84b - Brain States and Coma Flashcards

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1
Q

List the following brain states from most responsive to least responsive:

Coma, obtundation, stupor

A
  • Obtundation
    • Most responsive
  • Stupor
    • Vague term, between alert an in a coma
    • Patient can respond peruposefully, but requires constant stimulation
  • Coma
    • Unresponsive
      • Patient cannot be stimulated to responsd purposefully
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2
Q

What is the medical definition of brain death?

A
  • No purposeful response to any stimuli
    • Including noxious stimuli
  • No brainstem reflexes
  • No spontaneous respiratory movments
  • Clear underlying etiology
    • Not due to medications or sedatives

May be present:

Simple reflexes, circadian rhythm, autonomic function

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3
Q

How will a patient with abulia present/act?

A
  • Slowing of cognitive and behavioral function
  • Intact cognitive function
  • Apathy

Often caused by medial frontal lobe injuries

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4
Q

How can you tell if a patient is in a coma or “locked in”?

A

A person who is locked in may be able to move their eyes up in response to commands

  • Patients with locked in syndrome are conscious, but unable to effectuate muscles
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5
Q

What is the difference between a vegetative state and a minimally conscious state?

A
  • Vegetative state
    • No purposeful response to stimuli
      • No environmental awareness
    • No brainstem reflexes
    • No spontaneous repsiratory movements
    • Eyes may open and rove randomly
  • Minimally conscous state
    • May require respiratory support
    • Behavioral evidence of self or environmental awareness
    • Eyes may lock onto familiar faces, objects rather than just roving
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6
Q

Which part of the brain mediates arousal and sleep/wake changes?

A

Ascending reticular activating system (ARAS)

Damage to ARAS and/or pathway results in impaired arousal

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7
Q

What is the difference between a coma and a vegetative state?

A

Patinets who are brain-dead will progress from coma to vegetative state in 10-30 days

In both states, the patient cannot respond purposefully, has no respiratory drive, and no brainstem reflexes

  • Coma
    • No eye opening
    • No circadian rhythm
  • Vegetative state
    • Circadian rhythm restored
    • Periods of eye opening, roving eye movement
    • Autonomic changes observed
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8
Q

Injury at which 3 areas of the brain can result in decreased level of arousal?

A
  • Ascending Reticular Activating System in the midbrain
  • Bilateral thalami
    • Before ARAS branches off
  • Both cerebral hemispheres

Other focal deficits will not impair arousal

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9
Q

What is the difference between abulia and akinetic mutism?

A

Both involve slowing of cognitive and behavior functions

Akinetic mutism is extreme abulia

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10
Q

Injury to the ______ results in locked in syndrome

Describe the syndrome

A

Injury to the pons results in locked in syndrome

Patients are paralyzed except upward eye movments - no cognitive impairment

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