意識障害

Consciousness Disturbance

意識障害をきたす疾患は多岐にわたり，生命・機能予後に直結する疾患も多い。呼吸循環動態にも影響し，時にその安定を図りながら診断を進める必要がある。迅速な鑑別と治療が必要であるが，思い込みにより鑑別診断を狭めると誤診を招く。患者から詳細な問診ができないことは医療者に不利な点で，詳細な診察と注意深い鑑別を要す。経時的に鑑別診断が変わる場合があり，継続しての診察が重要である。筆者が経験した3例を紹介する。

Abstract

Various diseases cause consciousness disturbance, many of which are directly related to life and functional prognosis. As they often affect the respiratory and circulatory functions, differential diagnosis must be considered while stabilizing the patients. Although appropriate treatment should be started promptly after differential diagnosis, preconceptions could lead to misdiagnosis. A detailed medical interview cannot be conducted directly with the patient, which is a significant disadvantage faced by medical professionals in consciousness disturbance cases compared to other neurological disorders. Therefore, careful physical examination and diagnosis are important. At the same time, differential diagnosis may change over time, and follow-up examinations are necessary. Here, we would like to report three emergency cases of consciousness disturbance.