Description
Book SynopsisTrade ReviewThis is a great resource. It has been 12 years since the last edition and this edition was necessary to provide the most up-to-date information. (Weighted Numerical Score: 100 - 5 Stars!) * Shirley Ju, MD, Doodys *
Facing patients with impaired consciousness or coma is among the most urgent and difficult medical emergencies. The 1966 first edition of the "Diagnosis of Stupor and Coma" by Plum and Posner illuminated medical science with an orderly approach in dealing with the comatose patient. In this fifth edition, Saper and colleagues provide a concise state of the art update of this topic necessary for patient care and is a must read for all health care providers who wish to acquire or hone their knowledge to care for these patients. * David A. Hafler, MD, William S. and Lois Stiles Edgerly Professor of Neurology and Immunobiology, Chairman, Department of Neurology, Yale School of Medicine, Neurologist-in-Chief, Yale New Haven Hospital, CT *
Plum and Posner's Diagnosis and Treatment of Stupor and Coma has long provided the best description of both the pathophysiology and the diagnostic approach to disorders of consciousness. Remarkably, this edition was able to integrate the many new diagnostic and therapeutic tools that have become available while still maintaining the clarity and logic that made the book so useful. Every neurologist should read it!? * John Kessler, MD, Davee Professor, Davee Department of Neurology, Northwestern University, Chicago, IL *
This new 5th Edition of the seminal Plum and Posner's "Stupor and Coma" contributed by a brilliant, and partly renewed, band associating Posner, Sapper, Schiff, and Claassen is not a "USA dormant cop" (anagram of the title), but a worldwide must-read for all those interested by the neurology, physiology and anatomy of consciousness, and by its disorders. Keeping with the very insightful and hitherto unseen tone of the 1972 first edition, this new opus covers almost exhaustively the rich and fast-growing relevant literature, and it can be read at different levels of expertise ranging from fresh college students to emeritus professors, including active neurologists, intensivists, and medical practitioners. * Prof. Lionel Naccache, Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France *
The 5th edition of Plum and Posner's Diagnosis and Treatment of Stupor and Coma is as indelible a contribution as its four prior editions. Continuing in the tradition of the first edition's 1966 grounding in brain structure-function relationships as they apply to disorders of consciousness, this edition is a welcomeupdate to 2007's 4th edition capturing important advances in knowledge in the field. It is a comprehensive, yet succinct, well referenced, scholarly summary of our present day understanding of the molecular basis of consciousness as much as it is a practical clinician's guide to evaluation, treatment, and prognosis. A triumph - indeed! A wonderful and necessary addition to the bookshelf of a wide audience whose interests include the brain's role in modulating normal and disturbed states of consciousness. * David B. Rye MD, PhD, Professor of Neurology, Emory University School of Medicine, Atlanta, GA *
This new edition provides a comprehensive update of a classic and essential text. It preserves the best elements of the original - the succinct formulation of the pathophysiology of coma, the approach to examining a comatose patient - but brings the book solidly into the 21st Century with inclusion of modern technologies and methods. The expanded discussion of the treatment of comatose patients is most welcome, delivering a wealth of information in a concise format. This remains a remarkable book: at once both comprehensive and accessible, equally suitable for extended study and as a quick bedside reference. It deserves a place in the library of every practicing neurologist. * David G. Standaert, MD, PhD, John N. Whitaker Professor and Chair, Department of Neurology, The University of Alabama at Birmingham, AL *
