The brainstem exam is done to then determine if brain death is present. An artificial coma is quite different. [Locked-in syndrome: pseudocoma from pons sections]. [Alpha coma, pseudoalpha coma and alpha pseudocoma--differential diagnosis of so-called alpha coma]. Check finger-stick glucose and rapidly administer: . In his book ‘Time of Awakening’, the neurologist Oliver Sacks describes how he was able to wake up patients for a short time from the waking coma. Her clinical neurological findings and the brain CT scan showed no organic abnormalities. I have read and accept the terms and conditions, View permissions information for this article.

The International Journal of Psychiatry in Medicine, A Clinically Oriented Perspective on Psychogenic Nonepileptic Seizure-Related Emergencies, Dissociative disorders causing unconsciousness and collapse during oral surgery treatment, [A case of delayed awakening from general anesthesia caused by psychological unresponsiveness], Repeated episodes of difficulty with arousal following general anesthesia in a patient with ulnar neuropathy, An unusual case of hysterical postoperative coma, FACTITIOUS DISORDER AS A CAUSE OF FAILURE TO AWAKEN AFTER GENERAL-ANESTHESIA, Diagnostic and Statistical Manual of Mental Disorders: DSM-V, A diagnostic sign in states of apparent unconsciousness, Hysteria. in a water restriction test) consistent with diabetes insipidus or SIADH, leading to misdiagnosis. If both components are used, 1 speaks of analgosedation. Sign up to get access to 250+ video lectures for free! We present a clinical case and review the literature on psychogenic coma. A number below 8 points indicates a severe brain disorder that makes intubation necessary. Join ResearchGate to find the people and research you need to help your work. We present a clinical case and review the literature on psychogenic coma.

The use of repeated painful stimuli is therefore not recommended. Results of neurologic examinations were normal, as were laboratory tests and radiologie studies. In treatment-resistant polydipsic psychiatric patients, regulation in the inpatient setting can be accomplished by use of a weight-water protocol. Behavioural changes, including fluid-seeking behaviour; patients have been known to seek fluids from any available source, such as toilets and shower rooms.

We hereby present three cases, who presented with mutism as the presenting symptom and the differential diagnosis and management issues related to these cases are discussed. You can be signed in via any or all of the methods shown below at the same time. [16] It should also be ensured that the thirst isn't caused by diuretic use (particularly thiazide diuretics), MDMA use, excessive solute intake or chronic alcoholism.

chotics to assist the patient’s return to full consciousness.
This article presents an overview of the pathophysiology, causes, examination, and treatment of coma.
In diagnosis, primary polydipsia is usually categorised as: The terms primary polydipsia and psychogenic polydipsia are sometimes incorrectly used interchangeably – to be considered psychogenic, the patient needs to have some other psychiatric symptoms, such as delusions involving fluid intake or other unusual behaviours. All rights reserved. We presented a case of dissociative disorder that was revealed by the conditions found during the dental treatment. Semantic Scholar is a free, AI-powered research tool for scientific literature, based at the Allen Institute for AI. Herein we describe a 49year-old woman with a history of depression, for which she was receiving treatment, who did not awaken promptly after use of general anesthesia for ethmoidectomy. Some features of the site may not work correctly. Yudofsky, SC, Hales, RE, editors. The pressure on the fingernail is a common method and can suffice for a coma assessment: The use of the Glasgow coma scale, which was already developed in the 1970s, continues to be established in the clinical world. Behavioural treatments may involve the use of a token economy to provide positive reinforcement to desirable behaviour. We … All impairments of the vital functions are possible. [medical citation needed] However, a preference for ice-cold water is also seen in diabetes insipidus. HYPOnatremia: HYPERnatremia: A 17-year-old schizophrenic patient presents with new onset of seizures. Coma mimics can present with a picture that is similar to coma however the patient will not be in a ‘real’ coma. [12] Diagnosis may be complicated by the fact that chronic and extreme compulsive drinking may impair the response of the kidneys to vasopressin, thus reducing the kidney's ability to concentrate the urine. Medication, intracranial hemorrhage, infarction, infection, hypoxia, organ failure, and nutritional deficiency may cause unconsciousness following successful emergence from anesthesia. The 1st step to take when one encounters a coma patient is, therefore—always—to secure and keep the airways patent as well as to control the circulation. The neurology diagnosis was “psychogenic. Access to society journal content varies across our titles. [9] Some patients, most often with a history of mental illness, show a shrunken cortex and enlarged ventricles on an MRI scan, which makes differentiation between psychogenic and physiological cause difficult. Most cases prove to be due to primary psychiatric disorders, mostly mood disorders, especially mania, rather than schizophrenia. Drug intoxications are a leading cause of coma; however, other metabolic disturbances and traumatic brain injury are also common causes. The most common presenting symptom is tonic-clonic seizure, found in 80% of patients. [22] Diagnostic tests for primary polydipsia usually involves the fluid deprivation test to exclude ADH problems.

