Definitions

Clinical Patterns of Brain Dysfunction

• Akinetic Mutism
• Brain Death (see Brain Death, [[Brain Death]])
• Coma (see Obtundation-Coma, [[Obtundation-Coma]])
• Dementia (see Dementia, [[Dementia]])
• Locked-In Syndrome (see Locked-In Syndrome, [[Locked-In Syndrome]])
• Persistent Vegetative State: term was first used in 1972
• Minimally Conscious State

Etiology

Structural

• Brain Arteriovenous Malformation (AVM) (see Brain Arteriovenous Malformation, [[Brain Arteriovenous Malformation]])
• Brain Tumor
  • Glioblastoma Multiforme (GBM) (see Glioblastoma Multiforme, [[Glioblastoma Multiforme]])
  • Meningioma (see Meningioma, [[Meningioma]])
• Intracerebral Hemorrhage (Hemorrhagic Cerebrovascular Accident) (see Intracerebral Hemorrhage, [[Intracerebral Hemorrhage]])
• Ischemic Cerebrovascular Accident (CVA) (see Ischemic Cerebrovascular Accident, [[Ischemic Cerebrovascular Accident]])
• Sarcoidosis (see Sarcoidosis, [[Sarcoidosis]])
• Subarachnoid Hemorrhage (SAH) (see Subarachnoid Hemorrhage, [[Subarachnoid Hemorrhage]])
• Subdural Hematoma (SDH) (see Subdural Hematoma, [[Subdural Hematoma]])

Infection

• Encephalitis (see Encephalitis, [[Encephalitis]])
• Malaria (see Malaria, [[Malaria]])
• Meningitis (see Meningitis, [[Meningitis]])
• Rhino-Orbital-Cerebral Mucormycosis (see Mucormycosis, [[Mucormycosis]])
• Sepsis (see Sepsis, [[Sepsis]])
• Staphylococcal Toxic Shock Syndrome (see Staphylococcal Toxic Shock Syndrome, [[Staphylococcal Toxic Shock Syndrome]])
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Metabolic

• Central Pontine Myelinolysis (CPM) (see Central Pontine Myelinolysis, [[Central Pontine Myelinolysis]])
• Hypercalcemia (see Hypercalcemia, [[Hypercalcemia]])
• Hyperosmolar Hyperglycemic State (HHS) (see Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State, [[Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State]]): coma occurs in <20% of cases
• Hypoxemia (see Hypoxemia, [[Hypoxemia]])
• Lactic Acidosis (see Lactic Acidosis, [[Lactic Acidosis]])
• Rapid Change in pCO2 During Mechanical Ventilation
  • Epidemiology: this may particularly occur during the initial mechanical ventilation of a patient with chronic hypercapnia (chronic hypoventilation)
  • Mechanism: rapid shift in arterial pCO2 is almost immediately transmitted throughout the total body water (including the intracellular fluid compartment, the brain, and the cerebrospinal fluid), resulting in potential neurologic injury (it is likely that the rapid change in pCO2 is responsible rather than the alkalosis itself)
  • Clinical
    • Obtundation/Coma (see Obtundation-Coma, [[Obtundation-Coma]])
    • Seizures
  • Prevention: maintain pCO2 near patient’s baseline (or gradually decrease the pCO2)
• Metabolic Alkalosis (see Metabolic Alkalosis, [[Metabolic Alkalosis]]): with severe metabolic alkalosis
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Drug/Toxin

• Azacitidine (5-Azacytidine, Vidaza) (see Azacitidine, [[Azacitidine]])
• Beta Blocker Intoxication (see β-Adrenergic Receptor Antagonists, [[β-Adrenergic Receptor Antagonists]])
• Carbidopa-Levodopa (Sinemet) (see Carbidopa-Levodopa, [[Carbidopa-Levodopa]])
• Cefepime (Maxipime) (see Cefepime, [[Cefepime]])
• Digoxin Intoxication (see Digoxin, [[Digoxin]])
• Hydrogen Sulfide Gas Inhalation (see Hydrogen Sulfide Gas, [[Hydrogen Sulfide Gas]])
• Methamphetamine Intoxication (see Methamphetamine, [[Methamphetamine]])
• Methemoglobinemia (see Methemoglobinemia, [[Methemoglobinemia]])
• Metoclopramide (Reglan) (see Metoclopramide, [[Metoclopramide]])
• Nerium Oleander Intoxication (see Nerium Oleander, [[Nerium Oleander]])
• Serotonin Syndrome (see Serotonin Syndrome, [[Serotonin Syndrome]])
• Tricyclic Antidepressant Intoxication (see Tricyclic Antidepressants, [[Tricyclic Antidepressants]])
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Other

• Leukostasis (see Leukostasis, [[Leukostasis]])
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References

• CNS Disorder During Mechanical Ventilation in Chronic Pulmonary Disease. JAMA. 1964;189:993 [MEDLINE]