Approach To Coma

00:00 - Intro
01:08 - Case Presentation
02:31 - Early Management
05:56 - Neuroanatomy of Coma
17:35 - Intracranial Pressure Crisis
24:27 - Pathological Differential Diagnosis
26:13 - Vascular Pathologies
34:54 - Infectious Pathologies
38:29 - Traumatic Pathologies
42:42 - Neoplastic Pathologies
47:42 - Toxic, Metabolic Pathologies
53:07 - Immune-mediated Pathologies
58:43 - Case Progression
1:01:57 - Status Epilepticus Management
1:05:19 - Outcomes
1:12:14 - Brain Death Declaration
1:15:32 - Summary, Protocol Review
Narrated by:
Ram Gowda, MD
Igor Rybinnik, MD
Produced by:
Igor Rybinnik MD
Neurology Clerkship Director
Rutgers Robert Wood Johnson Medical School
Disclaimer: Please note that this material was simplified for educational purposes. For patient management, please review your clinical society's guidelines and engage expert consultation where appropriate. Also, the opinions expressed in this talk do not necessarily reflect those of Rutgers Robert Wood Johnson Medical school or Rutgers University as a whole.

[@hammah2299]

wtf, i didn't realize that such incredible teaching do exist!! You're a lifesaver.

[@theneurophile]

You’re welcome.

[@logesh8122]

This is the best medical lecture I have ever seen.

[@joshjones8691]

Your series for neurology clerkship has been the single greatest resource. I have been able to find for clinically relevant information. This lecture in particular has been extremely helpful for my Neuro ICU rotation. Thank you so much.

This is by far the best lecture I have seen on this topic. The design approach is very exciting and inspiring. Thank You so much for making these!

[@geebees1545]

Brain really fascinates me and so are your lectures. I am a chemistry teacher but have interest in medical sciences specially related to brain

[@dreaisonxo]

I am so glad I found this playlist and videos. Hands down the best lectures I have seen. Thank you so much for covering topics that can be daunting and presenting them in such a unique and engaging way! I am applying to neurology this match cycle, and videos like these make me excited to go into such a remarkable specialty.

[@theneurophile]

Thank you for your kind words.

[@Bullethealth]

This is literally the best lecture i have ever seen

[@TheDrmohit]

Best lecture with so much clarity and depth…

[@VyVy-ks5qj]

Everything from the image quality, sound quality, voice of lecturer, and of course the content is so professional and engaging. Neurology is hard but this helps me a lot. Thank you so much.

[@goodvibesnerd3228]

This is the best channel for neurology lectures

[@Hammoun]

I am preparing to take neurocritical care boards. And. This is simply amazing. Thank you so much

[@twistychristie3611]

Love the film inserts. This was extremely helpful, thank you.

[@mustafasaleem1197]

Amazing lecture! Very organized and easy to digest! Great work!

[@AkashMishra23]

One of the best presented and most engaging lectures I've ever seen

[@MrAhmedBakhsh]

An excellnt video with flood of. knowledge and excitement. Thanks a lot; highest regards

[@madalinaioana6717]

Extremely helpful. Thank you so much!

[@Nicky11881]

I'm in love with your lectures!!!

[@gentleman7951]

Thanks you very much for your time and work....awesome montage and Fantastic lecture

[@lindamezones8179]

Gracias ! Es la mejor exposición que he visto hasta ahora 🙌🏾

[@kwihanganaclement1169]

What a good lecture! thanks for your effort and courage in these neuro lectures

[@roulaasim8321]

awesome work! thank you for sharing this!

[@madridista3927]

Awesome video. Thank you very much!

[@radathiannitiworakun2469]

Thanks for sharing such great work for medical students around the world :)

[@vivianamaral8759]

Amazing Lecture! Thank you.

[@shami_neurology]

beyond all expectations, wooow

[@caiyu538]

great lectures.

[@cosmicbeing251]

Too good video. Captivating. Spell bound with the art of presentation. Great Content. NEXT Gen Presentation, Kudos Most Underrated Video. These videos should get more views. Thank you Very much for uploading it in youtube. Please make more videos. Looking forward for amazing content. Again, thank you very much sir.

[@zeljkacuk4498]

best lecture ever, thank you so much! cant wait to see thev other videos

[@sevakayvazyan]

Best lectures I have ever heard.

[@theneurophile]

Thanks!

[@aster.96]

Amazing thank youuuuuuu

[@deboraoliveiracardoso2815]

What an excelent content! I'm a neurology resident whatching you from Brazil. Congratulations for such relevant videos!