Table of Contents1. Pathophysiology of Signs and Symptoms of Coma ALTERED STATES OF CONSCIOUSNESS DEFINITIONS Consciousness Acutely Altered States of Consciousness Subacute or Chronic Alterations of Consciousness APPROACH TO THE DIAGNOSIS OF THE COMATOSE PATIENT PHYSIOLOGY AND PATHOPHYSIOLOGY OF CONSCIOUSNESS AND COMA The Ascending Arousal System Behavioral State Switching Relationship of Coma to Sleep The Cerebral Hemispheres and Conscious Behavior Structural Lesions That Cause Altered Consciousness in Humans 2. Examination of the Comatose Patient OVERVIEW HISTORY GENERAL PHYSICAL EXAMINATION LEVEL OF CONSCIOUSNESS ABC: AIRWAY, BREATHING, CIRCULATION Circulation Respiration PUPILLARY RESPONSES Examine the Pupils and Their Responses Pathophysiology of Pupillary Responses: Peripheral Anatomy of the Pupillomotor System Pharmacology of the Peripheral Pupillomotor System Localizing Value of Abnormal Pupillary Responses in Patients in Coma Metabolic and Pharmacologic Causes of Abnormal Pupillary Response OCULOMOTOR RESPONSES Functional Anatomy of the Peripheral Oculomotor System Functional Anatomy of the Central Oculomotor System The Ocular Motor Examination Interpretation of Abnormal Ocular Movements MOTOR RESPONSES Motor Tone Motor Reflexes Motor Responses FALSE LOCALIZING SIGNS IN PATIENTS WITH METABOLIC COMA Respiratory Responses Pupillary Responses Ocular Motor Responses Motor Responses MAJOR LABORATORY DIAGNOSTIC AIDS Blood and Urine Testing Computed Tomography Imaging and Angiography Magnetic Resonance Imaging and Angiography Magnetic Resonance Spectroscopy Neurosonography Lumbar Puncture Electroencephalography and Evoked Potentials 3. Structural Causes of Stupor and Coma COMPRESSIVE LESIONS AS A CAUSE OF COMA COMPRESSIVE LESIONS MAY DIRECTLY DISTORT THE AROUSAL SYSTEM Compression at Different Levels of the Central Nervous System Presents in Distinct Ways The Role of Increased Intracranial Pressure in Coma The Role of Vascular Factors and Cerebral Edema in Mass Lesions HERNIATION SYNDROMES: INTRACRANIAL SHIFTS IN THE PATHOGENESIS OF COMA Anatomy of the Intracranial Compartments Patterns of Brain Shifts That Contribute to Coma Clinical Findings in Uncal Herniation Syndrome Clinical Findings in Central Herniation Syndrome Clinical Findings in Dorsal Midbrain Syndrome Safety of Lumbar Puncture in Comatose Patients False Localizing Signs in the Diagnosis of Structural Coma DESTRUCTIVE LESIONS AS A CAUSE OF COMA DIFFUSE, BILATERAL CORTICAL DESTRUCTION DESTRUCTIVE DISEASE OF THE DIENCEPHALON DESTRUCTIVE LESIONS OF THE BRAINSTEM 4. Specific Causes of Stupor and Coma INTRODUCTION SUPRATENTORIAL COMPRESSIVE LESIONS EPIDURAL, DURAL, AND SUBDURAL MASSES Epidural Hematoma Subdural Hematoma Epidural Abscess/Empyema Dural and Subdural Tumors SUBARACHNOID LESIONS Subarachnoid Hemorrhage Subarachnoid Tumors Subarachnoid Infection INTRACEREBRAL MASSES Intracerebral Hemorrhage Intracerebral Tumors Brain Abscess and Granuloma INFRATENTORIAL COMPRESSIVE ESIONS EPIDURAL AND DURAL MASSES Epidural Hematoma Epidural Abscess Dural and Epidural Tumors SUBDURAL POSTERIOR FOSSA OMPRESSIVE LESIONS Subdural Empyema Subdural Tumors SUBARACHNOID POSTERIOR FOSSA LESIONS INTRAPARENCHYMAL POSTERIOR FOSSA MASS LESIONS Cerebellar Hemorrhage Cerebellar Infarction Cerebellar Abscess Cerebellar Tumor Pontine Hemorrhage SUPRATENTORIAL DESTRUCTIVE LESIONS CAUSING COMA VASCULAR CAUSES OF SUPRATENTORIAL DESTRUCTIVE LESIONS Carotid Ischemic Lesions Distal Basilar Occlusion Venous Sinus Thrombosis Vasculitis INFECTIONS AND INFLAMMATORY CAUSES OF SUPRATENTORIAL DESTRUCTIVE LESIONS Viral Encephalitis Acute Disseminated Encephalomyelitis CONCUSSION AND OTHER TRAUMATIC BRAIN INJURIES Mechanism of Brain Injury During Closed Head Trauma Mechanism of Loss of Consciousness in Concussion Delayed Encephalopathy After Head Injury INFRATENTORIAL DESTRUCTIVE LESIONS BRAINSTEM VASCULAR DESTRUCTIVE DISORDERS Brainstem Hemorrhage Basilar Migraine Posterior Reversible Leukoencephalopathy Syndrome