The Neurological Examination of Consciousness
The Neurological Examination of Consciousness
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DOI：
10.1016/b978-0-12-374168-4.00002-2
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发表时间：
2009-01-01
期刊：
影响因子：
--
通讯作者：
Blumenfeld, Hal
中科院分区：
文献类型：
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作者：
Blumenfeld, Hal
意识障碍对临床医生提出了诊断挑战，对治疗和预后具有重要意义。尽管神经成像和其他尖端技术取得了惊人的进步，但在评估这些患者时，仔细进行全身和神经学检查仍然至关重要。在本章中，我们将回顾在意识受损的主要状态下的神经学检查结果，从脑死亡、昏迷、植物人状态、最低意识状态到其他意识障碍，以及可以模仿意识受损的情况，包括心理障碍和闭锁综合征。在可能的情况下，将根据最近的多学科审查和共识声明，讨论确定每种情况的具体阳性和阴性检查结果。继续研究意识受损状态下的神经学检查将为患者的诊断和管理提供改进的前沿工具。此外，意识受损状态下检查结果的解剖学基础为意识正常和异常的基本机制提供了重要的线索。
Disorders of consciousness present a diagnostic challenge to the clinician, with crucial implications for treatment and prognosis. Despite spectacular advances in neuroimaging and other cutting-edge technologies, a carefully performed general and neurological examination remains critical in the evaluation of these patients. In this chapter, we will review the neurological examination findings in the major states of impaired consciousness ranging from brain death, coma, vegetative state, and minimally conscious state to other disorders of consciousness, and conditions which can mimic impaired consciousness including psychological disorders and the locked-in syndrome. When possible, specific positive and negative examination findings defining each condition will be discussed based on recent multi-disciplinary reviews and consensus statements. Continued study of the neurological examination in states of impaired consciousness will provide improved font-line tools for patient diagnosis and management. In addition, the anatomical basis for examination findings in states of impaired consciousness sheds important light on the fundamental mechanisms of normal and abnormal consciousness.