Impaired consciousness

Impaired consciousness ranging from lethargy to coma... 

Phenotype determined by cortical region activated (e.g. if motor cortex representing left thumb is activated, then left thumb jerking results). Consciousness is preserved Impaired consciousness lasting seconds to minutes, often associated with automatisms such as lip smacking Simple or partial complex seizure evolves into a tonic-clonic seizure with loss of consciousness. There are sustained muscular contractions (tonic) followed by periods of relaxation (clonic) lasting 1-2 min... 

Impaired consciousness at onset-with or without automatisms... 

Impaired consciousness (e.g., ranging from obtunded to markedly lethargic and somnolent)... 

Dementia may be hard to differ from delirium (Table 6.1). The most important tool is a thorough medical history. Dementia has a slow progress whereas delirium is characterised by a rapid change in cognitive functions. Depression and anxiety could be mistaken for delirium, but the impaired consciousness in delirium sets it apart from affective disorders. 

Young GB. (1998). Consciousness, in Coma and Impaired Consciousness A Clinical Perspective. Young GB, Ropper AH, Bolton CF, eds. New York McGraw-Hill. 

Oral ingestion of 3 ml caused coma or impaired consciousness in eight adult patients mistakenly administered tetrachlorethane. Dermal absorption has been suspected in some poisoning cases. Skin exposure may also produce dermatitis due to defatting action in rare cases, the dermatitis may be caused by hypersensitivity to the substance. ... 

A series of tranquilizers, drugs that relieve anxiety and nervous tension without impairing consciousness, have a benzene ring fused to a seven-membered ring containing two nitrogens. As a group they are called benzodiazepines. The two most successful are diazepam (Valium ) and chlordiazepoxide (Librium ) introduced in 1964 and 1960, respectively. Flurazepam (Dalmane ), first used in 1970, is a hypnotic. 

Encephalopathy Encephalopathy has been described in postmarketing reports and in the literature. Manifestations include impaired consciousness, convulsions, visual disturbances (including blindness), loss of motor function, movement disorders, and psychiatric disturbances. 

Table 2. A prehminary evaluation of the relationship between dopaminergic function and impaired consciousness in dementia with Lewy bodies.

Impaired consciousness is rated according to the Clinician Assessment of Fluctuation Values are fmol/mg tissue, specific binding, mean standard deviation, in autopsy brain Ba - Brodmann areas... 

Coarse tremor Marked GI upset Impaired consciousness Epileptic seizures... 

Biochemical changes such as increased aminolaevulinate excretion and inhibition of amino-laevulinate dehydrase may be detected in urine and blood, respectively, at blood lead levels of 0.4 to 0.6 mg mL-1. Anemia is a late feature, however. Neurotoxicity may be detectable at blood lead levels of 0.8 to 1.0 mg mL-1. At blood lead levels greater than 1.2 mg mL-1, encephalopathy occurs. Peripheral nerve palsies are rare, and the foot and wrist drop, which were once characteristic of occupational lead poisoning, only occur after excessive exposure and are now rarely seen. Similarly, seizures and impaired consciousness may result from involvement of the CNS. Bone changes are usually seen in children and are detected as bands at the growing ends of the bones and a change in bone shape. 

Two patients with diabetes mellitus developed lithium toxicity (serum concentrations 3.3 and 3.0 mmol/1) in association with impaired consciousness, and hyperglycemia that resolved after intravenous insulin and fluids (683). 

Most criminal offenses involve a deliberate decision to perform an act that is proscribed by the criminal law. The criminal law requires the state to prove that the defendant committed a guilty act (actus reus), while simultaneously manifesting the necessary mental state (mens rea, or guilty mind) that is specified for that crime. Consider a case in which a person hammers to death a family member and then claims to have been asleep at the time of the attack. Because a guilty act must be voluntary, a question of fact arises concerning the person s consciousness and the effect that impaired consciousness, or indeed unconsciousness, has on voluntariness (4). In addition, consciousness bears on the guilty state of mind and is therefore relevant to the mens rea inquiry. 

Strupp et al. 2003), often associated with nausea and vomiting (Thron et al. 1986). But the spectrum of symptoms and signs varies between an asymptomatic course and rapidly progressive neurological deficits and impaired consciousness. 

Impaired consciousness and coma may develop with increasing intracranial pressure. 

A decrease in mental status, drowsiness, progressive confusion and impaired consciousness may also be the major symptoms of deep cerebral venous... 

The clinical signs of meningitis include the classical triad of fever, stiff neck and impaired consciousness found together in around 44% of cases (van de Beek et ah, 2006). Over 90% of patients with community-acquired bacterial meningitis present with at least two of four symptoms ... 

Reports of overdose with maprotiline relate to doses of 750-3200 mg (21,22). The symptoms included impaired consciousness, convulsions, confusion, disorientation, visual hallucinations, and electrocardiographic changes similar to those seen with tricyclic compounds. Among 41 patients who had taken overdoses of maprotiline car-diotoxicity was equal to or greater than that of tricyclic drugs (23). Mania occurred in one case of maprotiline overdose (SEDA-17, 22). 

Early signs of intoxication include ataxia, dysarthria, coarse tremor, weakness, and drowsiness. More advanced toxicity can involve progressively impaired consciousness, neuromuscular irritability (myoclonic jerks), seizures, cardiac dysrhythmias, and renal insufficiency. A reversible Creutzfeldt-Jakob-like syndrome has been described (162). The severity of intoxication depends on both the extent and duration of exposure to raised lithium concentrations, as well as idiosyncratic factors. 

A 15-year-old woman developed impaired consciousness and psychomotor agitation and 10 minutes later reactive bilateral mydriasis and decerebration. A CT scan showed diffuse brain edema and subarachnoid hemorrhage. She had hyponatremia (119 mmol/1) and was considered brain dead 32 hours later. 

An 18-year-old woman developed impaired consciousness, psychomotor shaking, hallucinations, tics, and delirium. Her serum sodium concentration was low at 120 mmol/1 with a plasma osmolality of 242 mosm/kg and a urine osmolality of 562 mosm/kg, suggesting SIADH. Most other blood tests were within the reference ranges, except for a raised creatine kinase. Urine toxic screen was positive for amphetamines. Treatment with hypertonic saline brought about resolution of symptoms. The patient recalled taking three ecstasy tablets over 6 hours. 

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