Impaired consciousness in the pediatric intensive care unit: etiology and diagnostics-English version

This article provides an overview of the management of children with disorders of consciousness. Rapid diagnostics are necessary to identify treatable etiologies and minimize neurological sequelae. The differential diagnosis is extensive. Brief neurological findings include quantification of impaired consciousness using the Glasgow Coma Scale (GCS), testing of the eyes, motor function, and the presence of meningism. Laboratory tests include rapid exclusion of hypoglycemia and, if CNS infection is suspected, CSF examination. An emergency head CT is mandatory in cases of nonreactive unilateral or bilateral pupils before further diagnostic work-up is carried out. We recommend head MRI, especially if encephalitis, vasculitis, ischemic stroke, and sinus vein thrombosis are suspected. An EEG rarely provides clues to the cause of coma but it serves primarily as an objective measure of the severity of encephalopathy, the prognosis, and the effectiveness of therapy.