14.09.2020

Confusion of consciousness. Neurological symptoms with confusion. Confusion, treatment, symptoms, causes Confusion after eating

Confusion of consciousness - symptoms of a clouded consciousness of a person, which can be short-term or long-term in nature, depending on the underlying factor. This condition can be a manifestation of both a somatic process and a psychological disorder or a strong nervous shock. Such a symptom requires complex treatment under the supervision of a doctor.

Etiology

Clinicians identify the following etiological factors that can lead to the development of this human condition:

drug intoxication;
psychological illnesses;
traumatic brain injury;
strong;
vascular pathologies of the brain;
neurological disorders;
damage to the central nervous system;
metabolic disorders;
epileptic seizures;
toxic poisoning;
strong body and high body temperature;
hidden internal bleeding;

In some cases, confusion can be observed with circulatory disorders, especially with.

Classification

The following forms of this disorder are distinguished, depending on the etiological factor and the age of the patient:

hallucinatory;
manic;
catatonic;
confabulatory;
vascular.

Symptoms

Confusion of consciousness may be supplemented by the following symptoms:

partial, in most cases short in time - a person may forget what he did or said a few minutes ago, periodically does not recognize his relatives, passport data and other similar information;
the patient may forget all information about himself;
sharp - a state of complete rest can be replaced by sharp aggression even towards close people;
slow and inconsistent speech;
uncontrolled urination and defecation;

With cervical osteochondrosis, the above described clinical picture may be supplemented by such signs:

pain in the heart and retrosternal region;
impaired motor function;
weakening of muscle tone.

If the confused consciousness is caused by latent internal bleeding (most often intestinal), then the clinical picture may be supplemented by such signs:

increased sweating;
pallor of the skin;

Confusion of consciousness in a psychological disorder may be accompanied by such additional symptoms:

inappropriate behavior;
bouts of aggression;
misinterpretation of the actions of others;
unreasonable feeling of fear.

With this condition of the patient, you should urgently call for medical help. It is impossible to ignore the above described clinical manifestations, as this is fraught with the development of serious complications. In this case, a fatal outcome should not be excluded, since a person in this state is not responsible for his actions.

Diagnostics

With confused consciousness, you should turn to. After the initial examination, the doctor, if necessary, will refer the patient to or further treatment will be carried out jointly.

An initial examination of the patient with clarification of the anamnesis is mandatory. The conversation with the patient should take place together with a loved one who can specifically answer some of the doctor's questions.

To determine the underlying factor, the following laboratory and instrumental methods of examination can be prescribed:

blood sampling for general and biochemical analysis;
general urine analysis;
Ultrasound of internal organs;
dopplerography of blood vessels;
psychiatric consultation.

In any case, whatever the alleged etiological cause may be a violation of the clarity of human consciousness, consultation with a psychiatrist, even for preventive purposes, is mandatory.

Treatment

If confusion is a sign of a serious pathological process, and not a short-term symptom like post-traumatic psychosis, then hospitalization is required. If possible, one of the relatives should stay with the patient.

If the patient is in a state of excitement, the doctor may prescribe the following medications:

tranquilizers;
sedatives;
sleeping pills.

The drugs are administered intramuscularly, starting with the minimum dose. It is impossible to use such drugs on your own, as this can lead not only to irreversible pathological processes, but also to death.

This is a social problem, since death from a stroke occurs in 50% of patients. This happens when the first signs are not recognized in time, first aid is not provided, and the level of medical care and rehabilitation is insufficient. Only 5% of those who have had acute cerebrovascular accident (CVA) start working, and disability after a stroke occurs in 75% of cases, and most often there are severe complications that affect the ability to work and the quality of life of a person.

To help the patient, you need to know what strokes are. There are several classifications of stroke: according to the mechanism of occurrence, according to the degree of severity and according to the area of occurrence.

There are several causes of the disease. The approach to the treatment of stroke depends precisely on the reasons for which the catastrophe occurred in the brain, and what part of the central nervous system is affected. Each type of stroke is accompanied by its own symptoms and requires specific therapy, different principles of rehabilitation and preventive measures.

There are two types of cerebral stroke: ischemic and hemorrhagic. This group also includes subarachnoid hemorrhage, which occurs after a head injury.

It is often asked what is the difference between a stroke and a heart attack. Signs of stroke and heart attack are similar, occur according to the same mechanism and occur due to:

narrowing of the lumen or blockage of the vessel by a thrombus against the background of atherosclerosis - atherothrombotic;
blocking of a cerebral artery by an embolus - a migrating blood clot or thrombus in certain heart diseases;
sudden decrease in blood pressure - hemodynamic;
lesions of small peripheral arteries that feed the subcortical structures against the background of a pressure surge - lacunar stroke;
disorders of the blood coagulation system - hemorheological.

Hemorrhagic stroke is the formation of a hematoma in the brain of a non-traumatic nature. It is associated with rupture or stratification of blood vessels. Erythrocytes and blood plasma sweat through the wall of blood vessels, and form a limited focus that presses on the brain tissue and disrupts their normal function.

There is no such diagnosis as a microstroke, but this concept is used in cases of damage to a small area of the brain. At the same time, the severity of symptoms is insignificant, and less time is required for the full restoration of neuronal functions.

When making a diagnosis, the type of disease is indicated in accordance with the international classification of diseases - ICD 10, which can be found in the Wikipedia article "Stroke".

CVA can also occur in the spinal cord. The arteries of this department can also undergo spasm, blockage or rupture. In this case, a spinal stroke occurs, which is much more severe and leads to paralysis of the limbs. Most often, the cervical and lower thoracic regions are affected.

Predisposing factors for the occurrence of pathology of cerebral circulation are the following diseases:

hypertonic disease;
arrhythmias, paroxysmal tachycardia;
IHD: angina pectoris and myocardial infarction;
atherosclerosis;
vascular diseases;
diabetes;
obesity;
blood clotting disorder.

In the case history of neurology, stroke is indicated as a complication after the underlying disease, which are indicated above.

Violation of cerebral circulation is most often observed:

In men from 40 to 70 years.
Individuals whose relatives have had a stroke.
After emotional overload: a large amount of adrenaline in the blood contributes to vasospasm.
Due to physical fatigue.
Smokers and drinkers.

Recently, a catastrophe occurs in people 25-30 years old. The most common causes of stroke at a young age are aneurysms and malformations - a congenital pathology of the cerebral vessels, which leads to stroke.

Sometimes a completely healthy person may experience recurrent headaches, fluctuations in blood pressure, weakness, causeless fatigue, dizziness, and visual impairment. Most often, these symptoms resolve on their own and do not require treatment. When contacting a doctor, this condition is classified as vegetative-vascular dystonia and general strengthening therapy is prescribed. However, VVD is dangerous because it disrupts the regulation of vascular tone and the brain receives less oxygen and nutrients.

According to the mechanism of action, transient ischemic attacks (TIA) are similar to VVD. This is a short-term violation of the blood supply to neurons due to transient vasospasm. With them, dizziness, weakness, a feeling of numbness of the limbs, and sometimes a short-term loss of consciousness are possible. All these are harbingers of a stroke.

With stroke, there are general cerebral symptoms, as a reaction to damage, and local ones, which depend on the area in which the catastrophe occurred. By the severity of the symptoms, it is possible to determine which area of the brain is affected: with a left-sided stroke, the right side of the body is paralyzed. The stroke is extensive and leads to disruption of other functions.

In case of ischemic stroke in the history of the disease, it is noted that after emotional or physical overload, most often in the morning after waking up, an increase in headache occurs, then there are: numbness of the limbs, weakness, dizziness, nausea, impaired speech, vision, swallowing, loss of orientation, inability to perform elementary movements . With significant damage, loss of consciousness, vomiting, convulsions and epileptic seizures are possible. In this case, the pressure during a stroke most often decreases to normal numbers. The temperature during a stroke can be both high and low, while the lower it is, the more favorable the prognosis for recovery.

Of particular note is the right-sided stroke. In this form, confusion occurs first, and then mental disorders and dementia appear. Stroke of the right side of the brain is characterized by such symptoms: hallucinations, psychosis, delirium, aggressiveness or severe depression.

Manifestations of hemorrhagic stroke differ from ischemic by the rate of increase of symptoms: the occurrence of a sharp headache against the background of general well-being, severe lethargy, repeated vomiting and convulsions, paralysis. A stroke on the left side of the brain causes paralysis on the right side. Most often, with this type of stroke, patients fall into a coma. In young people, the symptoms of a stroke begin with a sharp headache, photophobia, then paresis and impaired consciousness appear. Therefore, errors often occur in the diagnosis.

It is important to know these symptoms, since in most cases the patient cannot independently say what worries him, and in such a situation every minute is precious - it is necessary to help the person before the provision of qualified assistance.

ONMK does not pass without a trace. A stroke of the brain leads to serious consequences. The most formidable complication after a stroke is death.: after hemorrhagic - mortality exceeds 80% of all cases, after ischemic - up to 40%, after subarachnoid hemorrhage - from 30% to 60%.

20% of patients fall into a soporous state, in which consciousness is preserved, but can be turned off for a while. A person is in unconsciousness or as in a deep stun: there is no orientation and there is a slowdown in all mental processes. Sopor mostly goes into a coma if resuscitation has not been carried out.

Coma is a state in which vital functions are depressed, consciousness is absent, reflexes are completely turned off. The patient may be depressed or extremely aggressive, but inadequate. The prognosis for coma after a stroke is unfavorable and in 90% of cases leads to death.

Cerebral edema in stroke is a common complication that leads to death. With edema, blood plasma sweats in response to brain damage, neurons and the intercellular space are filled with water, which leads to an increase in pressure in the brain tissues. With edema, the patient's condition deteriorates sharply in a short period of time: there is a loss of consciousness, convulsions, uneven breathing, convulsive syndrome, stupor.

Recurrent stroke can occur within a year after treatment. Its causes are the same as the primary one, but it proceeds much more severely and leads to death or complete immobility. It arises due to the fact that a person does not follow the recommendations of a doctor, as he feels absolutely healthy. After a primary stroke, it is necessary to conduct a CT scan or MRI of the head to detect vascular aneurysms, control blood pressure, normalize cholesterol metabolism, limit oneself from physical and mental overload in order to prevent a recurrent stroke and its consequences.

Paralysis or paresis of the arms and legs is one of the complications that affects the patient's quality of life. It is not always possible to fully restore limb function. And in most cases, the outcome is the inability to perform elementary motor skills.

It is necessary to highlight the hemorrhagic stroke of the right side, which leads to irreversible consequences of impaired movement and all types of sensitivity, prolonged paralysis and mental disorders.

To prevent complications, assistance to the victim should be provided in the first minutes. It is necessary to lay the patient with a raised head end, turn his head on his side, free his mouth from saliva or vomit, provide access to fresh air. If necessary, give artificial respiration. Bloodletting should not be done in case of a stroke - this will not bring an effect.

Qualified medical care is provided in intensive care units or intensive care units. Hemorrhagic stroke is treated surgically. In ischemic stroke, thrombolysis begins in the first 3-6 hours.

The main groups of drugs for stroke of the brain have the following goals:

prevention of cerebral edema - mannitol, dexamethasone;
improvement of microcirculation - cerebrolysin, cavinton;
prevention of thrombosis - plavike, tiklid, aspirin;
improvement of brain nutrition - nootropil, piracetam, actovegin.

Drugs after a stroke are prescribed to prevent a recurrent stroke and normalize brain function - cardiomagnyl, nootropil.

People often ask how long it takes to recover from a stroke. The recovery time after a stroke depends on the severity of the stroke and the area of damage, concomitant diseases and the patient's desire to recover. After discharge from the hospital, the doctor gives recommendations on taking medications for stroke and a rehabilitation plan.

What can you eat after a stroke. Pickles, preservatives, animal fats should be excluded, salty, fried, flour products should be limited. Include plenty of fiber-rich vegetables and fruits in your diet. As for the intake of alcoholic beverages, stroke and alcohol are incompatible concepts.

To know how to restore speech after a stroke, you need to consult a speech therapist, talk a lot with the patient, and also give him the opportunity to hear speech more often.

Recovering a hand after a stroke is a long process. To resume motor functions after paralysis or paresis, a complex is being developed that includes physiotherapy exercises and hand massage after a stroke. All this is acceptable for the restoration of the lower extremities.

As for sexual life, sex after a stroke is not only not contraindicated, but also gives a good therapeutic effect in the affected areas of the brain, and also helps in restoring lost functions.

If you feel dizzy after a stroke, you must constantly monitor blood pressure throughout the day and, if necessary, correct it with medications. It should be ensured that the patient is comfortable lying down, constantly turning so that he is not in one position. Some pills also cause dizziness.

Memory loss after a stroke is a common complication of stroke. The restoration of this function is a rather lengthy process and requires constant contact with the patient from relatives, exercises to develop new memorization skills.

According to the testimony of the medical commission, after a stroke they give disability. And depending on the severity of the course, complications and concomitant pathology, after undergoing MSEC, the patient can receive a group. Your doctor will tell you how to apply for disability after a stroke. Re-examination must be done annually.

