Coma And Impaired Conscious Level

CAUSES

INTRACRANIAL Trauma

Diffuse white matter injury Hatmatoma - extradural

- subdural

Neoplastic

Tumour with oedema

Other

Epilepsy Hydrocephalus

EXTRACRANIAL Metabolic

Hypo/hypernatraemia Hypo/hyperkalaemia Hypo/hyper cal caemia Hypo/hyperglycaemia Diabetic ketoacidosis Lactic acidosis Hypo/hyperthermia Uraemia Hepatic failure Porphyria

Hypercapnia -Hypoxia

Arterial occlusion

Vertebral artery disease Bilateral carotid disease

Drugs

Sedatives Opiates

Antidepressants Anticonvulsants Anaesthetic agents

Toxins

Alcohol

Carbon monoxide Heavy metals

Reduced cerebral blood flow

Vascular

Subarachnoid haemorrhage 'Spontaneous' intracerebral haematoma Cerebral infarct with oedema and 'shift' Brain stem infarction or haemorrhage

Infective

Meningitis

Abscess Encephalitis

Endocrine

Diabetes Hypopituitarism

Adrenal crisis (Addison's disease)

Hypo/hyperparathyroidism

Hypothyroidism

Respiratory insufficiency

Hypoventilation Diffusion deficiency Perfusion deficiency Anaemia

Decreased cardiac output

Vasovagal attack Blood loss Valvular disease Myocardial infarction Cardiac arrhythmias Hypotensive drugs

Psychiatric disorders

Hysteria

Catatonia (mutism with decreased motor activity)

Fugue states

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