TAILIEUCHUNG - COMMON NEUROLOGIC EMERGENCIES

Coma may be anticipated as an integral component of the terminal event of all fatal human illnesses. However, coma, which represents failure of the brain’s alerting system, may be completely reversible. The earlier the process inciting the comatose state is treated, the greater the likelihood of a more rapid complete recovery. The differential diagnoses of the causes of coma are numerous and varied. | COMMON NEUROLOGIC EMERGENCIES Sidney Starkman MD Professor of Emergency Medicine and Neurology UCLA School of Medicine Emergency Medical Center Los Angeles CA Grant C. Fowler MD Department of Family Practice and Community Medicine University of Texas Health Science Center at Houston Houston TX 265 This chapter will address common neurologic emergencies coma stroke and status epilepticus. These are time sensitive situations in which effective therapy may lessen or completely reverse a potentially catastrophic insult to the central nervous system. Coma may be anticipated as an integral component of the terminal event of all fatal human illnesses. However coma which represents failure of the brain s alerting system may be completely reversible. The earlier the process inciting the comatose state is treated the greater the likelihood of a more rapid complete recovery. The differential diagnoses of the causes of coma are numerous and varied. While proceeding towards the correct diagnosis with a directed history physical examination and prioritized laboratory investigations therapies that may be antidotes to the cause of the coma are administered. A systematic approach is described which ensures reaching the definitive diagnosis promptly. Ischemic stroke the most common form of stroke has one therapeutic intervention which increases the likelihood of a complete or near-complete recovery without increasing morbidity or mortality. The thrombolytic agent tissue plasminogen activator tPA must be administered within 3 hours of stroke onset the sooner after stroke onset tPA is given the greater its therapeutic efficacy. However tPA administration is associated with a definite risk. Thus the selection of eligible patients requires an extremely rapid response system and strict adherence to inclusion and exclusion criteria. A user-friendly checklist is provided. Status epilepticus continuous generalized tonic-clonic seizure activity needs to be aborted in less than 60 minutes .

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