A patient after a disaster is worried about how to live after a stroke. Only patience, kind attitude of medical personnel, relatives and friends will help to recover and retrain in order to become a full-fledged member of society.

Confused is usually understood as a state of consciousness in which the ability to think at a normal speed is lost, the clarity and sequence of thoughts are disturbed. Under this name, a whole group of injuries in the complex work of the brain is summarized. Let us consider in more detail the concept of "confused consciousness".

The first signs to detect confusion are problems with attention and orientation. Then disorders of memory and logical thinking may begin to appear. The violation does not necessarily affect all the higher functions of the psyche at once, only one of them, for example, speech recognition, can be damaged. Problems with memory or spatial orientation may be noted. In such cases, the diseases are respectively called aphasia, dementia and agnosia.

The appearance of confusional syndrome can be both fast and slow, depending on the causes that cause it. Often it is temporary, but it can also be permanent, usually associated with dementia and delirium.

Confused individuals are usually very silent, move little, and appear depressed. It happens that the disease is accompanied by illusions and hallucinations. If the former arise due to an incorrect interpretation of stimuli, then the latter appear without them at all.

It must be understood that the confused consciousness of each manifests itself individually, depending on the degree of intoxication or the severity of another cause. Slowness and inconsistency of thinking are clearly visible in the conversation, and these are the first symptoms accompanying the diagnosis of "confused mind". Therefore, in order to see the presence of a problem, you do not need to be a professional.

Disorientation can be both allopsychic, in which a person is not able to name the date and place where he is now, and autopsychic, in which his own identification is also difficult. Finding out the presence of disorientation is also easy by asking a couple of questions. According to the answers, the result is obvious - consciousness is clear; confused means it's time to get professional help. You should contact a psychiatrist or narcologist.

When providing assistance, sufficient attention should be paid to the meaning of the word "confused". A person in such a situation really experiences difficulties with the implementation of decisions, including those relating to consent to hospitalization, therefore, in such cases, it often becomes necessary to conduct it based on the indications of the state.

Root causes often cause manifestations of characteristic signs. With VSD, there is a clear vegetative and moderate pain, with a heart attack, the pain syndrome is very pronounced and sometimes can cause a state of shock. Metabolic causes are usually accompanied by various characteristic manifestations, such as odors.

Confused consciousness in older people is chronic, so they can partially develop an adaptation to it. If such a state is long in time, then most likely it will lead to a negative outcome. Speech in such cases is usually slow, inconsistencies can be observed in it, delusional ideas sometimes appear, illusory images may appear that turn into hallucinogenic ones. The mood of such persons also often changes and is difficult to predict, so you should treat them with caution. Changes in sleep are also observed, and they can be diametrically opposed: from complete insomnia to excessive sleepiness.

To make a diagnosis, both a classic survey and special neurological and psychiatric ones, such as the Glasgow Coma Scale, are used. And in case of organic diseases, it is necessary to conduct a blood test, urine test, make an ECG and MRI. This will help to identify the root cause and begin the correct treatment.

This violation can manifest itself due to a number of completely different reasons. That is why it cannot be a signal of a certain pathology, but it is necessary to be aware of its danger and try to find the cause. One thing is clear: such a disease indicates the existence of a neurological problem in the patient.

Consider the possible causes of confusion:

1. Traumatic. The disease can be the result of traumatic brain injuries, especially if they are of a penetrating nature. Although sometimes a brain injury can cause such problems due to the high sensitivity of brain tissue. Often the cause is aneurysms, characterized by a large number of dangerous manifestations.

2. Toxic. The cause of the disease can be poisoning with mercury, alcoholic beverages or drugs. In wartime, various neurotropic gases and organophosphorus substances were used as weapons that act in this way. Neurotoxins can be found in foods such as carambola, puffer fish. The appearance of similar consequences of mushroom poisoning is also common.

3. Consequences of diseases. Diseases accompanied by severe intoxication of the body and hyperthermia (flu, tonsillitis, acute respiratory infections and others) sometimes lead to confusion. This is especially true for children and adolescents. The risk of such conditions occurs when injuries, fractures and large blood loss occur. Tuberculosis and syphilis are other possible causes. Encephalitis, acute diabetes mellitus, severe hepatitis of various types, and the final stages of AIDS can also be the cause.

4. Neoplastic manifestations, and not necessarily arising in the brain tissues. This is due to the fact that tumors are always accompanied by severe intoxication, so confusion in oncology in the later stages becomes inevitable. The danger is not only classic tumors, but also leukemia. It appears in 15-30% of patients, and reaches 85% by the last weeks of life. It introduces additional tension in the state of the patient and his relatives and affects the symptoms and methods of cancer therapy, including correcting the effect on pain.

5. Pathologies of blood circulation. Both serious disorders, such as a stroke, and ischemia, which are considered transient, that is, proceeding without consequences and are only a signal of the presence of problems, often provoke confusion. The severity of the disease and the manifestation of symptoms will be different depending on the severity of the pathology that serves as a trigger. In myocardial infarction, confusion occurs due to problems with blood circulation and the severity of pain sensitivity.

6. Vegetovascular dystonia due to partial disorders in the areas of blood vessels and the autonomic nervous system is also accompanied by mild confusion.

7. Outcome of degenerative diseases. The manifestation can occur to a severe degree at the peak of senile dementia, insanity of various origins, Alzheimer's disease. In this case, it is caused by problems with brain activity and problems with orientation.

The starting points of such processes can be a variety of situations of varying severity. For emotionally weak people, a strong emotional shock is enough. Even a lack of vitamins, hypothermia, prolonged lack of sleep and oxygen can lead to similar consequences.

For the treatment of confusion of consciousness, it is initially necessary to establish the cause of its occurrence and already eliminate it. Since some drugs are often the cause, it is necessary to stop taking all drugs until all metabolic disorders are corrected. The etiology of confusion is often fairly easy to determine due to specific symptoms, but this can sometimes be helped with a full body examination.

Sometimes you can determine the cause and correct the triggering factors yourself. This applies to alcohol intoxication, lowering blood sugar levels. When the sugar level drops, sweet tea or candy will help. If you lose a large amount of fluid, you should resort to rehydration therapy using the products available at the pharmacy. Absorbents and a large amount of liquid will help from alcohol intoxication.

If the cause was an injury, it is important to identify and eliminate it in time. Sometimes this requires the use of neurosurgery. After an ischemic stroke, thrombolytics are used, with a hemorrhagic stroke, surgical disposal of a hematoma is practiced. Exposure to toxic substances, in particular heavy metals, and radiation exposure also require appropriate targeted treatment. Diseases accompanied by intoxication of the body and fever are treated with the use of antiviral and antipyretic drugs. With VVD, the daily routine and diet are adjusted, soothing drugs and teas are also used: chamomile, mint, lemon balm.

There are certain medicines that can help get rid of the disease, but the most effective is to maintain a therapeutic regimen. If the patient is in an excited state, beds with fences on the sides or a special chair are used. Sometimes doctors are forced to resort to fixing the patient, but this is desirable to avoid, giving him the possibility of unlimited movement in a limited space.

If the disease is associated with time disorientation, it is important to ensure that the room has things to help you navigate: large calendars and clocks. This will reduce anxiety levels and help patients feel more confident. For insomnia, you should provide the patient with a radio or leave him a book and a lamp on, which will help take time. In general, it is important to communicate with the patient, to support his faith in recovery. The confused mind in cancer is alleviated in this way.

If such drugs do not have a sufficient effect, they resort to drug treatment, usually consisting in taking antipsychotics. At the same time, there is no exact information about the advantage of any drugs over others, the main parameter is the presence of a sedative effect. However, they may not always be applicable. The drug is first prescribed at a minimum dose, and then gradually increased, while observing the resulting reaction. It is important that there are no manifestations of the opposite effect - an increase in behavioral disorders.

The difficulty causes and restore the cycle of sleep and wakefulness. Sometimes, in order to improve nighttime sleep, the patient is not allowed to fall asleep during the day. Sleeping pills rarely have the desired effect and more often the full cycle returns to normal only after the confusion has passed.

The main causes of confusion:

alcohol withdrawal syndrome
drug intoxication
Encephalitis
Vascular diseases of the brain
Alzheimer's disease
metabolic disorders
Hidden bleeding (including intestinal)
Epileptic twilight states
post-traumatic psychosis
Artifical (postresuscitation, after several sessions of ECT).

alcohol withdrawal syndrome

Alcohol intoxication is the most common. The state of acute confusion due to the intake of large amounts of alcohol is easily recognized. A detailed picture of the alcohol withdrawal syndrome ("trembling state") should not be a serious problem for diagnosis. Such patients are usually anxious and agitated, disoriented in time and place, do not understand the situation in which they find themselves when asked about it. Since a long period of alcohol intake is required for the onset of withdrawal syndrome, an alcoholic tremor of the outstretched arms will be detected on examination. The picture is complemented by icterus of the sclera and an increase in the liver on palpation. The most significant among laboratory studies are data indicating a violation of liver enzymes.

Tranquilizing drugs can also lead to intoxication and thus confusion and disorientation. Such patients are not anxious or agitated, rather there is a decrease in the level of wakefulness. In these cases, the eye symptoms are helpful: many remedies cause nystagmus and pupillary disturbances.

Eye symptoms with intoxication

Tremor may be present, but there is no icterus of the sclera, and laboratory findings are unremarkable. Drug intoxication is usually recognizable on the EEG: frontal (barbiturates) or generalized (benzodiazepine) beta waves appear, or dysrhythmic wave groups mainly in the temporal regions. It is useful to do a toxicological urine test, but usually the test is long enough to help on the spot. If it is possible to determine the level of antiepileptic drugs in the blood serum by an enzyme method, then this also applies to barbiturates and benzodiazepines, the most commonly used drugs. There are also qualifiers for other psychotropic drugs such as lithium.

The next condition in which there is an acute onset of confusion is encephalitis. The presence of any febrile illness prior to the onset of encephalitis is not mandatory. Unfortunately, the first symptoms of the disease - confusion and EEG changes - are rather non-specific. Neurological signs may not appear immediately. Hyperthermia does not always happen. Pleocytosis in the cerebrospinal fluid has not yet been determined. Only an increase in protein levels helps to suggest a diagnosis of encephalitis. Serological data will be available at the earliest in a week.

Encephalitis is often diagnosed by ruling out other possible causes. It is useful to pay attention to the acute onset of fever, headache and impaired consciousness. In case of rapid deterioration of the patient's condition, it is advisable to start therapy even when there is still no serological confirmation.

The subgroup of vascular diseases includes conditions of various etiologies, which are usually easily differentiated. Psychiatric disorders rarely dominate in ischemic stroke, while intracerebral hemorrhage can lead to confusion to the point of hemiplegia or brainstem syndrome. The diagnosis can be assumed if the patient has suffered from arterial hypertension for a long time. However, this circumstance should not be the only rationale for performing a lumbar puncture. An increase in local plus generalized EEG changes may confirm the diagnosis, but only a neuroimaging examination can accurately establish the diagnosis. The onset of a subarachnoid hemorrhage is sudden and usually causes a headache in people who have never experienced confusion before. With very few exceptions, there is stiffness of the neck. Then other meningeal signs appear. Often found oculomotor and pupillomotor symptoms, subfebrile condition. Lumbar puncture reveals blood in the cerebrospinal fluid, which becomes xanthochromic after centrifugation.

With a bilateral stroke in the basin of the posterior cerebral arteries, visual loss and a state of confusion are often observed. Anosognosia in acute cortical blindness may occur. Such patients do not respond to visual stimuli, sound stimuli attract the eye, but this is not a very accurate fixation. In addition, patients deny the existence of blindness and describe their environment when asked to do so using confabulations that complement the state of confusion. Optokinetic nystagmus is absent.

Multi-infarct dementia can lead to intermittent states of confusion. A series of small (sometimes large) strokes leads to a gradual deterioration of various cognitive functions, such as memory, speech, attention, which forms multi-infarct dementia. Episodes of nocturnal confusion are often observed. Emotionality flattens, complacency appears, sometimes pathological laughter and crying develop.

In this situation, the next stroke leaves the patient in a state of confusion. Diagnosis is based on a characteristic history and neurological deficit, which corresponds to a lesion in a particular vascular pool. Neuroimaging examination reveals residual phenomena of previous strokes.

In practice, it is very important to single out "atherosclerotic" patients who do not have a history of multi-infarct dementia, are quite balanced, reasonable elderly people. Only after, for example, surgery under general anesthesia can they wake up in a state of deep confusion, as well as during any acute illness. MRI reveals signs of past “silent” infarcts, usually lacunar.

On the contrary, in Alzheimer's disease, the neuropsychological deficit is constantly progressing. It is possible to identify mild neurological symptoms (especially with a mixed type of dementia). Initially, emotional reactions are preserved, as are the patients' habitual social skills. The onset of acute confusion is often associated with changes in the patient's life, such as a move, the loss of a dear family member, or admission to a hospital. Neuroimaging data indicate a global decrease in brain volume. Neuropsychological examination confirms the diagnosis.

