Unconsciousness and Altered States of Consciousness

  • Georges L. Kaiser


Unconsciousness and altered states of consciousness are of important clinical significance due to their frequency and many and diverse possible causes. For graduation of altered states of consciousness, the following terms may be used: clouding of consciousness, delirium, stupor, and coma ###. The most important causes of unconsciousness or altered states of consciousness are quoted in Table 3.1, as far as they are important for the pediatric and other surgeons and marked according to their frequency of occurrence.

The Glasgow Coma Scale (GCS) has been developed for patients with head injury with the aim to obtain an objective and reproductive clinical tool for quantification of altered consciousness and determination of the degree of brain injury by its course. It became soon necessary to adapt the GCS for small children and infants (Table 3.2) and to apply it to the other disorders leading to impaired consciousness. In addition, the correct assignment of maximum 15 points may be hindered by additional abnormal findings such as eyelid swelling or paresis and therapeutic measures, for example, intubation and relaxation.


Head Injury Glasgow Coma Scale Severe Head Injury Skull Fracture Conversion Disorder 
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Sections 3.1.1–3.1.2

  1. Amar AP, Aryan HE, Meltzer HS, Levy ML (2003) Neonatal subgaleal hematoma causing brain compression: report of two cases and review of the literature. Neurosurgery 52:1470–1474; discussion 1474PubMedCrossRefGoogle Scholar
  2. Chadwick DL, Bertocci G, Castillo E, Frasier L, Guenther E, Hansen K, Herman B, Krous HF (2008) Annual risk of death resulting from short falls among young children: less than 1 in 1 million. Pediatrics 121:1213–1224PubMedCrossRefGoogle Scholar
  3. Kaiser G (1978) Die acute posttraumatische Phase bei leichteren Formen von Schädel-Hirn-Verletzungen (The acute posttraumatic phase in milder forms of craniocerebral lesions in the child). Z Kinderchir 24:303–312Google Scholar
  4. Luerssen TG (1998) Central nervous system injuries. In: O’Neill JA Jr et al (eds) Pediatric surgery, vol I, 5th edn. Mosby, St LouisGoogle Scholar
  5. Vu TT, Guerrera MF, Hamburger EK (2004) Subgaleal hematoma from hair braiding: case report and literature review. Pediatr Emerg Care 20:821–823PubMedCrossRefGoogle Scholar

Section 3.1.3

  1. Becker DB, Cheverud JM, Govier DP, Kane AA (2005) Os parietale divisum. Clin Anat 18:452–456PubMedCrossRefGoogle Scholar
  2. Kos M, Luczak K, Godzinski J, Rapala M, Klempous J (2002) Midfacial fractures in children. Eur J Pediatr Surg 12:218–225PubMedCrossRefGoogle Scholar

Section 3.1.4

  1. Rekate HL (2001) Head injuries: management of primary injuries and prevention of secondary damage. Childs Nerv Syst 17:632–634PubMedCrossRefGoogle Scholar

Sections 3.1.5–3.1.6

  1. Gupta SN, Kechli AM, Kanamalla US (2009) Intracranial hemorrhage in term newborns: management and outcomes. Pediatr Neurol 40:1–12PubMedCrossRefGoogle Scholar
  2. Loh JK, Lin CL, Kwan AL, Howng SL (2002) Acute subdural hematoma in infancy. Surg Neurol 58:218–224PubMedCrossRefGoogle Scholar

