Psychogenic Unconsciousness Causes and Types

Study Notes

Psychogenic Cause of Unconsciousness

Prolonged motionless dissociative attack with absent or reduced response to external stimuli
Rare presentation; exclusion diagnosis, requiring rule out of other causes

Other Causes of Unconsciousness

Brain lesions
Systemic infections:
- Dengue fever
- Shock
- Typhoid fever
Trauma

Functional Stupor and Coma

Anxiety and social withdrawal reducing consciousness
Scale of consciousness: stupor (lack of action and response) to coma (complete unresponsiveness)

Characteristics of Functional Stupor and Coma

Time-limited, provoked by external factors (e.g., prolonged pain, anxiety, social withdrawal)
Normal brain function, despite contradictory behavior
Genuine problem experienced by the patient
Not explained by other psychiatric disorders (e.g., catatonia, depression, mania)
Often associated with minor psychiatric disorders (e.g., mild depression, anxiety)

Psychogenic Nonepileptic Seizures (PNES)

Paroxysmal changes in behavior, motor, sensory, autonomic, cognitive, and emotional functions without epilepsy
More common in females
Seizure-like symptoms, but not caused by epilepsy
Provoked by psychogenic triggers

Characteristics of PNES

Seizures last >2 minutes, posing high risk of ischemia
Fatal if untreated
Differentiated from epileptic seizures

Neural Tube Defects (NTDs)

Affect 3% of children and 20% of perinatal deaths
Common types include:
- Spina bifida
- Encephalocele
- Myelomeningocele
- Anencephaly
- Hydrocephalus
- Microcephaly

Causes of NTDs

Radiation, chemicals, and drugs
Malnutrition
Unknown factors (major contributor)

Diagnosis of NTDs

Early screening of α-fetoprotein and amniocentesis (weeks 16-18)
Cranial CT or MRI (after birth)

Prevention of NTDs

Folic acid (B9) supplementation (0.4 mg daily)
Fortified foods

Types of Spina Bifida

Spina bifida occulta:
- Midline defect, no protrusion, asymptomatic
- Sometimes with patches of hair, lipoma, or dermal sinus
Meningocele and myelomeningocele:
- Protrusion of meninges (usually on the lumbar sacral area)
- Flaccid paralysis, urinary dribbling, relaxed anus, and abnormal lower extremities
- The larger the protrusion, the more severe the neurological deficit
Meningocele:
- Only the meninges have protrusion, filled with fluid
- Spinal cord does not herniate, although it may have tethers
Myelomeningocele:
- The meninges protrude, and the spinal cord herniates
- Often with Chiari II malformations

Anencephaly

Absent or hypoplastic calvarium and a deformed sphenoid
CN II-V are present, but pons, cerebellum, and midbrain are absent
Descending tracts aplasia

Encephalocele

Skull defect allows herniation of intracranial content
Fluid-filled cyst covered by normal skin
Mostly occipital, can be frontal
Cranium meningocele:
- Just the meninges
Cranial encephalocele:
- Meninges, cortex, cerebellum, and brainstem
Abnormalities ahoy, usually in the occipital or inion, sometimes frontal or nasofrontal

Hydrocephalus

Accumulation of excessive CSF
Impaired flow of CSF
Impaired resorption
Overproduction (rare)
Associated with Chiari II malformation
Triad:
- Macrocephaly
- Sunset appearance (eyes look down)
- Venectasia (visible veins on the head)
Causes:
- Obstruction
- Aqueductal stenosis (x-linked recessive, together with occult spina bifida)
- Aqueductal gliosis
- Intrauterine viral infections
- Neonatal meningitis
- Mumps meningoencephalitis
- Vein of galen malformation
Treatment:
- Endoscopic third ventriculostomy
- Shunt from third ventricle to the subarachnoid space
- Ventriculoperitoneal shunt (shunt from ventricles to the peritoneal space)

Description

This quiz covers the psychogenic causes of unconsciousness, including dissociative attacks, functional stupor and coma, and their differences. It also touches on the exclusion diagnosis and other possible causes of unconsciousness.

Psychogenic Unconsciousness Causes and Types

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Questions and Answers

What is the primary characteristic of psychogenic stupor and coma?

What is the typical duration of psychogenic nonepileptic seizures (PNES)?

What is the primary difference between psychogenic stupor and coma and other psychiatric disorders?

What is the primary trigger for psychogenic nonepileptic seizures (PNES)?

What is the primary characteristic of psychogenic stupor?

What is the primary risk associated with psychogenic nonepileptic seizures (PNES) of more than 2 minutes?

What percentage of children are affected by neural tube defects?

What is the primary cause of neural tube defects?

What is the primary function of folic acid in preventing neural tube defects?

What is the typical location of meningocele protrusions?

What is the characteristic of anencephaly?

What is the primary characteristic of hydrocephalus?

What is the typical treatment for hydrocephalus?

What is the primary complication of hydrocephalus?