The state of acute confusion due to metabolic disorders is almost impossible to diagnose at the clinical level. Of course, it is well known that fluttering tremor, that is, asterixis, is observed in pathology of the liver and kidneys and other metabolic disorders. However, as a rule, the diagnosis is based on laboratory data. In the presence of a state of acute confusion of unknown etiology, screening for metabolic disorders is necessary.

The list of main causes, which, of course, is not complete, includes: diabetes mellitus, Addison's disease, dehydration, hypercalcemia, hyperinsulinism, hyper- and hypoparathyroidism, porphyria, respiratory acidosis and thiamine deficiency, kidney and liver failure, chronic lung diseases, etc. Metabolic encephalopathies, as a rule, are accompanied by a tendency to slow down the bioelectrical activity on the EEG.

In this regard, it should be noted that occult bleeding, including intestinal bleeding, can lead to such a decrease in the number of circulating erythrocytes that the result is global cerebral hypoxia, debuting as a state of confusion without neuropsychological disturbances or a decrease in the level of wakefulness. Characterized by pallor and, especially, tachycardia in a sitting position; with intestinal bleeding - black feces. More often hidden internal bleeding leads to fainting.

Twilight states of an epileptic nature can occur not only in patients who are aware of their illness, but also after the first attack. They may follow a major seizure or a series of seizures. In this case, the patient is disoriented in time and cannot correctly assess the situation. The patient may have delusional disorders, a vague sense of danger, misinterpretation of even the neutral movements of others, and aggressiveness.

With a continuous series of complex partial seizures, aggressiveness is not typical. Often, patients move slowly, perform inappropriate activities, and appear to be incompletely awake. Diagnosis is greatly facilitated if there are oral automatisms such as chewing, swallowing, and/or stereotypic hand movements, as often seen in an isolated partial complex seizure. The final diagnosis is based on observation of the patient and EEG.

The state of post-traumatic psychosis is often not diagnosed if it occurs when a patient wakes up after a post-traumatic loss of consciousness in the surgical department. Characteristic features are anxiety, restlessness and an illusory, disturbed interpretation of the environment. Patients tend to leave their bed or even leave the ward despite strict bed rest instructions. Often this is regarded as a violation of the regime, and the pathological nature of the condition is not recognized.

Sometimes in the postresuscitation state or after several sessions of electroconvulsive therapy, a transient state of confusion develops with disorientation and inappropriate behavior.

Confusion is not only the most common complication that occurs in elderly patients after hospitalization, but also the most serious. Although stroke is certainly a predisposing factor for the development of confusional syndrome, a number of studies have shown conflicting results with a range in incidence of confusion from 13% to 48%. The type and location of the stroke can affect the likelihood of confusional syndrome. Most often, it occurs after intracerebral hemorrhage, circulatory disorders in the basin of the internal carotid artery, and, according to some reports, the occurrence of confusion may be associated with damage to the nuclei of the thalamus and dentate nuclei of the cerebellum. However, there is no exact data on the causes of development and principles of treatment of confusion in the acute period of ischemic stroke, while the development of confusion has serious prognostic consequences - a longer hospital stay, a high risk of mortality and disability, dependence on care, an increase in the burden on relatives.

The purpose of the study was to evaluate the impact of confusion that developed during the acute period of ischemic stroke on the development of post-stroke cognitive impairment.

Materials and methods. We analyzed 238 case histories of patients with acute cerebrovascular accident of the ischemic type, examined 12 patients who developed severe confusion in the acute period of ischemic stroke, and 56 patients in whom the acute period of ischemic stroke was not complicated by the development of confusion. Acute confusion developed in 73 patients. The mean age was 72.3 years. Severe confusion was diagnosed according to the results of the DRS scale (Delirium Rating Scale), if the total score was at least

12 and persisted for less than 24 hours. Cognitive impairment was assessed using the following scales: Mini Mental Status Assessment (MMSE), 10 word test, Frontal Dysfunction Scale (FAB), Clock Drawing Test. Care workload for relatives was assessed using the Patient Assistant Workload Scale. In all patients, the diagnosis of ischemic stroke was confirmed by the results of computed tomography.

Results. In a neuropsychological study of patients after stroke, cognitive deficit was more pronounced in patients with developed confusion in the acute period of ischemic stroke: MMSE = 22.5 ± 1.0, 10 word test 4.1 ± 1.1, FAB = 13 ± 1, 8 (in the group with developed confusion) and MMSE = 27.8 ± 1.2, test 10 words 5.9 ± 1.4, FAB = 15 ± 1.2 (in the group without confusion). No statistically significant test results were found on the clock drawing scale. When interviewing relatives on the Scale of the load on the patient's assistant, the results were 53.3 ± 14.6 (in the group with developed confusion) and 32.0 ± 5.4 (in the group without confusion).

Conclusion. The statistically most significant dependence of cognitive impairment in patients who have experienced confusion in the acute period of ischemic stroke, in relation to patients who have had ischemic stroke, not complicated by severe confusion, has been established. In addition, when interviewing relatives, it was revealed that patients in whom ischemic stroke in the acute period was complicated by confusion, even after discharge from the hospital, presented significantly more difficulties in care.

Litvinenko I.V., Khlystov Yu.V.

Military Medical Academy, St. Petersburg

A pathology in which the nerve cells of the brain die is called a stroke. The cause of the violation is difficult blood circulation with varying degrees of severity.

There are such types of strokes:

Ischemic stroke (cerebral infarction) - occurs in 80% of cases. Basically, atherosclerotic plaques, thrombosis, heart failure, embolism, etc. are considered to be the cause of a heart attack. This species has the most favorable prognosis in terms of recovery.
Hemorrhagic stroke - every sixth hemorrhage in the brain belongs to this type. It develops as a result of damage to the vessel wall with its further rupture. Blood in direct contact aggressively affects the nerve cells of the brain and irreversibly damages them. After a stroke of this type, death occurs in 1/3 of cases.
Mixed stroke is a rare type of pathology. It is a hybrid of ischemic and hemorrhagic strokes. In this case, the diagnosis is difficult. Delayed treatment leads to death.

The consequences of ischemic and hemorrhagic stroke are largely similar. What are they like? What causes a cerebral infarction?

If an ischemic stroke occurs, the consequences are as follows:

Paresis or paralysis of the arms and legs.
Problems with coordination.
Hearing misunderstanding.
Loss of control over motor activity.
Having problems with speech.
Violation or complete loss of sensitivity to cold, heat and pain.
Inability to adequately perceive information.
Poor speech perception and difficulty concentrating.
The emergence of problems with elementary skills (combing, tying shoelaces, holding a spoon, etc.).
Committing unconscious acts that can harm the patient himself and those around him.
Passive behavior and apathy. The patient may refuse treatment.
Loss of coordination and inability to navigate in space. A person can walk and fall. Or it seems to him that he has paralysis of the arms and legs.
Amnesia.
Dementia.

The consequences appear 3-4 weeks after the acute period of the disease. It is during this period that long-term symptoms are determined, which are formed depending on the location of the lesion.

The consequences of hemorrhagic stroke are manifested in the following:

A sharp deterioration in the condition, up to a lethal outcome. It occurs with extensive hemorrhage and damage to vital areas of the brain.
Coma followed by death.
Paralysis of the arms and/or legs.
After a coma, a person falls into a stupor.
Swallowing problems.
Paresis of the legs and / or hands.
Loss of the ability to think logically.
Attacks of pain.
Exit from the vegetative state and subsequent deep disability.
Complete or partial loss of the ability to speak and perceive information.

A type of hemorrhagic stroke is a subarachnoid hemorrhage. It usually occurs as a result of a head injury.

The most common consequences are:

Vasospasm and development of ischemia.
Hydrocephalus.
Pathologies of organs and systems.
Memory and attention disorders.
Headache and nausea.
Epilepsy.
Aneurysms may worsen the condition and re-stroke.

A stroke of any type does not pass without a trace. Depending on the severity and area of localization, complications after a stroke can be very severe, moderate, and mild.

With a hemorrhagic type of stroke - more than 80% of patients die, after a cerebral infarction - 40% of cases end in death, with a subarachnoid type - up to 60%.

Clinical manifestations:

The psychological state of the patient is depressed.
The pupils react badly to light.
Pain sensations are reduced.
Possible loss of consciousness.
Confusion of consciousness and apathy.
The person does not make contact. Basically, the cause of this condition is a right-sided stroke.

Perhaps the onset of coma in the case of untreated stupor.

Timely diagnosis of sopor is important for the appointment of effective treatment. Impairment of consciousness can be identified by the results of:

BP measurements.
Evaluation of pupillary response to light.
Measurements of pulse and respiratory rate.
Temperature measurements.
Establishing the presence of the kinetics of the eyeballs.
Examination of the skin for manifestations of allergies, the presence of injuries and assessment of the condition of the vessels.

In the future, electroencephalography is performed, which makes it possible to evaluate the functioning of neurons. If sopor is confirmed, the patient must be immediately hospitalized.

To quickly eliminate anxiety symptoms, 40% glucose solution, thiamine and naloxone are administered intravenously. In the future, the pathological condition is treated individually, the treatment regimen is selected by the doctor.

After a stroke, such a serious condition as cerebral edema often develops. Symptoms:

Intense pain in the head.
Vomiting and nausea.
Memory losses.
Loss of consciousness.
Unsteadiness while walking.
Weakness and trembling of the hands.
Slurred speech.
Seizures.
Stupor.
Breathing problems.

Cerebral edema develops within 48 hours after a stroke, the maximum severity of symptoms occurs on days 3-5.

Diagnosis and treatment consist of the following steps:

Computed tomography (CT) is performed to determine the area of edema.
Magnetic resonance imaging (MRI) is performed.
A blood test is taken.
Pain relief is provided.
An individual course of therapy is prescribed.

In severe cases, when the specialist has no other choice, an operation is prescribed. Surgical intervention is possible to carry out:

Trepanation - to eliminate a blood clot and ensure the outflow of cerebrospinal fluid.
Endoscopically, by inserting a catheter.

The latter method is more modern, but not shown to all patients. If the doctor prescribes an operation, it means that other methods of treatment are not able to lead to the desired result.

The main causes of pneumonia in patients with stroke:

In violation of swallowing functions, food can enter the respiratory tract. This complication leads to aspiration pneumonia.
Prolonged immobility and stagnation in the pulmonary circulation leads to hypostatic pneumonia.

Inflammation of the lungs is treated with antibiotics.
In case of problems with swallowing, the patient is artificially fed. Oral hygiene is monitored, mucus and sputum are removed from the oropharynx in a timely manner. With a stable condition of the patient, after a while the probe is taken out and taught to eat on its own.
To prevent the respiratory sacs (alveoli) from collapsing, it is recommended to inflate balloons. Thus, breathing is restored, and the walls of the respiratory sac are moved apart.

Motility disorders due to stroke are of two types: paralysis - complete loss of motor activity of the arms and legs; paresis - partial loss of the ability to make movements.

Neurological paresis and paralysis are considered common complications of cerebral stroke.

In this case, the muscle tissues of the side that is under the control of the affected hemisphere are completely or partially affected.

Types of paralysis:

Central paralysis - the patient's motor activity is completely or partially impaired. Therefore, the patient has paralysis of the whole body or a certain half of it. Also, only an arm or leg may be paralyzed.
Peripheral paralysis - muscle tone decreases, its complete loss is possible. There is also a lack of reflexes.

Therapy for ischemic stroke includes methods such as:

Physiotherapy.
Recovery massage.
Manual therapy.
Psychological assistance for adaptation to life after the transferred condition.
Physiotherapy.
Acupuncture.
Working with a speech pathologist
Surgical and medical treatment.

If recovery occurs at home, then the control of the attending physician is required.

Treatment of hemorrhagic stroke:

Prescribing drugs to restore the choroid of damaged brain tissue.
If necessary, neurosurgical intervention is recommended.
Exclusion of any load.
Restoration of paralyzed arms and legs is possible only after the main course of treatment.

A serious complication after a stroke is repeated hemorrhage. The relapse develops against the background of a chronic lack of oxygen in the vessels of the brain.

Other significant factors are:

Vascular tone.
Intense physical activity.
Diseases of the cardiovascular system.
Hypertension.
Infectious diseases.

Often a recurrent stroke develops due to a person’s negligent attitude to their health. Therefore, prevention and a healthy lifestyle are the key to reducing the risk of recurrent hemorrhage.

After a stroke, urinary retention or urinary incontinence may develop, so bladder catheterization is performed, which can lead to the development of an inflammatory process in the urinary system.

When installing a catheter, asepsis rules come first.
The bladder should be washed at least 3 times a day.
Urine culture is periodically performed.
Inflammation should be treated with antibiotics.

After a stroke, amnesia develops if the hemorrhage has affected the temporal lobes of the brain, because that is where the memory centers are located.

Types of amnesia:

The person does not remember recent events.
Distant events are forgotten.
Complete loss of memories.

