LOSS OF CONCIOUSNESS

LOSS OF CONCIOUSNESS

Definitions:
Awareness:
Better awareness of self and environment capable berintraksi with.
Arousal:
Ability to intraksi with the surrounding environment and the full wake conditions.
awareness:
The ability to accept and understand the contents of the stimulus
Increases Arousal:
Very restless and unable to maintain a focus on relevant stimuli.
Decreased Arousal:
Required a strong and constant stimulation that the patient can maintain attention

Anatomy

Arousal

ARAS

Awareness
cerebral hemispheres with projections of:
brainstem - the hypothalamus - thalamus - cerebral hemispheres

3 Important Areas Of Awareness:
• The reticular formation (upper mesensefalon)
• bilateral diencephalon (Thalamus)
• bilateral cerebral hemispheres
When the lesions found in one area in neuroanatomical structures Conciousness above, either focal or diffuse, there will be disturbance of consciousness

Level Of Consciousness -
Glasgow Coma Scale (GCS)

Poin	Eyes	Verbal	Motorik
6	-	-	Following orders
5	-	good orientation	Able to localize the pain
4	Open eyes spontaneously	Can make a sentence, but found disorientasi	Avoidance of pain stimuli
3	Open eyes to the sound stimuli	Could make the words, but do not form sentences	Flexion (decorticate)
2	Open eyes to the pain stimuli	Only the sound (moaning)	Extensions (decerebrate)
1	No response	No response	No response

Delirium (DSM IV)
• Disturbance of consciousness (reduced awareness of the environment), accompanied by a decreased ability to maintain focus or divert attention
• Change in cognition (memory deficit, disorientation, language disturbance) or perceptual disorder
• Disturbance occurs within a short period of time (usually hours to days) and tends to fluctuate during the course of the disease

Somnolence (Obtundation)
• In this condition, the patient has decreased level of alertness mild to moderate and decreased interest in the surrounding environment.
• Often found as one of the stages of sleep.
• Patients still have avoidance reaction to pain stimulus

Stupor
• Decreased levels of alertness.
• It takes a very strong stimulus to be able to wake the patient in this condition

Coma
There are some characteristics in these conditions, among which are:
• decreased level of alertness,
• eyes closed,
• there is no any response to pain stimuli,
• sometimes accompanied by extension or flexion posture at both extremities

Persistent Vegetative State
• These conditions often arise post-coma.
• Patients in a state of arousal but not aware.
• Unable to understand any sensory stimulus, although the eye is open

Differential Diagnosis
• Akinetik mutism
   - Patients in a state of alert. But it can not recognize anything.  
     There were no spontaneous motor activity

• Locked-in syndrome
- Tetraparese with lower cranial nerve paralysis.
- There is no disturbance of consciousness.
- Patients can still communicate using eye movements.
- Caused by the presence of extensive lesions in the pontine area 
   that is not on the ARAS