Das unklare Koma: effiziente Diagnostik und Therapieoptionen

Abstract

The concept of the coma circumscribes a serious disturbance of consciousness without awake on strong external stimuli. Meningeale irritant symptoms or focal neurological signs suggest a primarily cerebral cause of the unconsciousness, nevertheless, should be secured by additional diagnostics. Heavy brain malfunctions as a result of non primarily cerebral illnesses develop mostly slow and are often a result of a progressive intracranial pressure increase as a result of a brain edema. Clinically are found with these patients beside a quantitative deterioration of the consciousness situation vomiting, hyperventilation, blood pressure increase as well as bilateral pyramid rooad signs. Nevertheless, focal neurological symptoms and cramp attacks are also observed in connection with metabolic disturbances and intoxications. Therapeutic strategies with primarily structural brain damage aim, primarily, at a therapy of the intracranial pressure increase and decrease of the secondary damage cascade. On the other hand the treatment of the basic illness is in the foreground with non primarily cerebral coma cause. The diagnostics and therapy of comatose patients shows with it an interdisciplinary challenge which needs of a narrow cooperation.