Consciousness and disturbances of consciousness

Summary The problem of consciousness is discussed briefly, including the contrary views of consciousness as a transcendental phenomenon and as an animistic fiction. Measurement of consciousness is possible only indirectly by means of quantitative assessment of accompanying behavioral deficits.Knowledge of the structural basis of consciousness is incomplete. The ascending reticular activating system (ARAS) is necessary for the maintenance of the state of consciousness. The monoamine and a great number of descending projections modulate the ARAS. The contents of consciousness depend also on telencephalic structures, primarily on the telencephalic cortex. Certain localized telencephalic lesions bring about disturbances of consciousness. The role of the corpus callosum in the problem of consciousness is discussed (one brain—two minds hypothesis).Then a classification of the various disturbances of consciousness is proposed. The term disturbances of vigilance is used for all disturbances of consciousness which are caused by a lesion in or a functional disorder of the ARAS or any of its modulating subsystems. The term disturbances of the contents of consciousness refers to disturbances of consciousness due to global or localized lesions or functional disorders of telencephalic structures. A list of characteristic features is given for each class of disturbance of consciousness.

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Zusammenfassung Das Problem Bewußtsein wird kurz skizziert. Dabei werden die gegensätzlichen Auffassungen über Bewußtsein als transzendentales Phänomen bzw. als animistische Fiktion erörtert. Die Messung von Bewußtsein ist indirekt nur über die Bestimmung des begleitenden Verhaltensdefizits möglich. Die Kenntnis über die strukturellen Grundlagen des Bewußtseins ist lückenhaft. Für die Aufrechterhaltung des Bewußtseinsgrades kommt dem aufsteigenden retikulären aktivierenden System (ARAS) eine notwendige — wenngleich nicht hinreichende — Bedeutung zu. Das ARAS wird durch monoaminerge und eine große Zahl vom Großhirn absteigender Projektionssysteme moduliert.Telenzephale Strukturen und vor allem der telenzephale Kortex scheinen für die Entfaltung von Bewußtseinsinhalten unentbehrlich. Auch umschriebene telenzephale Läsionen können partielle Störungen der Bewußtseinsinhalte verursachen. Die Bedeutung des Balkens für das Bewußtsein wird diskutiert (one brain—two minds-Hypothese).Im letzten Abschnitt wird eine Taxonomie der verschiedenartigen Bewußtseinsstörungen versucht. Unter dem Begriff Vigilanzstörungen werden alle Bewußtseinsstörungen zusammengefaßt, die durch Läsion oder Funktionsstörungen des aufsteigenden retikulären aktivierenden Systems (ARAS) — einschließlich seiner modulierenden Subsysteme — bedingt sind. Unter Störung der Bewußtseinsinhalte werden Bewußtseinsstörungen verstanden, die durch globale oder lokale Läsion bzw. Funktionsstörung telenzephaler Strukturen verursacht werden. Für beide Klassen von Bewußtseinsstörungen wird ein Merkmalskatalog beschrieben.

     

"Hyperfrontal" distribution of the cerebral grey matter flow in resting wakefulness; on the functional anatomy of the conscious state

Regional cerebral blood flow was measured with the intra-arterial 133 Xenon clearance technique using a multidetector device in 11 patients undergoing carotid angiography (with normal findings). During the flow studies the patients were awake and strict resting conditions were observed. The patients did not move or speak, and sensory stimulation were kept at a minimum. It was confirmed that the distribution of the grey matter blood flow showed a hyperfrontal pattern, the flow in frontal regions being significantly (20-40%) higher than in postcentral, occipital and temporal regions. There were no technical factors or morphological features of the telencephalon which could explain this difference. It was also shown that the distribution of the white matter flow and the relative weight of the grey matter corresponded in general to hemisphere morphology. Since in normal nervous tissue the blood flow is regulated by the neuronal activity, the following interpretation is given of the main finding. The hyperfrontal flow distribution of the grey matter (cortical) flow during resting wakefulness shows that there is a high activity in frontal "efferent" (motor-behavior) regions. At the same time there is a low activity in post-central and temporal "afferent" (sensory-gnostic) cortical areas. The high frontal activity suggests that in the resting conscious state--unaccompanied by movements, speech or behavioral reactions--the brain is active with an anticipatiory "simulation of behavior". The low postcentral flow, on the other hand, may possibly be related to a global inhibition of the sensory input. Several clinical as well as general biologic arguments are forwarded to support this interpretation. It is further pointed out that the hyperfrontal distribution of the resting activity in the cerebral cortex correlates to the resting EEG, in which lower frequencies (the alpha rhythm) predominate in postcentral and temporal regions where there is a low flow/activity, and high frequencies in frontal areas where the blood flow is high. This is in agreement with the finding that the blood flow and metabolism of the brain correlate to the EEG frequency content.     