A psychiatrist should treat a patient with amnesia; with the right therapy, the mnestic function is restored.

A coma after a stroke is a borderline state between life and death. This complication is rare and is a serious human condition. The main signs of coma:

Loss of consciousness.
Lack of response to stimuli.
Violation of vascular tone.

The coma has the following degrees:

If the brain damage is not extensive, then the person comes to his senses within 3 hours. Sometimes there is a short-term loss of consciousness, but the condition is characterized as moderately stable. At the same time, lethargy and drowsiness are observed. In this case, the prognosis is favorable.
The patient is in deep sleep, there is no reaction to stimuli, breathing is noisy and intermittent. If the condition is observed for up to several tens of hours, and then stabilizes, then there are significant chances to restore functions.
With full immersion in deep sleep, the patient's body temperature and blood pressure decrease, the person needs artificial stimulation. The patient's condition is serious and stable, the chances of recovery and exit are minimal.
In the fourth degree of coma, most of the brain is not recoverable. Basically, this condition leads to death.

Often pressure sores occur in patients with paralysis of the arms and legs, since such patients lead a sedentary lifestyle. The danger of pathology is the necrosis of tissues to cartilage and bones.

Prevention:

Changing the position of the patient's body every 2-3 hours.
Skin processing. Twice a day the body is rubbed with warm camphor alcohol.
The body must be examined daily.
A light massage is given.
The patient needs to organize good nutrition.

The mental state after a stroke is disturbed when the frontal part of the brain is damaged. Problems may appear as follows:

neurotic symptoms.
Increased moodiness and tearfulness.
Sharpening of character traits of moderate and severe degree.
Serious mental disorders.
Severe post-stroke dementia.
Sleep disorders.
Irritability.
Suspiciousness and anxiety.

It is necessary to treat disorders after consultation with a psychiatrist and a neurologist. Only a specialist is able to choose the necessary course of therapy.

Yakutina Svetlana

OInsulte.ru project expert

In this and subsequent articles, we called confusion conditions in which the patient loses the ability to think with normal speed, clarity and consistency. Disorientation, impaired attention and absent-mindedness, difficulty in assessing what is happening and processing information, a qualitative decrease in all types of mental activity are among the most common signs of confusion. Perceptual disturbances, including those with visual and auditory illusions and even hallucinations, occur less frequently.

In contrast to this delirium we call a special type of confusion, the main symptoms of which are agitation, perceptual disturbance or "sense fogging" (misinterpretation and identification), vivid and terrifying hallucinations and dreams, a kaleidoscopic series of strange and absurd fantasies and delusions, intense emotional experiences, insomnia and convulsive readiness. Delirium is also characterized by increased levels of brain activation, psychomotor agitation, and hyperactivity of the autonomic nervous system.

Some authors, especially psychiatrists, use the term "delirium" to refer to all forms of confusion that develop against the background of acute and even chronic diseases of the brain; they do not distinguish between delirium and other states of confusion. From our point of view, the circumstances of the onset of delirium, its symptom complex and pathogenesis make it possible to distinguish it from the group of all other states of confusion, which will be discussed further.

Some characteristics of this syndrome have already been discussed in our article on coma. In the classic cases of these conditions (due to poisoning or metabolic disorders), all intellectual functions are violated to some extent, but most significantly - the ability to understand all the details of a particular situation, the sequence of thinking, remembering recent events, the speed and accuracy of the reaction. The patient is inattentive and easily distracted, he is not able to maintain a conversation for a long time. Illusions and hallucinations may occur. Drowsiness is noted. As confusion deepens, the level of wakefulness gradually decreases and stupor develops.

The main causes of acute states of confusion are presented below. The morphological and pathophysiological changes discussed in this article are found in at least one large subgroup of confusional states. In most cases, morphological changes are not detected, and in many situations even the cause remains unclear. EEG is almost always changed, the degree of violations of the main rhythms reflects the severity of encephalopathy; in severe cases, high-amplitude slow theta or delta waves are usually recorded.

Delirium presented most fully in delirium tremens in patients with chronic alcoholism. Having stopped taking alcohol after a long period of its use, the patient becomes restless, anxious, he has a high-frequency tremor of action, sleep is disturbed, visual and auditory hallucinations and illusions are possible. Approximately every fourth patient before or at the beginning of delirium has one or more generalized convulsive seizures. These symptoms rapidly increase to a full picture of delirium: the patient is trembling, disoriented, restless, absorbed in his hallucinations. He talks non-stop and incoherently, unable to sleep. Temperature rise is possible.

In the presence of concomitant diseases, such as pneumonia, meningitis, liver failure or traumatic brain injury, psychomotor activity is reduced, so the characteristic manifestations of Delirium that distinguish it from other states of confusion disappear. And in most cases, delirium tremens disappears within a few days, without leaving behind any disturbances.

In the most typical cases, with an EEG, if it can be removed from such restless patient, either fast activity or diffuse theta activity with a frequency of 5-7 Hz is recorded, but not diffuse slow activity, characteristic of other states of confusion. Autopsy fails to detect any cellular damage in cases of death, which is not surprising, since there are no clinical consequences left when the delirium resolves.

medicalplanet.su

Confused mind: symptoms, causes and treatment

Symptoms of the disease

Fast and slow manifestation of the syndrome

Disorientation, its varieties

Root Cause Dependency

Confused consciousness: causes of appearance

Consider the possible causes of confusion:

1. traumatic. The disease can be the result of traumatic brain injuries, especially if they are of a penetrating nature. Although sometimes a brain injury can cause such problems due to the high sensitivity of brain tissue. Often the cause is aneurysms, characterized by a large number of dangerous manifestations.

2. toxic. The cause of the disease can be poisoning with mercury, alcoholic beverages or drugs. In wartime, various neurotropic gases and organophosphorus substances were used as weapons that act in this way. Neurotoxins can be found in foods such as carambola, puffer fish. The appearance of similar consequences of mushroom poisoning is also common.

3. Consequences of diseases. Diseases accompanied by severe intoxication of the body and hyperthermia (flu, tonsillitis, acute respiratory infections and others) sometimes lead to confusion. This is especially true for children and adolescents. The risk of such conditions occurs when injuries, fractures and large blood loss occur. Tuberculosis and syphilis are other possible causes. Encephalitis, acute diabetes mellitus, severe hepatitis of various types, and the final stages of AIDS can also be the cause.

4. Neoplastic manifestations, and not necessarily arising in the tissues of the brain. This is due to the fact that tumors are always accompanied by severe intoxication, so confusion in oncology in the later stages becomes inevitable. The danger is not only classic tumors, but also leukemia. It appears in 15-30% of patients, and reaches 85% by the last weeks of life. It introduces additional tension in the state of the patient and his relatives and affects the symptoms and methods of cancer therapy, including correcting the effect on pain.

5. Circulatory pathologies. Both serious disorders, such as a stroke, and ischemia, which are considered transient, that is, proceeding without consequences and are only a signal of the presence of problems, often provoke confusion. The severity of the disease and the manifestation of symptoms will be different depending on the severity of the pathology that serves as a trigger. In myocardial infarction, confusion occurs due to problems with blood circulation and the severity of pain sensitivity.

6. Vegetovascular dystonia due to partial disturbances in the areas of blood vessels and the autonomic nervous system, it is also accompanied by mild confusion.

7. Outcome of degenerative diseases. The manifestation can occur to a severe degree at the peak of senile dementia, insanity of various origins, Alzheimer's disease. In this case, it is caused by problems with brain activity and problems with orientation.

Confusion treatment

alcohol as a reason

Disorientation in time

Confusion

Confusion- this is a broad concept, which often includes many subspecies of clouding of consciousness and is, as it were, a collective name. But the very confusion of consciousness is still most inherent in asthenia. Most often, this condition develops when a person is weakened after an illness or any mental, labor overstrain. If a person has some kind of nervous weakness according to the type of natural tendency to this, such a condition can also be provoked. Its dangerous consequences vary depending on the severity, but this is a signal of individual mental problems or gaps. The more common meaning of confusion is often used, for example, when it is difficult to diagnose a specific condition that can appear in a person.

Confusion of consciousness - what is it?

In general, all violations of consciousness are combined into two huge groups: unproductive, with a blackout of consciousness, and productive, with clouding of consciousness. Confusion of consciousness is to some extent a transitional state, and it is not always possible to observe psychoproduction, but this state rarely occurs on its own. At some point, a certain resolution of the situation of confusion will definitely come, and it depends on the underlying pathology to the greatest extent. Some patients are able to gradually "boot", falling into a state of disconnection, while others, on the contrary, gradually becoming aroused, combine confusion with other more dangerous psycho-productive obscurations of consciousness, amentia, delirium. Depending on what suffers more and what pathology is the root cause, different specialists deal with this person, in the first case more neurologists and even resuscitators, but in the latter psychiatrists. When the doctor uses the term confusion, he is emphasizing the person's attention problems, as well as decreased wakefulness and thought sequencing. Cognitive decline is also characteristic, mostly temporary, but affecting several mental spheres.

Confusion of consciousness with asthenia- this state, accompanied by a flicker of clarity of consciousness, is expressed by the exhaustion of psycho-neuronal processes, the deepening of stupefaction in the evening. This condition is not produced out of nowhere, it progresses along with the underlying disease that caused it.

Confusion of consciousness is often used as a cumulative expression of obscurations of consciousness, but in fact, confusion turns into amentia or delirium. But if you evaluate it as a whole, then all these states can really be called confusion. For a better understanding of the term "confusion of consciousness" it is worth considering all the components included in it. So, delirium is a non-specific organic cerebral syndrome, which is accompanied by a clouding of consciousness with experiences of an illusory and hallucinatory composition. Amentia is the most severe form of clouding of consciousness, manifested by severe confusion, incoherence of associations, inability to assess the situation. All these states pass among themselves depending on the severity of pathological manifestations, while the time of day mainly affects the state of the person.

To diagnose confusion, it is important to understand Jaspers' criteria for clarity of consciousness. Disturbed consciousness can be considered when a person is alienated from the environment, disoriented, a person forgets the period of disturbed consciousness. But each subtype of violation has its own characteristics in all these violations. So, with confusion of consciousness without any more aggravating concomitants, amnesia, if any, is incomplete. Disorientation is mostly temporary and at the location, while knowledge about one's own person is preserved. If we talk about delirium in the structure of confusion, then amnesia is already more pronounced there, the memories that appeared under the influence of psychoproductive symptoms are well preserved, but the real events of that period are forgotten. Well, the most severe manifestation is amentia, in which amnesia is fully expressed for the entire period of stupefaction, there is also significant spatial disorientation with a violation of orientation in one's own personality.

The most common way to use this term is when there is no obscuration of consciousness yet, but there is also no clear consciousness either. Confusion can be diverse with its own manifestations, depending on the underlying causes and on the person himself, namely:

- Hallucinatory confusion is characteristic of verbal hallucinosis.

- Catatonic confusion of consciousness is manifested during catatonic excitation.

- Confabulatory confusion is present in the presence of problems with memory.

- Manic confusion of consciousness is formed with the expressive course of a manic syndrome, in a state of extreme excitement.

- Vascular confusion is characteristic of vascular pathologies.

- Confusion in the elderly is confusion in old age.

- Reactive confusion is also accompanied by confusion, disorientation and lack of understanding.

Confusion of consciousness: causes

This condition cannot be attributed to very specific or signaling a certain group of pathologies, but if it has appeared, then it is important to realize its danger. This means that the person clearly has some problems of the neurological group. This group can also include traumatic, traumatic brain injury with loss of consciousness can often lead to confusion, especially with a picture of penetrating trauma. Often, even a brain bruise can lead to a state of confusion due to the sensitivity of the brain tissue. Subarachnoid hemorrhages do not always cause injury, more often it is a rupture of an aneurysm in the brain, which, in addition to confusion, is characterized by many dangerous manifestations. Many neurological pathologies: Alzheimer's disease, multiple sclerosis, are also accompanied by confusion.

Toxic influences can also often affect the effect of confusion, lead poisoning, mercury poisoning, narcotic drugs and alcohol can lead to this condition. A variety of military neurotropic gases, as well as organophosphorus compounds and other neurotroxins, often provoke this condition. In some cases, even certain foods can be considered neurotoxins, such as carambola, puffer fish, stone fish and rambutan.

Diseases with a pronounced intoxication component and especially hyperthermia: influenza, colds, acute respiratory infections, measles, rubella, chicken pox, tonsillitis, meningitis also lead to confusion with delirium, especially in young individuals. Fractures, massive blood loss, and multiple injuries also pose a risk of developing these conditions. Encephalitis, caused mainly by a viral nature, herpes, Lymeboreliosis also leads to states of confusion. Tuberculosis and syphilis, especially reaching the brain stem, also pull irreversible consequences.

Various neoplastic manifestations and not only those associated with brain tissues also lead to this condition. After all, tumors are always intoxication, and in severe stages, confusion is inevitable, as is the risk of metastasis. Moreover, not only classic tumors are dangerous, but all types of leukemia.