[@theneurophile]

Wow, thank you!

[@thienphucnguyen7113]

Thank you so much . Your Lectures are beyond amazing

[@theneurophile]

Thank you for your kind words.

[@frogprincessss]

Thank you for this. Wish I saw this when I was a medical clerk

[@nahommulatu3294]

👏👏👏👏👏 Thanks so much.. Please more lectures.......

[@immadisarojini2775]

This is extra ordinary

[@aconcretemoth9382]

i cant imagine this will ever be topped. it unites so much in my head even on a first watch

[@theneurophile]

Thank you so much!

[@merrybr6937]

It was great, tnx

[@matias1892]

Nice!

[@nathancenz7935]

I think it's the best medical lecture in youtube.

[@theneurophile]

Thank you kindly. We are striving to improve neurological education one lecture at a time.

[@user-xv5bh9im7f]

very usefull lecture it solve all my defect in coma topic

[@jaydenkelly5934]

Very impressive. It is beyond me why this has so few views. This is honestly the best lecture I have seen. Igor, is there a way for me to access any more of your lectures? I'm reading Diagnosis of Stupor and Coma by Plum and this compliments it perfectly. Thank you for your presentation.

[@theneurophile]

Thank you . Please spread the word. We are slowly trying to design lectures covering the entire Neurology curriculum.

[@theneurophile]

Thank you! I am slowly making and posting more. Unfortunately, these take a while to make.

[@caiyu538]

excellent lectures, KZbin is a nice place that we can access to a lot of excellent teachers' tutorials for free. Thumb up, comment and share to friend is what I can do.

[@Deadioan196]

NICE!!!

[@marcelinoa.megantara8757]

Really helps me, but I thiink it would be better if you made a power point also and share it via link ;)

[@karimullah100]

This lecture is one of the best ones among neurology disciplines 'lectures. Q: the download button is not present, could you add it?

[@theneurophile]

Thank you! Downloads are not blocked on my end. I think unfortunately only KZbin Premium allows downloads.

[@amysho123]

Honestly one of the best lectures i've ever heard. Clearly breaks down super complicated topics I never understood until this lecture. And funny!

[@theneurophile]

Thank you! Stay tuned. We are slowly making the entire Neurology curriculum.

[@PortoMD]

Excellent explanation. Pure Gold👍🏻👍🏻👍🏻

[@theneurophile]

Thank you. We try.

[@henamamoni6407]

I loved it.💚. Thank you ❗❗ But query please... What about Kernohan phenomena in case of uncal herniation ❓❓

[@theneurophile]

Yes, that is true. As herniation progresses, both cerebral peduncles will ultimately become compressed. However, you want to intervene before that happens since chances of recovery decrease rapidly.

[@yoasakura2306]

i think bed-side glucose should be included in metabolic causes at 4:45. Common, easy to obtain and reversable

[@theneurophile]

Absolutely true. Hypoglycemia and hyperglycemia are common causes of encephalopathy. Typically, most of these patients with acute encephalopathy present as a stroke code, and glucose assessment is part of the stroke code protocol for that reason.

[@LEARNING-MEDICAL-EDUCATION]

cows mneomonic (cold opposite, warm same ) is for conscious patient (whose frontal eye field is intact)

[@theneurophile]

I’m glad you brought it up. That is absolutely correct. We wanted to make that exact point. We almost never test calorics on an awake patient. When we test a comatose patient, we don’t see nystagmus so the COWS mnemonic does not apply.

[@ezhilkugan2527]

Sir, i have a query. Plum and Posner textbook describes ARAS involves only the tegmentum of midbrain and upper pons. but many other resources say that ARAS is present diffusely in the brainstem tegmentum till the level of medulla. Which is correct?

[@theneurophile]

ARAS is mainly present in the diencephalon, midbrain and the pons. Isolated medullary lesions should not cause coma.

[@taehonglim3953]

Amazing! A quick question; you mentioned persistent vegetative state can be diagnosed at least one month after brain injury However, my understanding is: PVS is judged to be permanent after three months if induced nontraumatically. For traumatic brain injury, a year in this state is generally required to be considered permanent. Most data indicate that after three months in a PVS related to hypoxic-ischemic injury, recovery is rare and is associated with moderate to severe disability at best Please correct me if I'm wrong. Thanks!

[@theneurophile]

Thanks. Yes you are correct. This video is intended for medical students, so we avoided going into such depth with respect to exact PSV criteria.

