Psychogenic Unconsciousness Causes and Types

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)