At proper care using modern means support (nutrition, functional bed, vitamin complexes, exercise therapy, massages), leaving this state, the person will be able to return to a typical life in a relatively short period of time. But at improper care, the consequences can be irreversible: contractures, paresis, infectious complications, nutritional 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 activity and health improvement in sanatoriums are also shown.
Distinguish the following types consciousness: clear, clouded, stupor, stupor, coma, delirium, hallucinations.
In therapeutic clinics, patients are more likely to have clear consciousness. At the same time, the patient is fully oriented in the environment, clearly answers questions.
Darkened (unclear) consciousness manifests itself in the indifferent, indifferent attitude of the patient to his condition; He answers questions correctly, but late.
At stupor (stun) the patient is poorly oriented in the environment, sluggishly, slowly answers questions, sometimes not to the point, and immediately begins to doze off, fall asleep: he falls into a state of stupor.
Sopor- deep stupefaction of consciousness (stupefaction). In this case, the patient is in a state of "hibernation". Only a loud cry, painful effects (pricks, pinches, etc.) can bring him out of this state, but for a very short time; soon he falls asleep again.
Coma (deep sleep)- complete loss of consciousness. The patient does not respond to shouting, painful irritations and inhibitions. In coma, there are no reflexes. Coma indicates a significant severity of the disease. It develops, for example, in severe diabetes mellitus, in renal and liver failure, alcohol poisoning, etc.
In diabetes mellitus, in the event of a metabolic disorder, mainly carbohydrates and fats, due to a lack of insulin in the body, hyperglycemic (diabetic) coma occurs. It develops slowly. It is usually preceded by malaise, loss of appetite, headache, nausea, vomiting. Further, muscle tone decreases, dryness develops skin, their turgor decreases, the face becomes pink, the eyeballs become soft, tendon reflexes partially or completely disappear, noisy breathing (Kussmaul breathing) is noted, a characteristic smell of acetone (fruity) is felt in the exhaled air, the pulse slows down, blood pressure drops.
With adrenal insufficiency, as well as with an overdose of insulin and for a number of other reasons as a result of sharp decline hypoglycemic coma occurs. It starts quickly. Sometimes it is preceded by a feeling of hunger, weakness, sweating. The skin with this disease becomes pale, moist, muscle rigidity, body trembling, convulsive twitches are noted, the pupils dilate.
In connection with severe diffuse damage to the liver as a result of complete insufficiency of its function, hepatic coma develops. In this case, there is a sharp weakness, drowsiness, alternating with periods of excitement. The skin becomes icteric, scratching, "spider veins", hemorrhages are noted on them. Muscle twitches are also observed, a sweetish (liver) smell from the mouth is felt. Breathing is noisy (Kussmaul), pupils are immobile, dilated, arterial pressure is lowered, urine is dark yellow, feces are discolored.
In patients with chronic disease kidneys, accompanied by their pronounced functional insufficiency, a uremic coma occurs. Its initial features are general weakness, headaches, nausea, vomiting (especially in the morning, before meals), general anxiety, insomnia. Then comes the 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, Cheyne-Stokes type breathing, less often Kussmaul type, muscle tone increases, an ammonia smell (urine smell) is felt from the mouth.
For the sick alcoholic coma are characterized by a cyanotic face, dilated pupils, hyperemic sclera of the eyes, shallow, hoarse breathing, the smell of alcohol from the mouth, Cheyne-Stokes type breathing, a small rapid pulse, low blood pressure.
In the case of an anemic coma, "dead" pallor, sticky sweat, deafness of heart sounds, thready pulse, decreased blood pressure blood.
In some diseases (especially infectious ones 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 that described above. Such patients are restless, excited.
In addition, there may be a violation of 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, they have hallucinations.
hallucinations there are auditory, visual, tactile (sensation of crawling over the body of worms, insects, microbes, etc.).
During auditory hallucinations, the patient talks to himself or to an imaginary interlocutor.
At visual hallucinations patients see what is not really there, for example, mice that rush at them, devils, etc. This often happens with alcoholism.
Silent delirium is also characterized by unrealistic ideas, hallucinations, only patients behave outwardly calmly, often in a state of stupor or stupor, mutter something, utter incomprehensible and incoherent phrases.
Sopor is an oppression of consciousness that precedes a coma (subcoma, pre-coma), i.e. prelum state. In a state of sopor, a person is able to respond to loud sounds, a repeatedly repeated question, the pupils weakly, but still react to light, and the body to painful stimuli (pinches, slaps). However, it is possible to get a person out of a stupor with such irritants only for a short time.