All conditions with the presence of circulatory pathology with its violation also often provoke confusion. It can be either a serious violation, such as a stroke, or less dangerous, but signaling the presence of a problem, transient, that is, passing without a trace, ischemic attacks. Confusion of consciousness in conjunction with such manifestations is always present, but its severity and the depth of symptoms are highly dependent on the severity of the lesion and the severity of the underlying pathology.

Confusion of consciousness in myocardial infarction also a very characteristic condition belonging to this group. At the same time, it is provoked due to problems with blood circulation and severe pain sensitivity.

Confusion in VVD is also a very characteristic pathology that brings significant discomfort. This problem is associated with a violation of the innervation of individual vascular spaces and pathology in the normal functioning of the vegetative system. All this, depending on the subspecies, leads to different symptoms, but the accompanying confusion of a mild degree is inevitable.

The manifestation of a degenerative disease, Alzheimer's disease, Pick's disease, marasmus of any etiology, senile or vascular dementia also has confusion in its structure and this is combined not only with orientation disorders, but also with difficulties in brain activity. Confusion at pronounced stages reaches a severe degree and may even be with pronounced psychoproduction.

Metabolic disorders, encephalopathy, mushroom poisoning, acute complications of diabetes mellitus, especially hypoglycemic ones, can also lead to such difficulties. Due to confusion, the person is unable to navigate and quickly finds lethal "adventures". Excess fluid and certain electrolytes can also lead to similar effects. Vitamin deficiencies, like hypothermia, can also have similar outcomes.

Not only intoxication disorders, such as alcohol intoxication, but also the withdrawal syndrome can play a leading role in confusion. Moreover, not necessarily of alcoholic origin, possibly narcotic, toxic or drug-induced. But the most common is alcoholic confusion, which subsequently turns into delirium.

Severe hepatitis, as well as the final stages of AIDS, also lead to confusion. Sleep deprivation, especially in emotionally labile people, as well as severe emotional upheavals also become triggers in many of these problems.

Confusion of consciousness: symptoms and signs

Confusion of consciousness is a characteristic manifestation, specific for many pathologies.

Confusion of consciousness manifests itself in different people individually and depends on the degree of intoxication or other causes that caused it. It is difficult for a person to think, so thinking slows down, mainly with a violation of the sequence of these processes. In addition to mental disorders, disorientation is always observed, mainly allopsychic, that is, in place and time, but autopsychic is also possible, when even one's own personality becomes a mystery to a person. You don't have to be a doctor to check for these symptoms, as mental inconsistency and slowness can be seen in normal conversation. Well, to check the orientation, it is enough to ask the person to introduce himself, and also to clarify where he is and what the date is now. If a person names himself correctly, then the autopsychic orientation is correct and this is a favorable sign. But in order to check it, you need to have a document of the person or some of her acquaintances nearby, who could confirm the identity of the victim. Well, even a child is able to check the place and time, and with the correct indication of these data by the person, we are talking about the correct allopsychic orientation.

When consciousness is indicated, the term confused is used, that is, consciousness is no longer clear, and this is a factor that is important to pay attention to when providing assistance. Attention is greatly weakened, that is, such a person is not able to maintain a conversation, especially for a long time, very soon she is exhausted and stops answering questions. Making the least difficult decisions in such a state is problematic, even they are often not able to give a decision on hospitalization, then it is better to hospitalize according to the indications of the condition.

Depending on the root cause, other characteristic features may be mixed in. Confusion of consciousness in VSD is accompanied by pronounced autonomics with moderate pain manifestations. Often people with VSD are distinguished by a special somatotype and they are quite easy to distinguish. Confusion of consciousness during a heart attack is always accompanied, in addition to what is described, by an expressive pain syndrome, which in especially severe cases can plunge a person into shock. Metabolic causes also have additional symptoms in the form of odors or specific manifestations.

Confusion in the elderly is more chronic and they partially adapt to it, in addition to the disorientation itself, there are also pathognomonic senile disorders, such as a decrease in brain volume and cachexia. Confusion of consciousness in the elderly is a prognostically unfavorable sign, indicating significant mental disorders. Depending on the reasons, this condition may be transient or vice versa. If it is prolonged, then dementia with a negative outcome can be suspected. The speech of such persons also has a specific coloration, it is slow and not always consistent, fragmentary “inconsistencies” can often sound. Sometimes speech motor excitation is possible with illegibility of speech and a certain unpredictability of this personality. The mood of these people can be very changeable and difficult to predict, so you need to be careful about these people. In severe forms, confusion manifests itself with psychoproduction. Then fragmentary delusional ideas sound in the patient's speech. Often there can be illusory images, which subsequently flow into hallucinatory ones. The sleep pattern is also largely changed, but it can lead to complete insomnia or more often to expressive drowsiness.

In addition to the classic survey, common neurological and psychiatric questionnaires are used for diagnosis: the Glasgow Coma Scale and MMSE. Well, if the cause is an organic pathology, then MRI and laboratory tests are important: blood, urine, biochemistry, bacteriological analysis. All this helps to identify the root cause. All poisonings have additional symptoms, depending on the substance, as well as intoxication confusion. With alcohol withdrawal, delirious experiences with vivid figurative hallucinations are more characteristic.

Confusion of consciousness: treatment

Depending on the underlying causes of confusion, the treatment varies greatly. In case of traumatic pathologies, it is important to identify them in time and treat them correctly, often with the use of neurosurgery. In ischemic stroke, thrombolytics, such as Alteplase and Tenecteplase, in hemorrhagic stroke, surgery to remove the hematoma. It is important to remember that a person with a confused mind can cause trouble to others and harm himself, so it is very important to keep the patient in a safe room. Under the action of toxins, especially heavy metals and radiation, anti-radiation drugs of general action and Unithiol should be used. Diseases with intoxication and hyperthermia in the structure of confusion are treated with antiviral drugs: Groprinosin, Tamiflu, Oseltamivir, as well as antipyretics: Nurofen, Imet, Ibuprofen, Paracetamol.

Confusion in myocardial infarction is stopped by the action on the underlying pathology with the use of painkillers: Morphine, ACE inhibitors, beta-blockers, Propranolol, Atenolol. Confusion of consciousness in VSD is corrected by the regimen and diet therapy. Soothing chamomile and mint-melissa teas also work well. Of the drugs used: Persen, Valerian, Corvalol.

If a medicine has become a trigger for confusion, then you need to cancel it and correct all the violations caused by it. For meningitis and various serious diseases, it is important to use antibiotics: Penicillin, Bicillin, Ampicillin, Flemoklav. For tuberculosis: Rifampicin, Isoniazid, Ethambutol, Streptomycin, Etaperezide.

If there are behavioral disorders, then psychiatric drugs, tranquilizers or antipsychotics are used: Loxapine, Haloperidol, depending on the situation. But still, if possible, it is better to simply limit the person for the time of confusion, and then simply support it for a softer exit from this state. If a patient with senile dementia has confusion in the structure, then some little things in care are important. There should be things in the room that help the person navigate, like calendars and clocks. This will help relieve anxiety and give these people a little self-confidence. It is also important to look after the insomniac patient, it is better to leave the book and the light so that the person can occupy himself with something. In the absence of effectiveness, use sleeping pills: Azaleptil, Barbiturates, Chloral hydrate, Flurazepam, Clozepat, Oxazepam.

Dizziness - causes, diagnosis and treatment

Dizziness is one of the most common symptoms and accounts for approximately 5% of all complaints to doctors of various specialties. The proportion of patients increases with age, and in people older than 65 years is approximately 50%.

1. Causes of dizziness

Dizziness can be caused by many different causes. In young people, most often, this is too much alcohol or a sudden change in body position. At an older age, this problem can have much more serious grounds. That is why old people should not neglect such a symptom, especially if it is accompanied by others. In such situations, do not hesitate, but visit a specialist.

The reasons can be divided into the following groups:

neurological;

otolaryngological (ENT);

cardiovascular;

metabolic;

psychogenic (mental, psychological or emotional);

Neurological and otolaryngological causes

These include vertigo caused by damage to the vestibular apparatus in the inner ear, the nerve fibers that carry signals from it to the brain, the vestibular nuclei in the brainstem, or other structures of the nervous system responsible for maintaining balance.

An important point is that only one-sided damage gives a symptom of dizziness, and this does not occur if both sides are damaged.

Neurological and otolaryngological causes, which are closely related, can be divided into peripheral and central, based on the location of the "guilty" organs.

Causes related to the peripheral nervous system:

Trauma to the inner ear, for example, fracture of the pyramid of the temporal bone, formation of a perilymphatic fistula, concussion.

Inflammation of the inner ear and vestibular apparatus - this ailment can be the result of complications after the flu. Dizziness, nausea and vomiting persist for several days. Treatment is usually with antibiotics and steroids. It happens that a person is then sent to a special rehabilitation, where he is taught to keep his balance.

Vestibular neuritis - inflammation of the vestibular part of the vestibulocochlear nerve, most often caused by a virus, less often, autoimmune or vascular diseases. Symptoms worsen over several hours and include systemic dizziness with nausea, vomiting, and imbalance. After 2-3 weeks, the symptoms subside.

Tumors in the inner ear.

Ischemia of the inner ear - a decrease in blood supply, leading to a temporary disruption of its work or tissue damage.

Meniere's disease - fluid builds up in the inner ear, resulting in irritation of the vestibular apparatus, and sudden bouts of dizziness, nausea, and nystagmus (involuntary eye movements). These symptoms are accompanied by a feeling of fullness in the ear, ringing in the ears, and hearing loss. The symptoms last from a few minutes to several days, worse with head movement and better with closed eyes. Between attacks, tinnitus may persist for a period of time. During the course of the disease, hearing damage occurs. Meniere's disease is treated with diuretics, antihistamines, and steroids. Sometimes it is impossible to do without surgery.

Otosclerosis is an overgrowth of bone in the middle ear that can also affect the inner ear. Dizziness is not always observed, but short-term attacks are possible, which occur more often when moving the head.

Seasickness.

Causes related to the central nervous system:

Stroke of the brainstem and cerebellum.
Tumors, vestibular schwannomas (benign tumors).
Multiple sclerosis, demyelination (damage to the myelin sheath) when it affects the vestibulocochlear nerve.
Migraine.
Epilepsy.
Vertebrobasilar insufficiency is a violation of the blood supply to the brain, which also affects the vestibular apparatus.
Inflammation of the meninges and brain.

Dizziness can also occur with a number of many other diseases.

Cardiovascular and metabolic causes

Cardiovascular and metabolic diseases and disorders that can cause dizziness include:

reflex fainting (when changing the position of the body, coughing, emotional swings);

disturbances of consciousness associated with cardiac arrhythmia, heart defects, cardiomyopathy;

hypovolemia (reduction of blood in the body) caused by blood loss, dehydration, or anemia;

dysregulation of blood pressure;

diabetes;

kidney failure;

hypofunction of the thyroid gland;

menopause;

hyperventilation - too much breathing

neurotic disorders - mental disorders.

It is also worth mentioning the so-called pre-fainting state. It is accompanied by dizziness, darkening of the eyes, weakness in the legs, ringing in the ears, narrowing of the field of vision, pallor, nausea, sweating, but the person is conscious. It occurs in connection with the appearance of orthostatic hypotension - a sudden decrease in blood pressure, especially with a sharp change in body position (transition from a lying position to a sitting or standing position). This state usually does not last long, the pressure quickly equalizes, taking into account the new position of the body. However, in some people, especially the elderly, presyncope dizziness can be very severe and persist for several minutes. This condition can also be a consequence of changes in the cardiovascular system caused by atherosclerosis, coronary heart disease, arrhythmia (heart rhythm disturbance). Regardless of the cause, the result is too little cerebral blood flow, leading to non-systemic vertigo and pre-syncope, or even loss of consciousness.

No less important, and, moreover, very common, especially in old age, the cause of fainting is anemia. A reduced amount of hemoglobin in red blood cells causes an insufficient supply of oxygen to the cells. Although the main symptom of anemia is fatigue, due to insufficient oxygen being supplied to the brain, dizziness or lightheadedness can also occur.

The most common are neurotic disorders, which are associated primarily with the work of surrounding and ubiquitous external factors: stress, fear of losing consciousness, suffocation, symptoms of heart rhythm disturbances such as palpitations, neurological disorders in the form of tingling, weakness of the hands, mouth or nose. Very rarely, a feeling of false movement can join. Symptoms usually occur throughout the day. Usually accompanied by rapid and deep breathing (hyperventilation), which further increases the attack.

2. Neurological symptoms associated with dizziness

Systemic dizziness

When the cause lies in the vestibular apparatus or the connecting nerves between it and the brain, then such dizziness is called systemic or vestibular. It usually manifests itself in the form of periodic attacks - it is paroxysmal.

The symptoms are often accompanied by feelings of anxiety. A person may feel normal, and suddenly dizziness begins, which lasts from a few seconds to several hours, and in some cases disappears after more than one week. Moving the head clearly aggravates the symptoms, and closing the eyes relieves them.

