Apollinus syndrome (wakeful coma): symptoms and methods of treatment

A condition characterized by a loss of cognitive activity and complete indifference, which arose as a result of a violation of the functions of the cerebral cortex, is called apallic syndrome. This term was introduced into medicine in 1940 by the German psychiatrist E. Krechmer.

Causes

Most often the waking coma (this is the second name of the illness considered in this article) occurs after a serious craniocerebral trauma. Often, such a pathological disorder develops as a result of hypoxic, toxic, metabolic, vascular, infectious and other brain lesions. It was noted that this disease is diagnosed in 14% of patients who are in a long traumatic coma. Apical syndrome in a child often occurs after meningoencephalitis, resuscitation, craniocerebral trauma. In this case, the ailment can develop slowly enough for 2-3 months or even years. In patients who are in a coma of non-traumatic origin, this condition is associated with structural damage to the basal nuclei and the cortex with the relative preservation of the brain stem.

Clinical picture

Symptoms of this pathology become noticeable only after the patient leaves the state of coma. During this period wakefulness is restored. As a rule, the eyes of a person who is diagnosed with an apallic syndrome are open. It easily rotates them, but does not fix the sight. Any emotional reactions and speech are absent. Contact with such a person is impossible, since verbal commands are not perceived by them. In more severe cases, the patient is bedridden, he chaotic limbs. Often, patients with this pathology, paralysis, paresis, hyperkinesia, oculomotor disorders occur. This is due to the fact that in severe cases the ailment extends to the stem and subcortical structures of the brain. In this case, patients respond to various kinds of stimuli, most often painful, in the form of shouting out individual sounds or sudden movements. In some cases, there may be a grasping or oral reflex. The patient opens his mouth, and when the objects approach the face, the tongue protrudes. At the same time, all vegetative functions, such as swallowing, heart work, breathing, sucking, excretion of feces and urine remain. A typical posture of a person with a diagnosis of "apalysis syndrome" - the hands are clenched into fists, the feet are in a state of plantar flexion. The face is amylish, sometimes there is yawning. In the knee and elbow joints, a slight bending is also noticeable. In patients who are in a waking coma, there is a change in the period of wakefulness and sleep, independent of the time of day.

Complex diagnostics

Apallic syndrome (wakeful coma) is revealed on the basis of characteristic features. Also for the diagnosis of pathology use ultrasound examination of peripheral and main veins and arteries of the liver, head, limbs and kidneys. In addition, capillaroscopy of small blood vessels of the body is performed, ECG screening of ischemic changes in the heart muscle. The evaluation of brain function (electroencephalogram) and the state of vascular adaptability to emotional and physical stresses, as well as neurological and somatic examination are performed.

Characteristics

On the EEG in the first few weeks marked generalized changes are noted. And then in the course of two or three months, the predominance of thetaactivity remains. Six months later, alpha activity appears (with a low index). As a result of the CT scan, cerebral atrophy and ventricular expansion are detected.

Apallic syndrome. Treatment

In the most severe cases, resuscitation measures are shown . Methods of therapeutic activity are determined by the characteristics of the clinic, the etiology of the disorder and the general condition of the patient.

Resuscitative and intensive care

The main directions in the treatment of this pathological condition is the normalization of the activity of the heart and respiration, arterial pressure, homeostasis, hemodynamics (cerebral and general), fighting brain edema and hypoxia. It is very important to care for the patient. You should avoid tilting the head, tongue twisting. Periodically, the position of the patient's body (best of all - on the side) should be changed, and the toilet of the nasopharynx, bronchial tubes and oral cavity should be performed daily. In the intensive monitoring department, important indicators of the body condition are monitored. These are blood pressure, pulse rate, EEG, body temperature, ECG, volume and respiratory rate, as well as acid state and gas composition of the blood. In severe violation of breathing, urgent intubation is performed, as well as artificial ventilation of the lungs (warmed and humidified air). To improve the properties of blood intravenously, plasma-substituting solutions are found. This exercise is carried out under the control of venous pressure.

Prevention of ailment

Patients who are in a coma for a long time need intensive resuscitative measures to prevent the development of this syndrome. Such activities include stimulation of cardiac activity, artificial ventilation of the lungs, maintenance of blood pressure. In addition, it is recommended to use drugs that activate the metabolism of the brain and facilitate the transmission of impulses. Very important is normal care and correct, and in some cases - parenteral nutrition. Also, use a variety of symptomatic drugs and vitamins.

Nursing

Feeding is best done through a percutaneous thin gastrostomy, and not through a probe. Since the latter option with prolonged use, significantly increases the risk of reflux, aspiration, ulceration and sinusitis. Periodically monitor the weight of the patient. During feeding, the patient's torso should be raised by 50-60 degrees. Food should contain proteins, vitamins and trace elements, as well as saturated fatty acids. Caloric content is about 35 kcal / kg per day. To empty the bowels, oral laxatives are recommended, but no more than three times a week, as well as rectal suppositories. If the patient has diarrhea, you should periodically give him "live" yogurts and from time to time check whether there are stagnant food in the stomach. To improve bowel function, foods containing high in fiber should be included in the diet.

Patients with such disorders are shown a therapeutic massage. In some medical centers, a special rehabilitation program is conducted for people in wakeful coma. It includes multisensory, physical and medicamental therapy, as well as a number of other methods by which you can defeat the apallic syndrome.

Forecast

Unfortunately, in most cases the outcome of this disease is unfavorable. However, it is also possible for the reggegenic course of the disease, up to almost complete restoration of the functions. In the presence of progressive atrophic processes, which usually occur in the elderly, there may be a state of decerebral rigidity, characterized by the onset of seizures and other unpleasant symptoms.