Sopor should be distinguished from another medical concept - "stupor". Both are similar in external manifestations, but at the same time, stupor is a pathology of neurological etiology, while stupor is mental. In foreign sources, these concepts are differentiated differently. "Sopor" means "deep sleep", and the oppression of consciousness, on the contrary, is called stupor.
V international classification diseases of the 10th revision (ICD-10) sopor is assigned to subparagraph R40.1.
Causes of subcoma
Soreness can occur for many reasons. Internal causes divided into two groups: neurological and metabolic. External factors can also influence the development of an oppressed consciousness.
Neurological causes include:
- Acute cerebrovascular accident (CVA), including; especially characteristic is falling into a stupor in case of damage upper divisions brain stem as a result of hemorrhagic stroke;
- craniocerebral trauma 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 nervous 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 is why dysfunction of the nervous system and internal organs are growing;
- subarachnoid hemorrhage resulting from a ruptured cerebral aneurysm.
Metabolic factors:
- abnormal blood glucose levels in diabetes;
- self-poisoning of the body with uremia due to the accumulation of protein metabolism products;
- hypothyroidism (lack of hormones thyroid gland);
- a sharp drop in the level of sodium in the blood;
- hepatic and renal insufficiency;
- hypoxia (lack of oxygen), asphyxia (excess of carbon dioxide);
- severe hypertensive crisis;
- severe heart failure;
- blood poisoning (sepsis).
Sopor can be provoked by external factors:
- Overheating of the body (sun or heat stroke);
- hypothermia (hypothermia);
- poisoning with toxins (carbon monoxide, methyl alcohol, a number of medicines, for example, barbiturates).
What is the difference between coma and sopor
Sopor is a state of oppression of consciousness moderate. It may be preceded by more mild form depression of consciousness - stunning.
Coma is a more severe form, in which consciousness is lost altogether. Sopor can develop into a coma. With stupor, reflex reactions are preserved, while with coma they are practically absent. In both cases, the reflexes slow down, but in coma, the degree of slowing down is much greater.
In the soporous state, a person is not able to answer the question, but one can be sure that he hears it to some extent. For example, several times loudly turning to him, get a reaction in the form of opening his eyes. By pinching your hand, you can see by facial expressions that a person in a sopor feels pain. With a coma, all this is completely impossible. Even a weak response to external stimuli does not occur. Breathing in coma also weakens due to respiratory depression.
How long does the constipation last
Depending on the reasons for which it has arisen, the soporous state can last from a few seconds or minutes to several months. Then the person either comes out of it, or plunges even deeper into unconsciousness - into a coma.
How to get a person out of a stupor
It is impossible to stably bring the patient out of a stupor without the help of doctors. He can automatically open his eyes with a sharp pop or scream, but immediately closes them. Later, finally waking up, the patient does not remember anything, because. sopor is most often accompanied by amnesia.
Having noticed signs of oppressed consciousness in a person, you need to immediately call an ambulance team.
Signs of a soporous condition
Sopor resembles a state of deep, sound sleep. The person does not move, his body is relaxed, his eyes are closed. In the patient's brain, inhibition functions predominate. At loud sound, patting his cheeks, he can open his eyes for a few seconds. When pinching or slapping on the hand - pull it back, hit back. Breathing, swallowing, corneal reflex remain normal. With the hyperkinetic form of sopor, there are fragmentary mutterings and movements, 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 such a condition appear. If stupor is caused by a traumatic brain injury, dark blue circles around the eyes may serve as a sign. This points to possible fracture base of the skull.
Diagnostics
When diagnosing, it is important to correctly determine the degree of oppression of the patient's consciousness, i. soporous state with stunning and coma. The measures taken for further treatment will depend on this.
It is necessary to identify a causal relationship of sopor with other diseases or pathological conditions. Treatment will be effective only if the disease that caused the oppression of consciousness is eliminated.
To determine the causes 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 who accompanied him during the onset of sopor. The ambulance team usually examines the room in which the patient is located. Found bottles of alcohol, drug packaging, syringes can lead to conclusions about poisoning the body with alcohol, drugs, medicines due to their overdose. Traces of a fight, blood on things can indicate a traumatic brain injury, an injury from a fall due to a stroke, fainting, and other circumstances. Medical records, certificates that shed light on the presence of existing diseases are being studied.
The patient's body is examined to detect a skin rash, bruising, hemorrhage, injection marks, and the smell of alcohol. The patient's body temperature, blood pressure, blood glucose levels are measured. Auscultation (listening) of the heart, ECG. Blood is taken for general and biochemical analyzes. An MRI or CT scan of the brain, urine screening and a blood test 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.