Non-systemic dizziness

Accordingly, when dizziness is caused by problems with the central nervous system (brain and spinal cord), it is defined as non-systemic. People suffering from this problem have a visually difficult to detect feeling of uncertainty, instability of posture or gait. They have a feeling of instability, movement of the earth under their feet and poor orientation in space. These symptoms usually develop slowly. Their duration varies greatly, from a few seconds to several months or years. Characteristic is the appearance of ophthalmic symptoms, such as (blind spot in the field of vision), double vision, blurred vision, nystagmus, sometimes loss of vision in one eye. These symptoms may be accompanied by headache. Some vertigo may be accompanied by paresis (partial paralysis) of the cranial nerves, ataxia (impaired movement), dysarthria (impaired speech and / or understanding), other combinations of neurological diseases such as. Horner's syndrome (lowering of the upper eyelid, narrowing of the pupil, collapse of the eyeball).

3. When exactly is it time to see a doctor

The help of a specialist is necessary if there are:

repetitive and severe dizziness, combined with headache;

loss of consciousness;

muscle weakness in the legs or numbness and tingling in the limbs;

difficulty walking, talking, or blurred vision;

chest pain accompanied by dizziness;

arrhythmia (irregular heartbeat, too slow or too fast);

before that there was a head injury;

high temperature (over 38.5 C);

stiffness of the occipital muscles (their constant tension);

occasional hearing or visual impairment.

4. Diagnosis of dizziness

During the interview, when the patient complains of dizziness, it is most important for the doctor to find out:

symptoms appear suddenly or chronically;
what contributes to this, for example, a change in body position;
the duration of the symptoms and the sensations at the same time (circling, increasing, etc.);
Predisposing factors: ear infections, hypertension, heart disease, cardiovascular disease, diseases of the eyes, blood, drugs taken;
The presence of concomitant symptoms, such as hearing loss, impaired vision, speech, swallowing, signs of damage to the cranial nerves, paralysis of the limbs.

It is not always the case that a specialist (otolaryngologist, ophthalmologist or neuropathologist) can immediately make a diagnosis. Sometimes, in addition to a detailed survey, which even takes into account housing conditions and place of work, it is necessary to conduct additional research.

Research to identify the causes of dizziness

Provocative test - used to determine whether peripheral organs (vestibular apparatus and nerves) are at fault and from which side. They can be made using the Dix-Hallpike method. The patient, sitting on the couch, tilts his head to the side, and then also abruptly tilts it back, transferring him to the supine position so that the head begins to hang down by 30 °. At the same time, observe the manifestation of nystagmus and ask about dizziness. Or, in such a supine position, the vestibular apparatus is irritated with warm air to induce nystagmus. For a better assessment, the patient is put on Frenzel glasses, in which there are magnifying glasses and the vibrations of the eyes are better seen.
An audiometric test is a hearing test. During the test, the patient remains in an anechoic chamber wearing headphones that play sounds of various frequencies. When he could hear, he presses the button.
ENG and VNG, i.e. electro- and videonystagmography - the study of nystagmus (involuntary eye movements), using electrodes attached to the patient's temples, or special glasses with motion sensors.

Other studies used to identify causes of dizziness include computed tomography, magnetic resonance imaging, x-rays of the temporal bones and cervical spine. An ECG, doplerometry (determining the speed of blood flow in a certain place) or the method of evoked potentials (checking the electrical response of the brain to external stimuli) can also be prescribed.

5. Treatment of dizziness

The treatment of dizziness is based primarily on finding the cause. Part of it is aimed at eliminating the very feeling of dizziness and symptoms from other organs, incl. feeling of anxiety.

Medicines for the treatment of dizziness:

neuroleptics: chlorpromazine, promazine, thiethylperazine, promethazine;
antihistamines: dimenhydrinate, clemastine;
drugs acting on the vascular system: betahistine, cinnarizine, flunarizine, polfilin, nicergoline;
nootropic (brain-acting) drugs, such as piracetam.

A common drug in the treatment of vertigo is betahistine. The indication for its use is Meniere's disease, which is characterized by the following symptoms: dizziness (nausea, vomiting), progressive hearing loss, tinnitus.

The mechanism of action of betahistine is only partially known. In biochemical studies, it has been established that in the CNS, betahistine has a weak stimulating effect on the H1 form receptor and a strong inhibitory effect on the H3 receptor. These are two of the three forms of receptors for histamine, a substance produced in the body that plays an important role in the functioning of the central nervous system. The drug should be used with caution in patients with bronchial asthma, gastric or duodenal ulcers. The drug is not recommended for children under 18 years of age due to the lack of data on safety and efficacy in this group of patients.

Common side effects include nausea and indigestion, and headaches (headaches were as common in patients treated with placebo as in those treated with betahistine). Some patients experience mild gastrointestinal problems such as vomiting, pain and bloating, and gas. These symptoms usually improve when taken with food or when the dose is reduced. Allergic reactions are also possible - swelling, rash, itching, urticaria and anaphylaxis.

Another commonly prescribed drug is piracetam. It refers to nootropics that act on the central nervous system. Under their influence, cognitive processes improve, thereby improving perception, memory, concentration and awareness. The drug does not have a calming and mentally stimulating effect.

Piracetam increases the flow of blood through the vessels to the brain, affecting red blood cells, platelets and the vascular wall: it increases the elasticity of red blood cells, reduces the formation of platelets and reduces the likelihood of spasms of cerebral vessels. The drug is administered intravenously or intramuscularly.

During the use of the drug, side effects may occur. These include disorders of the nervous system, such as ataxia (impaired coordination of movements), imbalance, exacerbation of symptoms of epilepsy, drowsiness, insomnia, fatigue, headaches; gastrointestinal disorders (vomiting, diarrhea, abdominal pain, pain in the upper abdomen). On the part of the immune system, hypersensitivity reactions are possible: agitation, anxiety, confusion, Quincke's edema, dermatitis, itching, urticaria. If you have such problems, you should inform your doctor.

Vestibular rehabilitation

In case of damage to the musculoskeletal and vestibular apparatus, which are accompanied by slight dizziness, vestibular rehabilitation can be effective. This is a balance training that allows you to compensate for dizziness. It is also prescribed to people after neurosurgical operations (neurectomy, labyrinthectomy) after traumatic brain injury in patients with anxiety neuroses, Meniere's disease (when attacks occur less frequently than once a month), CNS and mixed injuries. This procedure is not suitable for people who experience dizziness and imbalance periodically in the form of seizures.

Surgery

Surgical treatment is used in some cases when certain causes of dizziness are known, such as a tumor or otosclerosis. Also, operations are prescribed when there is not sufficient improvement after conservative treatment for Meniere's disease - the symptoms still continue to be observed. These types of operations include:

intersection of the vestibular nerve;
removal of otoliths (“grains of sand” that irritate the channels) that cause benign paroxysmal positional vertigo;
removal of the organs of the inner ear (labyrinthectomy), in case of profound hearing loss.

Psychological support

On the part of doctors, an important component of treatment is also psychological support and a calm, detailed explanation of the nature of the disease and symptoms. And in the case of depression or neurotic disorders - adding antidepressants or tranquilizers to therapy, consultation with a neurologist or psychiatrist.

Dizziness caused by anxiety: features and treatment

Among the various emotional disorders, most often anxiety provokes dizziness, which doctors call psychogenic. Attacks are manifested by various unpleasant sensations: nebula in the head, cephalgia, fear of falling, tingling (noise) in the ears, a state close to mild intoxication.

Distinctive features of a psychogenic disorder

According to the accepted classification, dizziness can be true (vestibular) and imaginary. Dizziness associated with mental disorders differs from vestibular disorders in such characteristics:

There is no sense of whirling (movement) of one's own body and objects that are within sight.
Dizziness provoked by anxiety is characterized by spontaneity. They often occur in empty space, in the subway, when driving on a bridge, and also while climbing high stairs, steep steps.
They can occur both when walking and during inactivity - in a standing position, during rest (even a very short one) after intense physical labor.
Dizziness is manifested by vascular and autonomic disorders.
The first recorded case of an illness always originates from an episode covered by a feeling of strong anxiety, confusion.
Often, dizziness, inspired by fear and anxiety, is combined with congenital or chronic vestibular abnormalities.

Dizziness caused by anxiety and excitement is difficult to diagnose because it is not characterized by structural failures in the body. All systems function within the established parameters, analyzes have no deviations, examinations do not show affected foci.

However, against the background of general well-being, a person suffers from bouts of impotence, anxiety (often unreasonable), and dizziness. Feelings of anxiety - often associated with panic - are difficult for the patient to overcome on their own.

Symptoms accompanying dizziness with anxiety

Against the background of anxiety, depression or a panic attack, dizziness has the following symptoms:

a suffering person is covered by a feeling of loss, disorientation in space;
in the ears there is an incessant noise (ringing, light whistling, rustling);
the patient is not always able to soberly assess his situation, there is a slight clouding of the mind;
there is a persistent feeling of stiffness and tension;
there is increased sweating, including the head, feet, hands;
aching, paroxysmal headache is possible.

It is important to consider that not only anxiety causes dizziness. Often, headaches, including minor dizziness, can contribute to anxiety, anxiety, and panic.

The patient may experience pressure surges, myocardial arrhythmia, emotional imbalance, irritability, and insomnia. He is often overwhelmed by a sense of approaching danger, there is a desire to run away (hide). At the same time, there are no problems with visual function and hearing acuity, gait disturbances (unsteadiness), trembling in the legs, and other signs of disorders of the vestibular apparatus.

Identifying the causes of anxiety is the key to victory over the disease

To successfully get rid of dizziness associated with excitement and anxiety, it is important to understand what underlies the anxious feeling. Diagnosis of an abnormal condition includes two important steps.

Stage number 1. negative diagnosis. Its main task is to exclude other factors that cause dizziness.

These include:

Damage to the vestibular analyzer at any level.
Somatic neurological disorders.
Neurological ailments, leading to failures in walking and balance.

This stage involves various clinical testing, including ultrasound, tomography. It is important to carefully question the patient about the pathology (appearance and course) - his vision of the situation, feelings.

Stage number 2. Positive diagnosis of neurotic deviations that are produced by stress. In a feeling of acute anxiety that suddenly overtakes a person, it is not always possible to unearth the “root causes”. In psychogenic dizziness, the anxiety factor is almost 30%.

Confusion, anxiety in its pure form are recorded quite rarely. In 65% of patients, they are closely associated with a depressive period. Mental "pictures" of anxiety and depression are very similar, able to overlap each other. Depressive-anxiety disorders are the main "culprits" of an imaginary feeling of dizziness.

To overcome psychogenic dizziness provoked by increased anxiety, the most effective methods are those that include both pharmacological agents and a non-drug approach.

Non-drug treatments include:

Special gymnastics that trains the vestibular apparatus and reduces its excitability.
Abdominal breathing training. Its main rule is that the duration of the exhalation is twice as long as the inhalation.
Application of cognitive-behavioral psychotherapy.

In pharmaceutical preparations, preference is given to anxiolytic antidepressants, which are able to relieve anxiety, tension, anxiety. Paxil (Paxil), Fevarin (Fevarin) have proven themselves well. Less commonly prescribed (worse tolerated, has a number of side effects) Amitriptylinum (Amitriptyline).

Antihistamine, anti-anxiety effect has the drug Atarax (Atarax). Helps improve the quality of sleep, reduces the number of night awakenings, reduces nervousness and muscle tension. Means Betahistine (Betahistine) has a pronounced effect on the central nervous system, is used as an adjuvant.

Be attentive to your health, do not give the pathology a chance to go into a chronic stage.

Disturbances of consciousness are manifestations of dysfunctions of certain parts of the brain, which may be accompanied by a temporary complete or partial loss of connection with reality, hallucinations, delusions, aggression or fear.

Disturbances of consciousness include stupor, stunning, coma, twilight clouding of consciousness and some other conditions in which the patient is not capable of an adequate perception of reality.

Why does consciousness disappear?

The main causes of mental disorders include:

without visible structural changes in the brain;
and electrical activity of the brain;
, metabolic and mental illnesses;
drug addiction, alcoholism, substance abuse;

Types of disorders and disorders of consciousness

Disorders of consciousness are divided into two large groups: quantitative and qualitative. The group of quantitative includes coma, stunning (somnolence) and stupor. Qualitative ones include twilight stupefaction, ambulatory automatism, fugue and some other disorders of the brain.

