Some Necessary Examinations for Patients in Comatose and Vegetative States

In our clinical work, according to our experience, the following examinations are both routine and necessary for comatose patients and patients in vegetative state. 1. Transcranial Doppler (TCD): to understand the cerebral blood flow, especially the blood flow of the anterior and middle cerebral arteries. 2.Electroencephalography(EEG): to understand the function of each brain area in the cerebral cortex. Evoked potentials (EP): including visual evoked potentials (VEP), brainstem auditory evoked potentials (BAEP), somatosensory evoked potentials (SEP), to understand the function of the brainstem. (4) Imaging examination: (1) CT: head CT examination in the early stage of coma and vegetative state to observe whether the patient has diffuse edema of the whole brain, whether it is compressed to the surrounding tissues, especially the neuronal nuclei, and in the middle and late stages to understand whether the patient has hydrocephalus and the nature of hydrocephalus, and whether it is necessary to carry out ventriculo-ventricular shunt. (2) MRI: Cranial magnetic resonance imaging can more clearly show the location and nature of the brain parenchymal damage, but it is important to observe three slices (cross-sectional position, i.e., what is often referred to as the plain, sagittal, and coronal positions, especially the latter two are more important), to know whether there is a tiny hemorrhage foci, and to determine whether there is a diffuse axonal injury, the location and extent of brain stem injury, the location and extent of thalamus injury, and so on. All of the above tests, which are non-invasive, are also used to assess the effectiveness of various therapeutic measures, for example, whether treatment A is excitatory or inhibitory for the patient, and if it is inhibitory, it should be discontinued, and if it is excitatory, it should be adhered to. Some central excitatory drugs and drugs that nourish brain cells can induce epilepsy, and patients with traumatic brain injury are often accompanied by epilepsy, so it is necessary to identify whether it is epilepsy accompanied by post-traumatic injury or drug-induced epilepsy, and drug-induced epilepsy has to be discontinued immediately, and antiepileptic drugs have to be applied to the epileptic epilepsy that is accompanied by epilepsy, and at this time, electroencephalograms (EEGs) are very necessary, especially long-range video electroencephalograms (VEEG). Monitoring. VEEG can conveniently and continuously observe the patient’s EEG activity, which is helpful in understanding the nature and extent of the patient’s condition, prognosis, and the evaluation of the effect of interventions. Laboratory examination: (1) Biochemical examination: mainly to understand the electrolyte situation, especially the Na+ and K+ situation, the clinical phenomenon of low sodium and low potassium is common. (2) Cerebrospinal fluid examination: in addition to routine cerebrospinal fluid biochemistry, it is more important to know whether the pressure of cerebrospinal fluid is normal and whether the cerebrospinal fluid circulation is smooth.