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.

Пікірлер: 102

  • @hammah2299
    @hammah22999 ай бұрын

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

  • @theneurophile

    @theneurophile

    8 ай бұрын

    You’re welcome.

  • @logesh8122
    @logesh81223 жыл бұрын

    This is the best medical lecture I have ever seen.

  • @aconcretemoth9382
    @aconcretemoth93823 ай бұрын

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

  • @theneurophile

    @theneurophile

    3 ай бұрын

    Thank you so much!

  • @dreaisonxo
    @dreaisonxo4 жыл бұрын

    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

    @theneurophile

    4 жыл бұрын

    Thank you for your kind words.

  • @joshjones8691
    @joshjones86918 ай бұрын

    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.

  • Жыл бұрын

    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!

  • @VyVy-ks5qj
    @VyVy-ks5qj2 жыл бұрын

    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.

  • @TheDrmohit
    @TheDrmohit3 жыл бұрын

    Best lecture with so much clarity and depth…

  • @twistychristie3611
    @twistychristie36113 жыл бұрын

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

  • @geebees1545
    @geebees15453 жыл бұрын

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

  • @AkashMishra23
    @AkashMishra233 жыл бұрын

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

  • @Bullethealth
    @Bullethealth2 жыл бұрын

    This is literally the best lecture i have ever seen

  • @mustafasaleem1197
    @mustafasaleem11973 жыл бұрын

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

  • @lindamezones8179
    @lindamezones81792 жыл бұрын

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

  • @madalinaioana6717
    @madalinaioana67173 жыл бұрын

    Extremely helpful. Thank you so much!

  • @Hammoun
    @Hammoun3 жыл бұрын

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

  • @goodvibesnerd3228
    @goodvibesnerd32282 жыл бұрын

    This is the best channel for neurology lectures

  • @madridista3927
    @madridista39273 жыл бұрын

    Awesome video. Thank you very much!

  • @gentleman7951
    @gentleman79514 жыл бұрын

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

  • @roulaasim8321
    @roulaasim83212 жыл бұрын

    awesome work! thank you for sharing this!

  • @radathiannitiworakun2469
    @radathiannitiworakun24693 жыл бұрын

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

  • @shami_neurology
    @shami_neurology4 жыл бұрын

    beyond all expectations, wooow

  • @kwihanganaclement1169
    @kwihanganaclement1169 Жыл бұрын

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

  • @Nicky11881
    @Nicky118812 жыл бұрын

    I'm in love with your lectures!!!

  • @zeljkacuk4498
    @zeljkacuk44982 жыл бұрын

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

  • @sevakayvazyan
    @sevakayvazyan4 жыл бұрын

    Best lectures I have ever heard.

  • @theneurophile

    @theneurophile

    4 жыл бұрын

    Thanks!

  • @MrAhmedBakhsh
    @MrAhmedBakhsh4 ай бұрын

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

  • @vivianamaral8759
    @vivianamaral8759 Жыл бұрын

    Amazing Lecture! Thank you.

  • @thienphucnguyen7113
    @thienphucnguyen71134 жыл бұрын

    Thank you so much . Your Lectures are beyond amazing

  • @theneurophile

    @theneurophile

    4 жыл бұрын

    Thank you for your kind words.

  • @aster.96
    @aster.96 Жыл бұрын

    Amazing thank youuuuuuu

  • @caiyu538
    @caiyu5388 ай бұрын

    great lectures.

  • @nathancenz7935
    @nathancenz79353 жыл бұрын

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

  • @theneurophile

    @theneurophile

    3 жыл бұрын

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

  • @frogprincessss
    @frogprincessss Жыл бұрын

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

  • @cosmicbeing251
    @cosmicbeing2513 жыл бұрын

    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.

  • @deboraoliveiracardoso2815
    @deboraoliveiracardoso28158 ай бұрын

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

  • @theneurophile

    @theneurophile

    8 ай бұрын

    Wow, thank you!

  • @nahommulatu3294
    @nahommulatu32945 жыл бұрын

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

  • @matias1892
    @matias18925 жыл бұрын

    Nice!

  • @immadisarojini2775
    @immadisarojini27753 жыл бұрын

    This is extra ordinary

  • @user-xv5bh9im7f
    @user-xv5bh9im7f2 жыл бұрын

    very usefull lecture it solve all my defect in coma topic

  • @Deadioan196
    @Deadioan1963 жыл бұрын

    NICE!!!