The main types of violation and (or) clouding of consciousness:

Stupor (). Translated from Latin, this word means "numbness". A patient in a stupor stops responding to the surrounding reality. Even strong noise and inconveniences, for example, a wet bed, do not cause a reaction in him. During natural disasters (fires, earthquakes, floods), the patient does not realize that he is in danger and does not move. Stupor is accompanied by movement disorders and lack of response to pain.
Twilight clouding of consciousness. This type of disturbance is characterized by sudden onset and also suddenly disappearing disorientation in space. A person retains the ability to reproduce automated habitual actions.
locked-in syndrome. This is the name of the condition in which the patient completely loses the ability to speak, move, express emotions, etc. People around mistakenly believe that the patient is in and cannot adequately respond to what is happening. In reality, the person is conscious. He is aware of everything that is happening around him, but due to paralysis of the whole body, he does not even have the opportunity to express emotions. Only the eyes remain mobile, with the help of which the patient communicates with others.
. This is a condition in which the patient is conscious but confused. Him understanding of the surrounding reality. The patient easily finds the source of sounds, reacts to pain. At the same time, he completely or practically loses the ability to speak and move. After their cure, patients say that they were fully aware of everything that was happening around them, but some kind of force prevented them from adequately responding to reality.
. Characterized by a constant desire to sleep. At night, sleep lasts much longer than it should be. Awakening usually does not occur without artificial stimulation, such as an alarm clock. Two types of hypersomnia should be distinguished: the one that occurs in a perfectly healthy person, and the one that is characteristic of people with mental and other types of abnormalities. In the first case, increased drowsiness may be the result of chronic fatigue syndrome or. In the second case, hypersomnia indicates the presence of the disease.
Stun(or stupor syndrome). During stunning, the already mentioned hypersomnia and a significant increase in the threshold of perception of all external stimuli are observed. The patient may have partial amnesia. The patient is unable to answer the simplest questions by hearing voices and knowing where the source of the sound is. There are 2 types of stunning consciousness. In a milder form, the patient can follow the commands given to him, moderate drowsiness and partial disorientation in space are observed. In a more severe form, the patient performs only the simplest commands, his level of drowsiness will be much higher, disorientation in space will be complete.
Awake coma (). Develops after serious. The name "coma" this condition received because, despite being conscious, the patient is not able to come into contact with the outside world. The patient's eyes are open, the eyeballs are rotating. However, the view is not fixed. The patient has no emotional reactions and speech. The patient does not perceive commands, but is able to experience pain, reacting to it with inarticulate sounds and chaotic movements.
. A mental disorder that occurs with impaired consciousness. The patient suffers from visual hallucinations. Him there is disorientation in time, orientation in space is partially disturbed. There can be many causes for delirium. Elderly people and alcoholics suffer from hallucinations. Delirium may also indicate the presence of schizophrenia.
. Due to trauma and for some other reasons, a person loses the ability to mental activity. The patient's motor reflexes are preserved. The cycle of sleep and wakefulness is maintained.
dissociative fugue. A type of mental disorder in which the patient completely loses his former personality and begins a new life. The patient usually seeks to move to a new place of residence, where no one knows him. Some patients change their habits and tastes, take a different name. The fugue can last from several hours (the patient, as a rule, does not have time to radically change his life) to several years. Over time, there is a return to the former personality. The patient may lose all memories of the life he led during the fugue. A mental disorder can be caused by events that traumatize the psyche of a character: the death of a loved one, divorce, rape, etc. Psychiatrists believe that the fugue is a special defense mechanism of our body that allows us to symbolically “escape” from ourselves.
. A confusional disorder in which the patient loses the ability to synthesize. The general picture of the world for him breaks up into separate fragments. The inability to connect these elements together leads the patient to complete disorientation. The patient is not capable of productive contact with the surrounding reality due to the incoherence of speech, the meaninglessness of movements and the gradual loss of his own personality.
Coma. The patient is in an unconscious state, from which it is impossible to get him out of it by conventional means. There are 3 degrees of this condition. In a first-degree coma, the patient is able to respond to stimuli and pain. He does not regain consciousness, but responds to irritation with protective movements. Being in a coma of the second degree, a person is not able to respond to stimuli and experience pain. In third-degree coma, vital functions are in a catastrophic state, muscle atony.
Brief loss of consciousness ( , ). Fainting is caused by a temporary disruption of cerebral blood flow. The causes of short-term loss of consciousness can be a state of low oxygen content in the blood, as well as conditions accompanied by violations of the nervous regulation of blood vessels. Syncope is also possible with some neurological diseases.

Twilight state of consciousness and its types

Clouding of consciousness (twilight) occurs at , and . This type of disorder of consciousness is called transient, that is, unexpectedly occurring and transient.

Prolonged obscuration (up to several days) is possible mainly in epileptics. This condition may be accompanied by fear, aggression and some other negative emotions.

Twilight disorder of consciousness is characterized by hallucinations and delusions. The visions are terrifying. Expressed aggression is directed at people, animals and inanimate objects. For a person suffering from twilight obscuration, amnesia is characteristic. The patient does not remember what he said and did during his seizures, and also does not remember the hallucinations he saw.

Twilight consciousness occurs in several variants:

Ambulatory automatism. This condition is not accompanied by delusions, hallucinations or aggressive behavior. Outwardly, the behavior of the patient is no different from his behavior in the normal state. A person automatically performs all the usual actions. The patient may wander aimlessly down the street following familiar routes.
Rave. The patient's behavior does not always change. This state is characterized by silence, an absent look. The patient may be aggressive.
Oriented twilight clouding of consciousness. The patient fragmentarily retains consciousness, is able to recognize loved ones. Delusions and hallucinations may be absent. The patient experiences fear or aggression.
hallucinations. The visions that visit the patient during an attack are threatening. Patients see red or blood. Visions may contain fictional characters or fantastic creatures that show aggression. The patient begins to defend himself, harming even the closest people.

At the first signs of twilight conditions, a person needs to provide first aid, provide care and supervision. The patient should not be left alone. If consciousness is not completely lost, contact can be maintained with it.

Sometimes familiar faces become the only reference for someone who loses touch with reality. You should not wait until the patient has completely lost contact with the outside world. He needs urgent transport to the hospital.

First aid for impaired consciousness

During an attack in a patient, the people around him should take urgent measures. If consciousness is completely lost, you need to try to bring the person to his senses: let him smell ammonia, put a napkin soaked in cold water on his head.

You should also immediately call an ambulance, even if the unconscious person managed to get out of a fainting state.

With a partial loss of consciousness, the provision of first aid may be complicated by the patient's inappropriate behavior. With an incomplete loss of connection with reality, it is necessary to conduct a constant dialogue with a person so that there is no complete break with reality.

The patient should not be left alone with himself. However, others need to remember that in such a state a person may be subject to various kinds of hallucinations. He can harm those he loves.

Provision of medical care

A person suffering from any kind of mental disorders should be constantly observed by a psychiatrist and undergo a medical examination on time. Since the causes of impaired consciousness may vary, treatment may also differ on a case-by-case basis.

For example, if a patient suffers from kidney failure, he is prescribed hemodialysis. In case of drug overdose Naloxone needed. Loss of consciousness caused by alcohol poisoning requires large doses of thiamine. In addition, in case of any poisoning, you must first rinse the stomach.

If during the next attack the patient lost consciousness for a long time, fell into a coma, a vegetative state or stupor, the doctor needs to evaluate the vital functions and find out whether the patient's body can independently provide for its vital functions.

(Tizercin,) - drugs most commonly used in the treatment of disorders of consciousness, administered intramuscularly. Cordiamin is prescribed for the prevention of the collaptoid state. In the presence of the first signs of the patient must be hospitalized. A nurse is assigned to the patient for care and constant monitoring.

Disturbances of consciousness are a group of mental illnesses and disorders that prevent the patient from helping themselves on their own. A huge responsibility is placed on the relatives and friends of a sick person.

They should not allow the patient to remain on his own for a long time, and at the first sign of the onset of a seizure, they must be able to help him.

Confusion - symptoms of a person's clouded consciousness, which can be short-term or long-term in nature, depending on the etiological factor. This condition is a manifestation of a somatic process and a psychological disorder or a strong nervous shock. Such a symptom requires complex treatment in a hospital.

Diseases for which the symptom is characteristic:

diabetes;
hyperthyroidism;
schizophrenia;
bipolar personality disorder;
encephalitis;
traumatic brain injury;
severe concussion;
atherosclerosis;
myocardial infarction;
Alzheimer's disease;
epilepsy;
oncology of the central nervous system (CNS);
post-traumatic psychosis;
toxic poisoning;
multiple sclerosis;
alcohol withdrawal syndrome;
sudden drop in body temperature (hypothermia).

Confusion of consciousness: a general characteristic

The disease is characterized by a clouded consciousness of a person, in which speech disorders, drowsiness and hallucinations are noted. Pathology is temporary or permanent, depending on the reasons for which it appeared. Confusion can develop against the background of psychological disorders, neurological diseases, or circulatory disorders of the brain. This pathology requires observation by a specialist, careful diagnosis and treatment. Approximately 10% of patients admitted to a hospital with acute illness, the condition is complicated by the appearance of confusion.

Etiology and pathogenesis

Clinicians identify the following etiological factors that can lead to the development of this human condition:

drug intoxication;
psychological illnesses;
encephalitis;
traumatic brain injury;
severe concussion
vascular diseases of the brain;
neurological disorders;
damage to the central nervous system;
metabolic disorders;
post-traumatic psychosis;
epileptic seizures and twilight conditions;
Alzheimer's disease;
toxic poisoning;
severe intoxication of the body and high body temperature;
multiple sclerosis;
alcohol intoxication and withdrawal syndrome;
hidden internal bleeding;
myocardial infarction;
artificial state (postresuscitation).

The state of acute confusion, due to the intake of large amounts of alcohol, is easily recognized. Such patients are usually anxious, disoriented in time and place, do not understand the situation in which they find themselves. If they are asked about this situation, motor excitation will be observed.

Tranquilizing drugs can lead to intoxication, which can cause confusion and disorientation. Such patients are not anxious and agitated, there is a decrease in the level of wakefulness. In these cases, eye symptoms are helpful: many drugs cause nystagmus (involuntary oscillatory eye movements of high frequency) and pupillary disturbances.

Eye symptoms of intoxication are described in the table below.

It is useful to do a toxicological urine test, but usually the test is long enough to help on the spot.

The next condition in which there is an acute onset of confusion is encephalitis. The first symptoms of the disease are nonspecific. Often this diagnosis is made by ruling out other possible causes. It is useful to pay attention to the acute onset of fever, headache and impaired consciousness.

A subgroup of cerebrovascular diseases includes conditions of various etiologies, which are usually easily differentiated. In ischemic stroke, mental disorders rarely dominate, while intracerebral hemorrhage can lead to confusion and symptoms of brain stem damage (dizziness, nausea, coordination disorders, walking, facial numbness, hoarseness, swallowing and speech disorders).

In Alzheimer's disease, the nervous system is damaged, in which a person gradually loses mental abilities. Common symptoms include unreasonable anxiety, depression, delusions, inability to recognize familiar objects and faces, forgetting certain words, disorientation in space and time, indifference to events happening around, problems with gait, inability to make decisions. Initially, emotional reactions are preserved, as are the patients' habitual social skills. The onset of acute confusion is often associated with changes in the patient's life, such as a move, the loss of a dear family member, or admission to a hospital.

The state of acute confusion due to metabolic disorders is almost impossible to diagnose at the clinical level. The list of main causes includes: diabetes mellitus, Addison's disease, dehydration, hypercalcemia, hyperinsulinism, hyper- and hypoparathyroidism, porphyria, respiratory acidosis and thiamine deficiency, kidney and liver failure, chronic lung diseases, etc.

Occult bleeding, including intestinal bleeding, can lead to a decrease in the number of circulating red blood cells. The result will be a global lack of oxygen to the brain. The state of confusion is characterized by the absence of neuropsychological disturbances, or a decrease in the level of wakefulness.

A twilight state of an epileptic nature can occur not only in patients who are aware of their illness, but also after the first attack. It manifests itself differently in each patient. Sometimes an attack may be accompanied by an aura (disturbance of sensitivity in the form of numbness of parts of the body, crawling sensations, cold or heat, tingling, hallucinations of visual, auditory, olfactory). A person temporarily loses contact with others, falls or slides to the ground, there is a contraction of the muscles of the body of considerable strength. After the cessation of the attack, the patient feels weakness, drowsiness, headache.

The characteristic features of the state of post-traumatic psychosis are anxiety, restlessness and an illusory disturbed interpretation of the environment. Patients tend to leave their bed, or even leave the ward, despite strict bed rest instructions. Often this is regarded as a violation of the regime, and the pathological nature of the condition is not recognized.

Sometimes in the postresuscitation state or after several sessions of electroconvulsive therapy, a transient state of confusion develops with disorientation and inappropriate behavior.

In some cases, confusion can be observed with circulatory disorders, especially with cervical osteochondrosis. The disease is characterized by a violation of the structure of the intervertebral disc, which leads to pinching of the nerve endings and blood vessels.

Symptoms

Confusion of consciousness is a form of clouding of consciousness, in which separate elements of its various syndromes are combined, primarily amentia and delirium. Amentia is a severe clouding of consciousness, accompanied by a violation of orientation in place, time and one's own personality (the patient may forget all information about himself). Loses the ability to synthetic perception, pronounced confusion, incoherence of thinking, speech and movements. Delirium is a psychopathological syndrome that is accompanied by true hallucinations, delusions, behavioral and emotional disorders.

The syndrome can manifest itself gradually or rapidly, depending on the reasons against which it began to develop. Most often it is temporary and after treatment the disease completely disappears.