After a period of apparently incomplete apathy, the patients were beginning to feel joy and ideas. Under local anesthesia the implant was removed with monitoring the general condition. Prominent research in patients with disorders of consciousness investigated the electrophysiological correlates of auditory deviance detection as a marker of consciousness recovery. abstract = "Failure of a patient to awaken promptly after use of general anesthesia may be due to various causes, including medication-related effects, neurologic insults, or metabolic disturbances. [25][26], Treatment for psychogenic polydipsia depends on severity and may involve behavioural and pharmacological modalities. Lean Library can solve it. problem in our country, where the situation is not differ from the world status. Berg AT, Berkovic SF, Brodie MJ et al. An adapted psychiatric care allowed the patient to recover his autonomy after three days of hospitalization. Deviation of the eyes towards the ground with the patient lying on each side is proposed as a diagnostic sign in psychogenically mediated states resembling coma or epilepsy. Where no underlying medical condition is found…, Physicians may encounter patients with a collection of psychologic disorders that present with neurologic symptoms or signs, yet…, We treated a case of iatrogenic hypermagnesemia that clinically mimicked a central brain-stem herniation syndrome…, A síndrome do encarceramento se caracteriza basicamente por tetraplegia, anartria e preservação do nível de consciência, além de…, International journal of oral and maxillofacial…, International journal of psychiatry in medicine, Psychiatrie, Neurologie und medizinische…, By clicking accept or continuing to use the site, you agree to the terms outlined in our, Psoriasis as the single risk factor for “Locked-in syndrome” after ischemic stroke in a young patient: case report and literature review. of Otolaryngology and Head and Neck Surgery. Single‐day sensory discrimination was unrelated to patients’ outcome in both modalities. Sindrome do encarceramento. McGraw-Hill Education; 2015. In a coma, if CN III/IV/VI/VIII pathways are intact, the eyes tonically deviate toward the cold stimulus with no fast phase. © 2008-2020 ResearchGate GmbH. Daily medical practice, however, demands immediate information with measurable and easily comparable numerical values. Can make a thumbs up, peace, or fist ‘responds to the command’, Open spontaneously but does not track your fingers ‘does not respond to the command’, Infection including meningitis and encephalitis, The danger of infection, e.g., lung infection, Say/yell the patient’s name (verbal stimulation), Press on patient’s nail beds (peripheral painful stimulation), Sternal rub/nasal swab (central painful stimulation). Presenting syndromes can include pseudoparalysis, pseudosensory syndromes, pseudoseizures, pseudocoma, psychogenic movement disorders and pseudoneuro-ophthalmologic syndromes. EM guidemaps—Coma. Failure of a patient to awaken promptly after use of general anesthesia may be due to various causes, including medication-related effects, neurologic insults, or metabolic disturbances. In psychiatry, this disorder is currently part of the "dissociative disorder not otherwise specified". USMLE Step 3 Neurology. Read more about the editorial team, authors, and our work processes. with the terms: somnolent, soporous and comatose, the GCS numerically marks the depth of the disturbances of consciousness, which, recorded in a graph, indicate the fluctuations of consciousness. Pseudoneurologic syndromes: recognition and diagnosis. If the causes are not obvious, one should think of injuries or diseases of the brain and consider poisoning or metabolic disorders. Login failed. Education of family and other professionals that symptoms are real and not consciously feigned may be important. The recognition of etiology and clinical characteristics of delirium in pediatric age will help for early diagnosis and for adequate treatment, so that not to evolve to coma and in this way will contribute to reduce the mortality rate. STUDY. Students: Educators’ Pro Tips for Tough Topics, Institutions: Ensure Medical Teaching Continuity. They also risk being placed on medications that are harmful to the fetus.

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