(disturbed level of conscious)
Signs of lateralization:
deviation of the angle of the mouth.
Deviation of the tongue.
.Weakness on one side with withdrawal on painful stimulus
Change in the tone on one side.
Babiniski (extensor planter response)
Causes: A-With lateralizing signs: ( need CT
1CVS (stroke): cerebral hge or infarction( thrombus or
B-Without lateralizing signs: (mostly metabolic causes
Chronic liver ds (LCF) >>>if he came with lateralizing signs, do CT
Chr. renal failure
Severe electrolyte disturbance
CNS infection e.g. encephalitis or meningitis
Other causes of DLC:
Drugs & toxins
Space occupying lesion e.g. abscess or brain tumor
N.B.: Hypoglycemic coma & coma due to HTN encephalopathy are not essentially associated with lateralizing signs.
of DM ( hemotest, urine for sugar & acetone
Of alcohol intake
Of drug abuse >>>> Antidote
Of any systemic ds
BP >>>>> HTN encephalopathy
Temp. >>>>> fever for e.g. meningitis, encephalitis, chest infection
RR >>>>> resp. distress due to RF e.g. COPD
Examine for signs of lateralization
ABG , ECG , X- ray chest , CT brain
Cerebrovascular stroke (CVS)
The hallmark is abrupt onset of symptoms & neurological deficits
e.g. weakness, deviation of angle of mouth, tongue, convulsions, incontinence, coma
Ask rapidly about DM, HTN, old age, smoking, heart ds.
valve replacement, collagen ds >> vasculitis, obesity
VD: BP, pulse,
if DM >>> hemotest, urine for sugar & acetone.
, CXR, ECG.
PT, PTT if AF or recurrent stroke.
Ryle for feeding if chocking.
Value of CT scan white>>> hge, black>>> infarction)
It demonstrates: - Cerebral hge (from the 1st moment): consult
- Cerebral infarction: if free follow up CT should be done
- Space occupying lesion >>> CT with contrast, MRI: consult
- Brain edema>>> sulci & gyri are not clear
TTT of stroke:
ttt of risk factors:
HTN >>> BP should be reduced gradually (not more than 140/90 to maintain cerebral perfusion), DM, Ht ds, hyperlipidemia...
Brain dehydrating measures
To treat brain edema around area of hge or infarction.
Mannitol followed by lasix
If # as in renal failure or ht failure >>> give Decadron or Glycerin
Pt on Mannitol should follow serum creatinine
Nootropil ( neuroprotective) 2amp /6hr
Care of comatosed pt
Frequent change of position in bed.
Ryle for feeding.
Regularly check: urine output, DVT, Bed sores, auscultate chest…
Anticoagulants in case of infarction:
: - Valve replacement
- Dilated cardiomyopathy
- Stroke in evolution
- Post circulation stroke
- Recurrent stroke
: - Recent surgery
- Malignant HTN
- Bl. Tendency
- Inf. endocarditis except if the pt with valve replacement.
Heparin 5000IU IV/ 4hr >>>follow up with PT
Antiplatlet (Aspocid) (Trental) in case of infarction
Epanotin is given in case of IC hge to inhibit fits especially in lesions near cortex.