Unconsciousness and

seizures
By:
Dr. Khalil Abdulqawi El-Aajam
PhD, M.Sc. B.Sc.
• Unconsciousness: is apparent in the patient who is not oriented, does
not follow commands, or needs persistent stimuli to achieve a state of
alertness.
• Coma: defined as a prolonged state of unconsciousness.
Causes
• The cause may be:
a) neurologic (head injury, stroke)
b) toxicologic (drug overdose, alcohol intoxication)
c) metabolic (hepatic or renal failure, diabetic ketoacidosis).
• As the patient’s state of alertness and consciousness decreases, there
will be:
• changes in the pupillary response
• eye opening response
• verbal response
• motor response.
• Usually apparent as behavioral changes such as:
• restlessness or increased anxiety
Diagnostic methods
• Clinically (Glasgow coma scale)
Medical Management
• The first priority of treatment for the patient with altered LOC is to
obtain and maintain
• 1. Patent airway. The patient may be orally or nasally intubated, or a
tracheostomy may be performed. Until the patient’s ability to
breathe on his or her own, a mechanical ventilator is used to maintain
adequate oxygenation.
• 2. The circulatory status (blood pressure, heart rate); An intravenous
cannula is inserted to provide access for fluids and intravenous
medications.
3. Neurologic care focuses on the specific neurologic pathology.
4. Nutritional support, using either a feeding tube or a gastrostomy
tube.
Complications
• Respiratory
• Pneumonia :it is common in patients receiving mechanical ventilation or in
those who cannot maintain and clear the airway.
• pressure ulcers due to immobility
• renal failure
• Paralysis
• Death
Seizures
• Seizures are episodes of abnormal motor, sensory, autonomic, or
psychic activity (or a combination of these) resulting from sudden
excessive discharge from cerebral neurons. A part or all of the brain
may be involved.
Classification
• The international classification of seizures differentiates between two
• main types:
1. partial seizures that begin in one part of the brain
2. generalized seizures that involve electrical discharges in the whole
brain
Causes
• Electrical disturbance (dysrhythmia) in the nerve cells in the brain,
causing them to emit abnormal, recurring, uncontrolled electrical
discharges.
• The specific causes of seizures can be categorized as
1. idiopathic (genetic, developmental defects)
2. acquired.
• acquired seizures:
• hypoxemia of any cause, including vascular insufficiency, fever
(childhood), head injury, hypertension, central nervous system
infections, metabolic and toxic conditions (eg, renal failure,
hyponatremia, hypocalcemia, hypoglycemia, pesticides), brain tumor,
drug and alcohol abuse.....
• in the elderly, cerebrovascular disease is the leading cause of seizures
Clinical manifestation
1. loss of consciousness
2. excess movement or loss of muscle tone or movement
3. disturbances of behavior, mood, sensation, and perception.
The epilepsies
• An estimated 2 to 4 million people in the United States have epilepsy
(1 in 100 adults is affected), and onset occurs before the age of 20
years in greater than 75% of patients.
• Epilepsy is a group of syndromes characterized by recurring seizures.
Types of epilepsies are differentiated by how the seizure activity
manifests.
• It is generalized seizures and partial-onset seizures.
• Epilepsy can be primary (idiopathic) or secondary, when the cause is
known such as a brain tumor.
Causes
• The cause of seizures in many people is unknown.
• Epilepsy can follow birth trauma, asphyxia (neonate), head injuries,
some infectious diseases (bacterial, viral, parasitic), toxicity (carbon
monoxide and lead poisoning), circulatory problems, fever, metabolic
and nutritional disorders, and drug or alcohol intoxication.
• It is also associated with brain tumors, abscesses, and congenital
malformations.
• In most cases of epilepsy, the cause is unknown (idiopathic)
• In simple partial seizures, only a finger or hand may shake, or the
mouth may jerk uncontrollably. The person may talk unintelligibly,
may be dizzy, and may experience unusual or unpleasant sights,
sounds, odors, or tastes, but without loss of consciousness.
• In complex partial seizures, the person either remains motionless or
moves automatically but inappropriately for time and place, or may
experience excessive emotions of fear, anger, elation, or irritability.
the person does not remember the episode when it is over.
• Generalized seizures, previously referred to as grand mal seizures,
involve both hemispheres of the brain, causing both sides of the body
to react. There may be intense rigidity of the entire body followed by
muscle relaxation and contraction
In generalized seizures
• The tongue is often chewed, and the patient is incontinent of urine
and stool.
• After 1 or 2 minutes, the convulsive movements begin to subside; the
patient relaxes and lies in deep coma, breathing noisily. The
respirations at this point are abdominal. In the postictal state (after
the seizure), the patient is often confused and hard to arouse and
may sleep for hours. Many patients complain of headache, sore
muscles, fatigue, and depression
Diagnosis
• The electroencephalogram (EEG)
Medical Care During a Seizure
1. Provide patient privacy
2. Ease the patient to the floor, if possible.
3. Protect the head with a pad to prevent injury
4. Loosen constrictive clothing.
5. Push aside any furniture that may injure the patient during the seizure.
6. If the patient is in bed, remove pillows and raise side rails
7. Insert an oral airway to reduce the possibility of the tongue or cheek
being bitten.
8. Do not attempt to open jaws
9. No attempt should be made to restrain the patient during the seizure
because muscular contractions are strong and restraint can produce
injury.
10. If possible, place the patient on one side with head flexed forward,
which allows the tongue to fall forward and facilitates drainage of saliva
and mucus.
11. If suction is available, use it if necessary to clear secretions.
Medical Care After the Seizure
1. Keep the patient on one side to prevent aspiration. Make sure the
airway is patent.
2. There is usually a period of confusion after a grand mal seizure.
3. The patient, on awakening, should be reoriented to the
environment.
4. If the patient becomes agitated after a seizure (postictal), use calm
persuasion and gentle restraint.
Prevention

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