What are the four stages of impaired consciousness?

Impaired consciousness can be divided into several stages, and there are different levels of impaired consciousness. First, the patient will experience drowsiness, lethargy, and coma. Coma can also be divided into three stages: shallow, moderate, and deep. However, everyone needs to pay attention that some people may have more serious symptoms, while others may have milder symptoms. If you cannot judge at home, you need to go to the hospital for examination.

Consciousness impairment classification

1. According to the abnormal level of consciousness, consciousness disorders are divided into 3 levels: drowsiness, lethargy and coma, and coma is further divided into mild, moderate and deep coma. Clinically, only two steps are needed to make a rough judgment:

(1) The first step is to provide language stimulation:

Awakening response: can be awakened--------------Sleepy

Awakened by loud calls----------Sleeping

Not awakened -------------- coma

(2) The second step is to determine the degree of coma and provide pain stimulation:

Pain response: responsive ---------------- mild coma

Only responds to severe stimulation -------- coma

Unresponsive ---------------- Deep coma

Detailed identification points for disorders of consciousness also include examination of unconscious spontaneous movements, healthy reflexes and light reflexes, which can be referred to in the fifth edition of Neurology. The Glasgow Coma Scale is now mostly used for grading coma, see the table below.

2. There is both a decrease in the level of consciousness and changes in the content of consciousness, including confusion and delirium. The key points to distinguish between the two are:

Confusion: Drowsiness, disorientation, and hallucinations are prominent manifestations.

Delirious state: both orientation and self-awareness are impaired, with abundant illusions and hallucinations.

3. Special types of consciousness disorders, namely wake-like coma, include decorticate syndrome and akinetic mutism. The key points for distinguishing between the two are:

Decorticate syndrome: extensive cortical damage, decorticate rigid posture, pathological signs (+)

Akinetic mutism: reticular activating system damage, decerebrate rigid posturing, pathological signs (-)

4. Finally, there are vegetative state and brain death, each of which has its own diagnostic criteria. Brain death also involves legal ethics, which I will not elaborate on here. Those who are interested can check it out.