  • @jaydenkelly5934
    @jaydenkelly59345 жыл бұрын

    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

    @theneurophile

    5 жыл бұрын

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

  • @theneurophile

    @theneurophile

    5 жыл бұрын

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

  • @merrybr6937
    @merrybr69372 жыл бұрын

    It was great, tnx

  • @caiyu538
    @caiyu538 Жыл бұрын

    excellent lectures, KZread 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.

  • @amysho123
    @amysho1235 жыл бұрын

    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

    @theneurophile

    5 жыл бұрын

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

  • @marcelinoa.megantara8757
    @marcelinoa.megantara87573 жыл бұрын

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

  • @LEARNING-MEDICAL-EDUCATION
    @LEARNING-MEDICAL-EDUCATION9 ай бұрын

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

  • @theneurophile

    @theneurophile

    9 ай бұрын

    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.

  • @henamamoni6407
    @henamamoni6407 Жыл бұрын

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

  • @theneurophile

    @theneurophile

    Жыл бұрын

    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.

  • @karimullah100
    @karimullah1008 ай бұрын

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

  • @theneurophile

    @theneurophile

    8 ай бұрын

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

  • @PortoMD
    @PortoMD5 жыл бұрын

    Excellent explanation. Pure Gold👍🏻👍🏻👍🏻

  • @theneurophile

    @theneurophile

    5 жыл бұрын

    Thank you. We try.

  • @yoasakura2306
    @yoasakura23062 жыл бұрын

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

  • @theneurophile

    @theneurophile

    Жыл бұрын

    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.

  • @krissn3614
    @krissn36142 жыл бұрын

    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

    @theneurophile

    2 жыл бұрын

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

  • @CosmoConstant
    @CosmoConstant2 жыл бұрын

    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

    @theneurophile

    2 жыл бұрын

    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.

  • @ezhilkugan2527
    @ezhilkugan2527 Жыл бұрын

    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

    @theneurophile

    Жыл бұрын

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

  • @taehonglim3953
    @taehonglim39532 жыл бұрын

    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

    @theneurophile

    2 жыл бұрын

    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

    @taehonglim3953

    2 жыл бұрын

    @@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

    @theneurophile

    2 жыл бұрын

    @@taehonglim3953 Thank you kindly.

  • @samuela1437
    @samuela14379 ай бұрын

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

  • @brainman709
    @brainman7093 жыл бұрын

    Kindly explain the difference between delirium and coma.

  • @theneurophile

    @theneurophile

    3 жыл бұрын

    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).

  • @lolahpearl6679
    @lolahpearl66792 жыл бұрын

    💯💯💯❤️

  • @vivekpachange6017
    @vivekpachange60173 жыл бұрын

    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

    @theneurophile

    3 жыл бұрын

    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

    @vivekpachange6017

    3 жыл бұрын

    @@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

  • @juanpedrogarcia9323
    @juanpedrogarcia93232 жыл бұрын

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

  • @theneurophile

    @theneurophile

    2 жыл бұрын

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

  • @nivyab6276
    @nivyab62764 жыл бұрын

    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

    @theneurophile

    4 жыл бұрын

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

  • @sundaygodfrey6193
    @sundaygodfrey61932 жыл бұрын

    Can it be downloaded

  • @theneurophile

    @theneurophile

    2 жыл бұрын

    Sorry, can what be downloaded?

  • @iqbalbuneri7469
    @iqbalbuneri74693 жыл бұрын

    👍👍👍

  • @divyag3647
    @divyag3647 Жыл бұрын

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

  • @theneurophile

    @theneurophile

    Жыл бұрын

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

  • @divyag3647

    @divyag3647

    Жыл бұрын

    @@theneurophile thanku!

  • @dewplayz3421
    @dewplayz34214 жыл бұрын

    How do you know if your not in a coma?

  • @theneurophile

    @theneurophile

    4 жыл бұрын

    “I think, therefore I am”

  • @monvicasabbi8792
    @monvicasabbi87927 ай бұрын

    🤯🤯🤯🤯

  • @user-do5hg6vr7e
    @user-do5hg6vr7e3 жыл бұрын

    Images are blurred sir!

  • @theneurophile

    @theneurophile

    3 жыл бұрын

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

  • @Meotamthe9999
    @Meotamthe9999Ай бұрын

    3:48

  • @theneurophile

    @theneurophile

    Ай бұрын

    ?

  • @yashwanthrao98055
    @yashwanthrao980559 ай бұрын

    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

    @theneurophile

    9 ай бұрын

    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

    @yashwanthrao98055

    9 ай бұрын

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