Sopor treatment
Sopor treatment should begin as soon as possible. The patient must be taken to the intensive care unit of the hospital. It should be under the round-the-clock control of medical workers, under the control of the equipment.
The choice of treatment method depends entirely on the cause that caused the oppression of consciousness. Sopor is not a separate disease. This is just one of the symptoms in the clinical picture of a stroke, intoxication with poisons, 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, drugs such as furosemide, enticing, torasemide, papaverine and some others are used for this. The choice of drug is up to the doctor.
If the treatment is not approached correctly, the cells of the brain tissue will die, which will lead to even more disastrous consequences. In order to prevent this from happening, it is necessary to ensure good blood supply to the brain, to prevent swelling of the tissues. Depending on the cause of stupor, doctors treat hepatic or kidney failure, restore the rhythm of the heart, correct the level of sugar in the blood, stop bleeding (according to the situation). Medical measures supplemented by the introduction of trace elements missing in the body. If stupor appeared on the background of an infectious disease, they are prescribed 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. With bleeding with significant blood loss, a blood infusion is given. Blood products, saline, plasma may also be administered. To improve the nutrition of brain cells, the doctor may prescribe thiamine, piracetam, cordarone, magnesium preparations.
In cases where stupor was preceded by epileptic seizures, prescribed anticonvulsants: sibazon, carbamozepine, seduxen, valprok, relanium. After a stroke, vascular preparations are used in therapy. If a brain hematoma has formed, it may be necessary to emergency operation. 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, sopor can stretch for months.
With prolonged sopor, the patient will need special care. In order not to form bedsores, a person needs to be turned over, wiped with water, massaged muscles. In addition, it will have to be spoon-fed. If this is not possible, feeding will have to be carried out through a tube.
Forecast and consequences
The prognosis for a person falling into a state of stupor is very ambiguous. An important role is played by the reasons for which it arose, the degree of oppression of consciousness. It is also important how quickly treatment is started.
If the processes have affected vital areas of the cerebral cortex, the patient may completely lose personal qualities. while maintaining vital functions a person can get out of the sopor as a disabled person. Such a person will require life maintenance and care. He can no longer take care of himself.
Doctors use the Glasgow Scale to predict. If a low level of points is determined by it, then most likely it will not be possible to return a person to his former life.
With a slight degree of depression of consciousness and proper treatment a speedy recovery is possible. However, being in a pre-coma state leaves a mark on the cognitive abilities of the brain anyway. To minimize the risks of recurrence and the development of new diseases, a person who has had sopor needs to urgently reconsider his lifestyle. You need to set yourself up for a healthy life, eliminate any bad habits.
A full-fledged human consciousness is manifested by wakefulness and the absolute realization 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, a violation of the correct brain activity is possible. Sopor is one of the options for the oppression of consciousness, in which the reflex activity of the human body is preserved, but its ability to cause behavioral reactions is sharply reduced. More details about the features of the condition, the principles of diagnosis and treatment are described later in the article.
There are several degrees of impaired consciousness, among which stupor (subcoma, stupor) occupies an intermediate place:
- Stunning - 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 disturbances. Stunning can be manifested by delusions, hallucinations, frequent heartbeat and an increase in blood pressure.
- Coma is a complete absence of consciousness, which, depending on the manifestations, is divided into several degrees of severity.
- Moderate coma - some reflex reactions and pupillary response to light stimuli are preserved, a number of deep reflexes are normal.
- Coma of a deep degree - the absence of reflexes, severe hypotension, breathing, as well as the work of the heart and blood vessels are sharply impaired.
- A coma of an extreme degree is manifested by dilated pupils, lack of reactions to irritations, and a sharp violation of all vital functions.
The state of coma is assessed on a specific scale (Glasgow), in which each of the reactions has a certain digital designation. Qualified specialists assess the opening of the eyes (from 1 to 4 points), the motor response to irritation (from 1 to 6 points) and the speech of a sick person (from 1 to 4 points).
Important! The highest score is assigned to an adequate response, the lowest - to its absence. The state of coma 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 a state of stupor occurs. They are divided into several large groups, since they have a different development mechanism.
Neurological disorders
This group includes such diseases and pathologies:
- violation of cerebral circulation of an ischemic or hemorrhagic nature - appears due to changes in the work of the upper parts of the brain stem;
- traumatic injuries, accompanied by the formation of a hematoma, hemorrhage, destruction of nerve tissues;
- tumor processes;
- the formation of a brain abscess;
- pathological accumulation of fluid;
- severe course of epilepsy with the appearance of epistatus.
