Coma and cerebral ischaemia

Walker, Richard; Sair, Mark

doi:10.1016/j.mpaic.2007.08.003

« Previous Next »Anaesthesia & intensive care medicine
Volume 8, Issue 10 , Pages 403-404, October 2007

Coma and cerebral ischaemia

Richard Walker, BSc, MRCP, FRCA, is Specialist Registrar in the South West Deanery. He qualified in London and has an interest in Intensive Care Medicine

Mark Sair, PhD, MRCP, FRCA, is Consultant in Intensive Care Medicine at Derriford Hospital, Plymouth. He qualified from the University of Bristol and trained in anaesthetics and intensive care medicine in London. His research interests are the effects of sepsis on the microcirculation and tissue oxygenation

Abstract

The differential diagnosis of coma includes cerebral ischaemia. Four patterns of disorder are recognized: focal cerebral ischaemia; diffuse cerebral hypoxia; global cerebral ischaemia; and cerebral infarction. Of these, the last two types are more commonly associated with coma. This article outlines the initial management and investigation of a patient who is comatose, and gives an overview of the causes of cerebral ischaemia. Specific management of stroke due to thrombosis or embolism are discussed. The role of anti-platelet therapy, anticoagulation, thrombolysis, and surgical decompression are summarized.

Keywords: coma, embolism, stroke, thrombolysis