INFRATENTORIAL INFLAMMATORY DISORDERS INFRATENTORIAL TUMORS CENTRAL PONTINE MYELINOLYSIS 5. Metabolic and Diffuse Encephalopathies: Disruption of the Internal Milieu DISTINGUISHING FEATURES OF METABOLIC ENCEPHALOPATHY Mental status testing, delirium, and grading level of unresponsiveness Distinguishing metabolic encephalopathy from focal causes of coma Distinguishing metabolic encephalopathy from diffuse or multifocal causes of coma Key features of the neurological exam in metabolic encephalopathy THE INTERNAL MILIEU: AN OVERVIEW OF CEREBRAL METABOLISM AND THE ENVIRONMENT NECESSARY TO MAINTAIN NORMAL NEURONAL FUNCTION Cerebral blood flow, glucose, and oxygen utilization Acid-base balance and osmolality Ionic environment in the brain and spreading depression Synaptic environment in the brain and seizures DISORDERS OF THE INTERNAL MILIEU: LACK OF SUBSTRATE Cerebral hypoxia Hypoperfusion (global ischemia, multifocal vascular compromise) Hypoglycemia Lack of metabolic cofactors (thiamine) Mitochondrial disorders DISORDERS OF THE INTERNAL MILIEU: IONIC AND OSMOTIC ENVIRONMENT Hyponatremia Hypernatremia Hypercalcemia Metabolic acidosis Hyperglycemia, hyperosmolar state Hypo-osmolar state DISORDERS OF THE INTERNAL MILIEU: HORMONAL AND TEMPERATURE Hypothyroidism Hyperthyroidism Adrenal insufficiency Hypothermia Hyperthermia DISORDERS OF THE INTERNAL MILIEU: ELECTRICAL ENVIRONMENT Seizure disorders Spreading depression DISORDERS OF THE INTERNAL MILIEU: ABNORMAL CSF PRESSURE OR CONSTITUENTS Intracranial hypertension Intracranial hypotension Subarachnoid hemorrhage Acute bacterial meningitis Chronic bacterial or fungal meningitis Viral meningitis vs. encephalitis Carcinomatous meningitis DISORDERS OF ENDOGENOUS TOXINS Hypercarbia Hepatic encephalopathy Renal failure Pancreatic encephalopathy Systemic septic encephalopathy Auto-immune disorders: specific antibodies Auto-immune disorders: acute disseminated encephalomyelitis DISORDERS OF EXOGENOUS TOXINS Sedative/hypnotic drugs and anesthetics (GABA-A receptor enhancers) Ethanol, methanol, and propylene glycol (including withdrawal) Ketamine, phencyclidine (NMDA receptor antagonists) Antidepressants Neuroleptics Opiates Aspirin and acetaminophen Overdose of unknown type 6. Psychogenic Unresponsiveness CONVERSION REACTIONS CATATONIA PSYCHOGENIC SEIZURES CEREBELLAR COGNITIVE AFFECTIVE SYNDROME ''AMYTAL INTERVIEW'' 7. Approach to Management of the Unconscious Patient A CLINICAL REGIMEN FOR DIAGNOSIS AND MANAGEMENT ALGORITHM AND PRINCIPLES OF EMERGENCY MANAGEMENT SUPPORT VITAL SIGNS: AIRWAY, BREATHING, AND CIRCULATION Ensure Oxygenation, Airway, and Ventilation Maintain the Circulation HISTORY, EXAM, AND BASIC DIAGNOSTICS Emergency Examination of the Comatose and Stuperous Patient Emergent Treatment that Should be Considered for All Patients with Stupor or Coma More Definitive Treatment of Etiologies of Stupor and Coma 8. Management of Frequently Encountered Causes of Unconsciousness MANAGEMENT OF FREQUENTLY ENCOUNTERED CAUSES OF UNCONSCIOUSNESS STRUCTURAL LESIONS: SUPRATENTORIAL OR INFRATENTORIAL COMPRESSIVE/DESTRUCTIVE ETIOLOGIES Aneurysmal Subarachnoid Hemorrhage Intracerebral Hemorrhage Traumatic Brain Injury Subdural and Epidural Hematoma Arterial Ischemic Stroke Venous Sinus Thrombosis Brain Tumor Brain Abscess NONSTRUCTURAL LESIONS: METABOLIC, DIFFUSE, OR MULTIFOCAL COMA Central nervous system infections Autoimmune causes of coma Hypoxic Brain Injury / cardiac arrest Metabolic coma GENERAL MANAGEMENT CONSIDERATIONS APPLYING TO ALL OR MOST BRAIN INJURED PATIENTS GOALS OF CARE FINAL WORD 9. Prognosis in Coma and Related Disorders of Consciousness and Mechanisms Underlying Outcomes 10. Brain Death - Joseph J. Fins DETERMINATION OF BRAIN DEATH CLINICAL SIGNS OF BRAIN DEATH Brainstem Function Confirmatory Laboratory Tests and Diagnosis Diagnosis of Brain Death in Profound Anesthesia or Coma of Undetermined Etiology Pitfalls in the Diagnosis of Brain Death Brain Death versus Prolonged Coma Management of the brain dead patient