Changes from metabolic processes
Another group of reasons that provoke the occurrence of stupor in humans. Its representatives are diabetes, hypofunction of the thyroid gland, insufficiency of the liver and kidneys. An important reason is uremia. It is characterized by accumulation in the bloodstream a large number 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 insufficiency and stagnant processes.
Sopor on the background of a stroke
The main reason for the development of a soporous state in stroke is a violation of the work of cerebral vessels. Pathology can have varying degrees of damage to the brain functions of a sick person up to the necrosis of brain cells.
Unfortunately, sopor can develop not only during acute manifestations, but also during rehabilitation measures. Ignoring pathological condition leads to the transition of the stupor into a coma.
The most severe form is observed with a hemorrhagic stroke, which is manifested by the presence of a 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 the consciousness of a person is not so disturbed, more often it does not reach the sopor. The main manifestation is stun.
Other reasons
Sopor can occur against the background of the following diseases and pathologies:
- severe degree of hypertensive crisis;
- significant hypothermia or, conversely, aggressive exposure to direct sunlight;
- influence of toxic and poisonous substances;
- reproduction in the blood of pathological microorganisms.
Infectious diseases are dangerous because they can provoke the formation of abscesses in the brain tissues. 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 violations from 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.
- There are uncontrolled movements, constant muttering (not always, it occurs in some clinical cases).
- Possible seizures, tension muscular apparatus neck.
- Change in the sensitivity of the skin, paralysis of the upper and lower extremities, the occurrence of weakness of certain muscle groups - in the event that the violations affected the pyramidal system.
An important symptom of the development of sopor is pathological drowsiness. When examining a sick person, it seems that he is sleeping, cannot answer the questions posed. Only a loud or painful stimulus can make him open his eyes or make any movement. In this case, the patient opens his eyes, swears, mutters something, tries to move aside the place that is exposed to the stimulus. 
In parallel with the symptoms of depression of consciousness, there are signs of a disease that provoked a change in brain reactions. Associated symptoms may be:
- bruising around the eyes;
- discharge of blood or cerebrospinal fluid from the ears;
- the presence of a sharp pathological odor from the patient (for example, with 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 the indicators of blood pressure, pulse rate, checking reflexes, muscle tone and response to painful stimuli. The presence of the following points is specified:
- mechanical damage;
- hemorrhages;
- the presence of the smell of alcohol;
- rashes;
- injection marks.
Specialists study medical documentation the patient, examine his personal belongings, ask relatives if the patient has any diseases that could provoke the development of the condition (for example, epilepsy, diabetes mellitus, liver or kidney pathology). 
Examine the patient's blood and urine, assess the level of sugar in the blood, conduct a toxicological study, electroencephalography, CT and MRI of the brain. Assess the work of the heart by auscultation and ECG. If the doctor suspects the development infectious process, carry out bacteriological culture of blood and cerebrospinal fluid.
Sopor treatment
The principles of therapy include not only the stationary stage of treatment of the condition, but also the provision of first aid. If the development of sopor has occurred in the conditions of the home, work or other place, the following measures should be taken:
- Call a team of qualified specialists.
- Lay the patient on his side, control the position of the tongue.
- measure vitally important indicators(blood pressure, pulse, respiratory rate).
- Assess condition eyeballs, their response to light stimuli.
- If possible, thiamine and glucose solution should be injected into the vein.
Important! Activities should be carried out before the arrival of a qualified ambulance.
Further assistance is provided to the patient in the conditions of the intensive care unit and intensive care. The first step is oxygen therapy. At mechanical damage the neck area is fixed with special splints, collars. Doctors monitor changes in blood pressure, heart rate, respiration, changes in blood oxygen saturation, and fluid 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, treatment of the main cause of the brain disease is prescribed, antibiotics, decongestant therapy are used, and detoxification measures are taken. 
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 bedsores. It is necessary to change the position of the patient's body on the couch every few hours.
Deep pathology of the brain requires feeding the patient through a tube or through parenteral administration of nutrient mixtures.
Forecast and consequences
As a rule, the outcome of the pathological state of the brain depends on the speed of rendering assistance to a person. Most people who abuse alcohol end up dead because they have an antisocial lifestyle and do not seek help.
The level of change in brain function is assessed on 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 losing 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 leading healthy lifestyle life, refraining from alcohol abuse and drug use, regular medical examinations, annual health improvement.
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