手十二井穴刺络放血对中风患者意识状态、心率等影响的临床观察

目的：观察手十二井穴刺络放血对中风初期患者意识状态等的影响。方法：以中风发病后3d有意识障碍的患者为观察对象，按病情分为损伤大面积、中面积、小面积3组，每组随机分为刺络组与对照组， 刺络组和对照组均进行正常治疗，仅刺络组增加井穴刺络放血。将意识状态进行量化，观察患者意识状态、血压、心率等的变化。结果：手十二井穴刺络放血可使损伤面积小的患者意识状态好转；收缩期血压上升；可使各组患者的心率加快。结论：手十二井穴刺络放血可使损伤面积小的患者意识状态好转。     

颈动脉狭窄成形术中的支架和脑保护装置选择

颈动脉狭窄是缺血性脑卒中的主要发病原因之一，而颈动脉支架及其脑保护装置是经血管内治疗颈动脉狭窄的有益材料。通过了解和熟悉不同类型的支架和脑保护装置的特点、特性、应用方法和并发症预防．有助于提高颈动脉狭窄成形治疗的临床水平。     

急性脑血管病血清心肌酶谱的临床观察

目的:探讨脑血管病变患者急性期血清心肌酶谱的异常表现及临床意义。方法 :分析128例脑血管病变患者的心肌酶谱 ,并与正常组对照。结果 :急性脑梗死患者与健康查体者比较 ,血清GOT、LDH、CK、α -HBDH、CK -MB差异均有非常显著性(P<0.01) ;急性脑出血患者与健康查体者比较 ,血清GOT、LDH、CK、α -HBDH、CK -MB差异均有非常显著性(P<0.01) ;脑梗死组与脑出血组比较血清GOT、LDH、CK、α -HBDH、CK -MB差异均无显著性(P>0.05)。46例有意识障碍与82例无意识障碍患者比较血清GOT、LDH、α -HBDH、CK -MB差异均有显著性(P<0.05) ,CK差异有非常显著性(P<0.01)。结论 :急性脑血管病患者检测心肌酶对判断其病变程度、愈后及检测心脏受损情况有重要的临床意义。     

护理人员隐蔽艾滋病职业暴露的防护

目的探讨如何提高护理人员对隐蔽艾滋病的防护意识。 方法分析近年来国内所报道的及我科护理人员艾滋病职业暴露12例的相关资料。 结果12例职业暴露中至少有9例是在毫无防范的情况下发生的。 结论临床护理人员应高度重视隐蔽艾滋病职业暴露的防护。     

重视医院知识产权保护

简述了医院知识产权保护的范围及其重要性,提出医院知识产权保护现状不容乐观,强调必须尽快加强医院知识产权管理,重点一是要强化知识产权意识,建立相应的机构与制度;二是要对科研项目和商业技术秘密等实行全程知识产权跟踪管理;三是要专设科研项目知识产权协调管理员;四是要为知识产权保护提供相应的配套服务,并制定激励政策.     

结缔组织病合并隐球菌脑膜炎的临床特点

目的：分析结缔组织病(connective tissue disease,CTD)合并隐球菌脑膜炎的临床特点及预后。方法：回顾 分析2000年1月至2017年1月期间中南大学湘雅医院风湿免疫科诊断的18例CTD合并隐球菌脑膜炎患者的临床资料。 结果：CTD合并隐球菌脑膜炎患者的常见症状为头痛、发热、恶心、呕吐,出现抽搐、意识障碍等严重临床表现的 患者均死亡。Logistic回归分析表明出现意识障碍、外周血淋巴细胞计数下降是造成CTD合并隐脑预后不良的相关因 素(P<0.05)。CTD合并隐球菌脑膜炎的病死率为61.11%,治疗有效率为38.89%。结论：CTD合并隐球菌脑膜炎患者死 亡风险高。出现意识障碍、外周血淋巴细胞计数降低与疾病预后不良相关。     

Rabies virus vaccines: Is there a need for a pan-lyssavirus vaccine?

All members of the lyssavirus genus are capable of causing disease that invariably results in death following the development of clinical symptoms. The recent detection of several novel lyssavirus species across the globe, in different animal species, has demonstrated that the lyssavirus genus contains a greater degree of genetic and antigenic variation than previously suspected. The divergence of species within the genus has led to a differentiation of lyssavirus isolates based on both antigenic and genetic data into two, and potentially a third phylogroup. Critically, from both a human and animal health perspective, current rabies vaccines appear able to protect against lyssaviruses classified within phylogroup I. However no protection is afforded against phylogroup II viruses or other more divergent viruses. Here we review current knowledge regarding the diversity and antigenicity of the lyssavirus glycoprotein. We review the degree of cross protection afforded by rabies vaccines, the genetic and antigenic divergence of the lyssaviruses and potential mechanisms for the development of novel lyssavirus vaccines for use in areas where divergent lyssaviruses are known to circulate, as well as for use by those at occupational risk from these pathogens.