[@taehonglim3953]

@@theneurophile Thanks for the clarification. I'm one of the pgy2 residents in Ohio and want you to know your videos are super helpful to the junior residents as well!

[@theneurophile]

@@taehonglim3953 Thank you kindly.

[@CosmoConstant]

Aren’t motor findings in uncal herniation actually ipsilateral (at 16:00 you say contralateral). Isn’t this the scenario the Kernohan phenomenon where the opposite side cerebral peduncle is compressed (which crosses back to ipsilateral side in the medulla)?

[@theneurophile]

Thank you for your question. Let's review an example. During the left uncal herniation, left temporal lobe herniates unto the left midbrain, which will cause ipsilateral (left) CN3 palsy but contralateral (RIGHT) hemiparesis. Left cerebral peduncle contains crossed corticospinal/corticobulbar fibers, which don't become ipsilateral until they get to the medulla. If left uncal herniation progresses, ultimately the contralateral (right) midbrain can get compressed against the tentorium causing LEFT hemiparesis (Kernohan phenomenon). Really at that point, the patient will be weak on both sides and may experience posturing.

[@krissn3614]

Not only good for students but also for residents taking their specialty boards! Thanx a lot. By the way what is the name of the movie at 39:10???

[@theneurophile]

Enjoy. The movie is "The man with two brains." It's from 1983 (oldie but goodie)

[@samuela1437]

Sir can i get ur slides please. I respect u sir thank you so far

[@sundaygodfrey6193]

Can it be downloaded

[@theneurophile]

Sorry, can what be downloaded?

[@divyag3647]

Can you please mention the references. I need for my presentation..

[@theneurophile]

Most of the information is based on the Plum and Posner's Coma book and AAN's CONTINUUM

[@divyag3647]

@@theneurophile thanku!

[@brainman709]

Kindly explain the difference between delirium and coma.

[@theneurophile]

If you go to the timestamp 11:48 in the video, you will see a graph describing level of consciousness. Patient is considered to be in a coma when there are no purposeful responses (below the red line). Delirium, acute confusional state, acute encephalopathy all mean the same thing and are generic term describing patients with alteration of awareness but still showing purposeful responses (above the red line).

[@juanpedrogarcia9323]

Never ever forget hypoglicemia, otherwise I think it's a masterpiece.

[@theneurophile]

Yes, that's under "toxic/metabolic" causes right at the top.

[@lolahpearl6679]

💯💯💯❤️

[@iqbalbuneri7469]

👍👍👍

[@vivekpachange6017]

I need help my father get stroke in posterior circulation infarct involving cerebellum , brain stem and occipital loves BA to thrombosis ,k/c/o hypertension on 5 July 2020 so till now he his unconscious doc said it totally depend on my father and they are giving totally negative statements so I want to know how much time it will take I love my father I can go beyond the limit for him just want to know how much time it will take plz share your experience it's request from a son

[@theneurophile]

I'm sorry for your difficulties. Unfortunately it would be impossible for me to judge without having evaluated your father. Each case is different. My best wishes for his recovery.

[@vivekpachange6017]

@@theneurophile he his fine there is body movement like legs move head move limbs blinks only hand and eyes is not opening he his stable now he is on oxygen and breath by his own every body part is normal

[@user-do5hg6vr7e]

Images are blurred sir!

[@theneurophile]

Thank you for letting me know. I just tested, and it looks ok on my end. It may be an issue with internet connection.

[@nivyab6276]

Is there any possibility that a patient can wake up after 7mnths in something like coma.. but he is not in coma.. a slight unconsciousness...

[@theneurophile]

There are cases of transient unconsciousness like seizure and syncope. Coma usually refers to prolonged unconsciousness.

[@monvicasabbi8792]

🤯🤯🤯🤯

[@dewplayz3421]

How do you know if your not in a coma?

[@theneurophile]

“I think, therefore I am”

[@yashwanthrao98055]

Dude killed her despite the 1 hour lecture 🫥🫥🫥 cuddy saved you mate from my wrath of unsubscribing ⚡️ best always in orchestrating a clinical based practical perception lecture ⚡️

[@theneurophile]

The outcome in the case was unfortunate, but that’s the reality sometimes. And that was the reality in this case. Unfortunately we can’t win them all, but we certainly do our best to try.

[@yashwanthrao98055]

@@theneurophile i agree 🙂 🧠 I was just kidding 😅😜