medicina56巻4号

2019年04月発行

増刊号 一人でも慌てない！—「こんなときどうする？」の処方箋85 どうする?　神経

47　意識障害を目の前にして呆然としないために

著者： 小嶌祐介¹

所属機関： ¹JCHO星ヶ丘医療センター総合内科

ページ範囲：P.256 - P.261

症例呈示
様子がおかしいために救急車で搬送された80歳男性．
●前日から発熱があった．
●来院時，問いかけには反応するが自発語はなく傾眠．
●バイタルサインは体温38.0℃，血圧120/70mmHg，脈拍100/分，SpO₂ 95％，呼吸数12/分である．

参考文献

（last updated：Jul 18, 2018）　https://www.uptodate.com/contents/stupor-and-coma-in-adults?topicRef=289＆source=related_link

2）Tokuda Y, et al：Pupillary evaluation for differential diagnosis of coma. Postgrad Med J 79：49-51, 2003

3）Forsberg S, et al：Metabolic vs structural coma in the ED；An observational study. Am J Emerg Med 30：1986-1990, 2012

4）Ikeda M, et al：Using vital signs to diagnose impaired consciousness；Cross sectional observational study. BMJ 325：800-802, 2002

5）Johkura K, et al：Wrong-way deviation；Contralateral conjugate eye deviation in acute supratentorial stroke. J Neurol Sci 308：165-167, 2011

6）Marks WJ Jr, Laxer KD：Semiology of temporal lobe seizures；Value in lateralizing the seizure focus. Epilepsia 39：721-726, 1998

7）Vaduganathan M, Johnson JH：Ping-pong gaze. N Engl J Med 372：e34, 2015

8）Husain AM, et al：Non-convulsive status epilepticus；Usefulness of clinical features in selecting patients for urgent EEG. J Neurol Neurosurg Psychiatry 74：189-191, 2003

9）van de Beek D, et al：Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med 351：1849-1859, 2004

10）Karen E, et al：The diagnostic accuracy of Kernig's sign, Brudzinski's sign, and nuchal rigidity in adults with suspected meningitis. Clin Infect Dis 35：46-52, 2002

11）Granerod J, et al：Causes of encephalitis and differences in their clinical presentations in England；A multicentre, population-based prospective study. Lancet Infect Dis 10：835-844, 2010

12）Powers WJ, et al：2018 Guidelines for the Early Management of Patients with Acute Ischemic Stroke；A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke 49：e46-e110, 2018

13）Qureshi AI, et al：Intensive blood-pressure lowering in patients with acute cerebral hemorrhage. N Engl J Med 375：1033-1043, 2016

14）Hemphill JC 3rd, et al：Guidelines for the Management of Spontaneous Intracerebral Hemorrhage；A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke 46：2032-2060, 2015

15）Connolly ES Jr, et al：Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage；A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke 43：1711-1737, 2012