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PRINCIPLES OF NEUROLOGY - PART 4

Huyết áp không ổn định, liên quan đến hệ thống vết thương nhiễm trùng hệ thống hoặc thủ tục phẫu thuật thần kinh, sốt cấp tính hoặc bán cấp tiến hóa, sử dụng thuốc aminophylline hoặc catecholamine khởi phát cấp tính hoặc bán cấp | Trauma Signs of cranial and CT and MRI show brain Unstable blood pressure Coma without focal or Brain abscess Hypertensive encephalopathy eclampsia Meningitis and facial injury Neurologic signs depending on location Blood pressure 210 110 lower in eclampsia and in children headache seizures hypertensive retinal changes Stiff neck Kernig sign contusions and other injuries see Chap. 34 cT scan and MRI CT CSF pressure elevated CT scan pleocytosis associated systemic injuries Systemic infection or neurosurgical procedure fever Acute or subacute evolution use of aminophylline or catecholamine medications Subacute or acute onset lateralizing signs with signs of meningeal irritation encephalitis Subarachnoid hemorrhage fever headache Stertorous breathing hypertension stiff neck Kernig sign increased protein low glucose in CSF CT scan may show blood and aneurysm bloody or xanthochromic CSF under increased pressure Sudden onset with severe headache continued 159 160 TABLE 17-2 Important Points in the Differential Diagnosis of the Common Causes of Coma continued General group Specific disorder Important clinical findings Important laboratory findings Remarks Coma without focal Alcohol Hypothermia Elevated blood alcohol May be combined with neurologic signs or meningeal irritation CT scan and CSF normal intoxication hypotension flushed skin alcohol breath head injury infection or hepatic failure Sedative Hypothermia Drug in urine and History of intake of drug intoxication Opioid intoxication Carbon monoxide intoxication hypotension Slow respiration cyanosis constricted pupils Cherry-red skin blood EEG often shows fast activity Carboxyhemoglobin suicide attempt Administration of naloxone causes awakening and withdrawal signs Anoxia Rigidity decerebrate postures fever seizures myoclonus CSF normal EEG may be isoelectric or show high-voltage delta Abrupt onset following cardiopulmonary arrest damage permanent if anoxia exceeds 3-5 min Hypoglycemia Same as in anoxia Low blood and