Section 3.1.7

  1. Bariciak ED, Plint AC, Gaboury I et al (2003) Dating of bruises in children: an assessment of physicians accuracy. Pediatrics 112:804–807PubMedCrossRefGoogle Scholar
  2. Dube SR, Anda RF, Felitti VJ et al (2001) Childhood abuse, household dysfunction, and the risk of attempted suicide throughout life span: findings from the adverse childhood experiences study. JAMA 286:3089–3096PubMedCrossRefGoogle Scholar
  3. Duhaime AC, Gennarelli TA, Sutton LM, Schut L (1988) The “shaken baby syndrome”: a misnomer? J Pediatr Neurosci 4:77–86Google Scholar
  4. Duhaime AC, Christian C, Moss E, Seidl T (1996) Long-term outcome in infants with shaking-impact syndrome. Pediatr Neurosurg 24:292–298PubMedCrossRefGoogle Scholar
  5. Gilbert R, Widom CS, Browne K, Fergusson D, Webb E, Janson S (2009) Burden and consequences of child maltreatment in high-income countries. Lancet 373:68–81PubMedCrossRefGoogle Scholar
  6. Gilles EE, Mc Gregor ML, Levy-Clarke G (2003) Retinal hemorrhage asymmetry in inflicted head injury: a clue to pathogenesis? J Pediatr 143:494–499PubMedCrossRefGoogle Scholar
  7. Harris BH, Stylianos S (1998) Special considerations in trauma: child abuse and birth injuries. In: O’Neill JA Jr et al (eds) Pediatric surgery, vol I, 5th edn. Mosby, St LouisGoogle Scholar
  8. Keenan HT, Runyan DK, Mashall SW et al (2003) A population-based study of inflicted traumatic brain injury in young children. JAMA 290:621–626PubMedCrossRefGoogle Scholar
  9. Kemp AM, Dunstan F, Harrison S, Morris S, Mann M, Rolfe K, Datta S, Thomas DP, Sibert JR, Maguire S (2008) Patterns of skeletal fractures in child abuse: systematic review. BMJ 337:a1518. doi: 10.1136/bmj.a1518, Comment in: BMJ (2008); 337:a1398, a2279PubMedCrossRefGoogle Scholar
  10. Labbé J, Caouette G (2001) Recent skin injuries in normal children. Pediatrics 108:271–276PubMedCrossRefGoogle Scholar
  11. Miller R, Miller M (2010) Overrepresentation of males in traumatic brain injury of infancy and in infants with macrocephaly: further evidence that questions the existence of shaken baby syndrome. Am J Forensic Med Pathol 31:165–173PubMedCrossRefGoogle Scholar
  12. Reijneveld SA, van der Wal MF, Brugman E et al (2004) Infant crying and abuse. Lancet 364:1340–1342PubMedCrossRefGoogle Scholar

Section 3.3

  1. Aebli N, Rocco P, Krebs J (2005) Fettembolie – eine potentiell tödliche Komplikation während orthopädischen Eingriffen (Fat embolism – a potentially fatal complication during orthopaedic surgery). Schweiz Med Forum 5:512–518Google Scholar
  2. Forster C, Jöhr M, Gebbers J-O (2002) Fettembolie und Fettembolie-Syndrom. Schweiz Med Forum 2:673–678Google Scholar
  3. Hulman G (2000) The pathogenesis of fat embolism. J Pathol 176:3–9CrossRefGoogle Scholar
  4. Levy D (1990) The fat embolism syndrome. A review. Clin Orthop 261:281–286PubMedGoogle Scholar

Section 3.4

  1. Dickerman RD, McConathy WJ, Lustrin E, Schneider SJ (2003) Rapid neurological deterioration associated with minor head injury in chronic hydrocephalus. Childs Nerv Syst 19:249–251PubMedGoogle Scholar

Section 3.6

  1. Del Zoppo GJ, Mori E (1992) Hematological causes of intracerebral hemorrhage and their treatment. Neurosurg Clin N Am 3:637–658PubMedGoogle Scholar
  2. Greene RM, Kelly KM, Gabrielsen T, Levine SR, Vanderzant C (1990) Multiple intracerebral hemorrhages after smoking ‘crack’ cocaine. Stroke 21:957–962CrossRefGoogle Scholar
  3. Kazui S, Naritomi H, Yamamoto H, Sawada T, Yamaguchi T (1996) Enlargement of spontaneous intracerebral hemorrhage: incidence and time course. Stroke 27:1783–1787PubMedCrossRefGoogle Scholar
  4. Sutton LN (1998) Central nervous system tumors and vascular malformations. In: O’Neill JA Jr et al (eds) Pediatric surgery, vol I, 5th edn. Mosby, St LouisGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Georges L. Kaiser
    • 1
  1. 1.Department of Pediatric Surgery InselspitalUniversity of BerneBerneSwitzerland

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