Confusion of consciousness may be supplemented by the following symptoms:

partial memory loss, in most cases of short duration - a person may forget what he did or said a few minutes ago, periodically does not recognize his relatives, passport data and other information;
sudden mood swings - a state of complete rest can be replaced by sharp aggression even towards close people;
slow and inconsistent speech;
uncontrolled urination and defecation;
sleep disturbance, insomnia.

If the confused consciousness is caused by latent internal bleeding (most often intestinal), then the clinical picture may be supplemented by such signs:

loss of consciousness;
increased sweating;
pallor of the skin;
black feces;
low blood pressure;
tachycardia.

Confusion of consciousness in a psychological disorder may be accompanied by such additional symptoms:

misinterpretation of the actions of others;
unreasonable feeling of fear.

Impairment of consciousness can be one of the symptoms of osteochondrosis. The disease is characterized by limited mobility of the joints of the cervical spine, which causes insufficient blood supply to the brain. A common cause of osteochondrosis is stress.

With cervical osteochondrosis, the above described clinical picture may be supplemented by such signs:

pain in the region of the heart and behind the sternum;
increased sweating;
impaired motor function;
weakening of muscle tone.

Violation of the structure of the intervertebral discs and depression can lead to confusion. It is necessary to get rid of osteochondrosis and depression.

Causes

Confusion can manifest itself due to a number of different reasons. That is why it cannot be a signal of a certain pathology. However, it is very important to be aware of its danger and try to find the cause.

Consider the possible causes of confusion:

traumatic. The disease can be the result of traumatic brain injuries, especially if they are of a penetrating nature. Although sometimes a brain injury can cause such problems due to the high sensitivity of the brain tissue;
toxic. The cause of the disease can be poisoning with mercury, alcoholic beverages or drugs, mushrooms. In wartime, various neurotropic gases and organophosphorus substances were used as weapons;
consequences of diseases. Diseases accompanied by severe intoxication of the body and hyperthermia (flu, tonsillitis, acute respiratory infections, etc.) sometimes lead to confusion. This is especially true for childhood and adolescence;
neoplastic manifestations. This is due to the fact that tumors are always accompanied by severe intoxication, so confusion in oncology in the later stages becomes inevitable. The danger is not only classic tumors, but also leukemia. Manifested in 15-30% of patients, and by the last weeks of life reaches 85;
circulatory pathology. Serious disturbances, such as stroke and ischemia, are often provoked by confusion, which are considered transient, proceed without consequences and are a signal of the presence of problems;
vegetative-vascular dystonia. Pathology is characterized by impaired blood circulation to the brain, in which the autonomic system suffers. As a result, fainting and impaired speech may occur;
outcome of degenerative diseases. The manifestation can occur to a severe degree at the peak of senile dementia, insanity of various origins, Alzheimer's disease. Even a lack of vitamins, hypothermia, prolonged lack of sleep and oxygen can lead to similar consequences.

It is very important to establish the cause of this condition, since the correctness of treatment and the speed of recovery depend on it. Only a doctor with extensive experience will be able to analyze the data of additional methods of examination of the patient, the development and course of the disease in order to exclude pathologies that do not correspond to this case.

Risk factors

Confusion risk factors:

age over 85;
the presence of encephalopathy or dementia;
accession of pneumonia or urological infection;
osteochondrosis of the cervical region;
lack of control of blood glucose levels in patients with diabetes mellitus;
violation of the level of hemoglobin;
weight disorder (overweight and underweight);
the presence of atrial fibrillation (as a trend);
the presence of cerebrovascular factors;
severity of traumatic injuries;
insufficiency of cerebral circulation.

Most often, the state of confusion occurs in the departments of therapeutic and neurological profile.

Varieties

Depending on the age of the patient and the etiological factor, several forms of this condition are distinguished.

Forms of confusion:

hallucinatory (the main symptom is frequent hallucinations);
manic (in this case, the patient has delusional ideas);
vascular (associated with circulatory disorders);
catatonic (there are deviations in the mental state of the patient);
confabulatory (noted with severe intoxication with drugs and is characterized by confusion in the answers to the questions posed).

There are clinical and dynamic variants of states of confusion:

transient (with erased psychopathological symptoms, occurring once or episodically, mainly at night);
abortive confusion (large, compared with transient, the severity of psychopathological disorders and arousal, periodically occurring at night, sometimes during the day);
extended confusion (pronounced disorders that occur regularly and are accompanied by psychomotor agitation).

Confusion in the elderly is a separate form, since the disorder can develop against the background of certain diseases and age-related changes.

Associated symptoms in diseases

The root causes cause the manifestation of characteristic signs. With vegetative-vascular dystonia, the patient is concerned about digestive disorders, drowsiness and moderate pain. In a heart attack, the patient is very anxious. He is worried about a severe pain syndrome that can cause a state of shock. Metabolic causes of confusion are usually accompanied by various characteristic manifestations, such as the smell of acetone from the mouth.

Confusion in a child

This symptom occurs at high temperatures. Confusion can occur with head injuries, insufficient supply of oxygen or blood to the brain, which often occurs upon impact. In this case, the child must be immediately taken to the hospital.

Doctor's advice! The first help will be laying the child on the bed, making a side rail so that he does not fall. Be there. Don't disturb the child. If fever is high, give medicine containing paracetamol but not aspirin

Confusion in the elderly

Separately, there is such a form of the symptom as confusion in the elderly. In this case, the manifestation of such a violation may not always be due to a particular ailment, the symptom may be the result of age-related changes. Confused consciousness in older people is chronic, so they can partially develop an adaptation to it. If such a state is long in time, then most likely it will lead to a negative outcome.

The speech of such patients is usually slow, there may be discrepancies in it, sometimes there are crazy ideas, illusory images may appear. The mood of such patients also often changes and is difficult to predict, so they should be treated with caution. Changes in sleep are also observed, and they can be diametrically opposed: from complete insomnia to excessive sleepiness.

First aid

If confusion is suspected, a doctor should be called immediately. First aid for this pathology includes a soothing conversation with a person. The patient must be laid down and talked with him about the real reality (what day it is, who he is, where he is). It is not recommended to give sedatives, as this can harm. First of all, complaints of head trauma, dizziness, numbness, weakness, ringing in the ears, speech disorder, blurred vision should be alerted. Such manifestations may be signs of a stroke.

When and which doctor to contact

With confused consciousness, you should turn to. After the initial examination, the doctor, if necessary, will refer the patient to, or further treatment will be carried out jointly. Transportation of a patient with an upset consciousness causes difficulty due to the occurrence of aggressive states of excitation. Therefore, there must be at least three accompanying persons. When a patient is in acute psychosis, he is placed in a separate ward. In any case, whatever the alleged etiological cause may be a violation of the clarity of human consciousness, consultation with a psychiatrist, even for preventive purposes, is mandatory.

Diagnostics

To treat confusion, it is initially necessary to establish the cause of its occurrence and then eliminate it. Since some drugs are often the cause, it is necessary to stop taking the drugs until all metabolic disorders are corrected. An initial examination of the patient with clarification of the anamnesis is mandatory. The conversation with the patient should take place together with a loved one who can specifically answer some of the doctor's questions. In patients with an acute state of confusion, an anamnesis is often impossible to collect.

To determine the underlying factor, the following laboratory and instrumental methods of examination can be prescribed:

blood sampling for general and biochemical analysis;
general urine analysis;
electrocardiogram (ECG);
ultrasound examination (ultrasound) of internal organs;
vascular dopplerography (a method that allows you to assess blood flow in the vessels);
electroencephalogram (EEG);
computed tomography (CT);
magnetic resonance imaging (MRI);
psychiatric consultation;
screening for metabolic disorders.

Based on the data obtained, the doctor determines the cause of the disease and prescribes treatment.

Treatment

With confusion, treatment is carried out in a hospital and is directed to a somatic disease, because it worsens the mental state. Whenever possible, doctors advise relatives to stay close to the patient. If the patient is in a state of excitement, the doctor may prescribe medications.

The following drugs are prescribed for treatment (table below).

	tranquilizers	Sedative drugs	Sleeping pills
A drug	Haloperidol	Melipramine	Aminazin
Relief of symptoms	5-10 mg intramuscularly, every 4-8 hours, not more than 50 mg per day	25-50 mg 3-4 times a day, then daily increase the dose by 25 mg and bring it up to 200-250 mg / day, the duration of treatment is 4-6 weeks	1-5 ml of 2.5% solution intramuscularly, no more than 3 times a day, daily dose - 0.6 g
Supportive care	0.5-20 mg per day in tablets. The duration of the course of treatment, on average, 2-3 months	After the dose is gradually reduced (by 25 mg every 2-3 days) and switched to maintenance therapy at a dose of 25 mg 1-4 times a day for another 4-6 weeks	25-300 mg/day. Dragee taken after meals. The duration of the course of treatment should not exceed 1-1.5 months
Indications	Delusions and hallucinations of various origins	Conditions of various etiologies, accompanied by motor retardation	Diseases accompanied by psychomotor agitation, fear, insomnia; acute alcoholic psychoses
Contraindications	Coma of various etiologies, acute period of stroke, severe toxic CNS depression caused by drugs or alcohol	Hypersensitivity to the drug, myocardial infarction, impaired intracardiac conduction	Disease of the liver and kidneys, cardiovascular system, peptic ulcer of the stomach

The drugs are administered intramuscularly or intravenously, starting with the minimum dose. It is impossible to apply them on their own, as this can lead not only to irreversible pathological processes, but also to death.

Important! Confusion of consciousness is a condition in which a person's ability to think at a normal speed is lost, the consistency and clarity of thoughts are disturbed. The symptom occurs with craniocerebral trauma, oncological processes, mental disorders. Treatment is aimed at getting rid of the cause of the disease.

The patient needs to provide complete rest and care. In this state, a person is not responsible for his actions, he needs care, including in terms of hygiene. The duration of treatment is individual. Basic therapy depends on the age of the patient and the cause of the impairment of consciousness. There is no general treatment program for this symptom. It is impossible to make adjustments to the course of therapy on your own, even if you feel better.

Possible consequences and complications

Consequences and complications after confusion may arise mainly due to a late established etiological factor. Therefore, the treatment was prescribed only symptomatic, and not to eliminate the cause of the disease. Most people do not regard confusion as an important symptom and the visit to the doctor is postponed. These factors affect the final outcome of the disease and the completeness of the patient's recovery.

Prevention

To avoid the occurrence of impaired consciousness, it is necessary to limit the use of alcoholic beverages, foods high in cholesterol and get rid of bad habits. Patients are also advised to eat a balanced diet with plenty of vitamins, minerals and fiber, and take prescribed medications. Proper sleep has a positive effect on health. If the patient is diabetic, he must control the level of glucose in the blood. It is also recommended to do morning exercises and constantly train thinking, develop memory.

Forecast

For a patient with confusion, the prognosis depends on the underlying causes and the time it takes to stop or inhibit those causes. Pathology can be temporary or permanent. This condition can develop against the background of psychological disorders, neurological diseases or circulatory disorders in the brain. The prognosis depends on the age of the patient, on the presence of bad habits, concomitant pathologies. The outcome of the disease varies from complete recovery to permanent brain damage or death. If the patient adheres to the recommendations of the doctor, then the prognosis will be favorable.

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Etiology

Classification

Symptoms

Diagnostics

Treatment

The main causes of confusion:

alcohol withdrawal syndrome

Confused mind: symptoms, causes and treatment

Symptoms of the disease

Fast and slow manifestation of the syndrome

Disorientation, its varieties

Root Cause Dependency

Confused consciousness: causes of appearance

Confusion treatment

alcohol as a reason

Disorientation in time

Confusion

Confusion of consciousness - what is it?

Confusion of consciousness: causes

Confusion of consciousness: symptoms and signs

Confusion of consciousness: treatment

Dizziness - causes, diagnosis and treatment

1. Causes of dizziness

Neurological and otolaryngological causes

Causes related to the peripheral nervous system:

Causes related to the central nervous system:

Cardiovascular and metabolic causes

2. Neurological symptoms associated with dizziness

Systemic dizziness

Non-systemic dizziness

3. When exactly is it time to see a doctor

4. Diagnosis of dizziness

Research to identify the causes of dizziness

5. Treatment of dizziness

Medicines for the treatment of dizziness:

Vestibular rehabilitation

Surgery

Psychological support

Dizziness caused by anxiety: features and treatment

Distinctive features of a psychogenic disorder

Symptoms accompanying dizziness with anxiety

Identifying the causes of anxiety is the key to victory over the disease

Why does consciousness disappear?

Types of disorders and disorders of consciousness

Twilight state of consciousness and its types

First aid for impaired consciousness

Provision of medical care

Confusion of consciousness: a general characteristic

Etiology and pathogenesis

Symptoms

Causes

Risk factors

Varieties

Associated symptoms in diseases

Confusion in a child

Confusion in the elderly

First aid

When and which doctor to contact

Diagnostics

Treatment

Possible consequences and complications

Prevention

Forecast

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