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Nervous System > Lecture 10.2: Assessment of Consciousness > Flashcards

Lecture 10.2: Assessment of Consciousness Flashcards

1
Q

What is Consciousness?

A
  • Your awareness of external events
  • Your awareness of internal sensations
  • Your awareness of yourself as a unique being
    having experiences
  • Your awareness of your thoughts about these
    experiences
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2
Q

Theories on the Origins of Consciousness (4)

A
  • Creation: God’s gift.
  • None: consciousness is mythical, like demons.
  • By-product of evolution of cognitive complexity.
  • Evolution by natural selection: increases ability to
    survive and reproduce.
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3
Q

Levels of Awareness (6)

A
  • Awake
  • Sleep
  • Anaesthesia
  • Coma
  • Persistent Vegetative State
  • Death
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4
Q

What is Brain Death?

A
  • Total unawareness of externally applied stimuli
  • No movements or breathing during a period of at
    least one hour
  • No reflexes
  • Flat EEG (no brain waves)
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5
Q

What does Anaesthesia do to consciousness?

A
  • Anaesthetics inhibit neuronal activity
  • As anaesthetic dose is increased, metabolic
    activity in the brain decreases
  • At some point, consciousness is abruptly lost
  • Activity in high order association areas is reduced
  • Significant decrease in thalamic activity
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6
Q

What is the Reticular Activating System?

A

Diverse spread of interconnected nuclei in the brainstem that send projections to a range of cortical and spinal regions

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7
Q

What is Coma?

A
  • A sleep like state with no purposeful response
    from which the patient cannot be aroused
  • Due to disturbance in function of brainstem,
    reticular activating system or both hemispheres
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8
Q

What is Stupor?

A

State of reduced consciousness where patient may show poorly directed reflexes to physical stimuli

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9
Q

What can cause altered consciousness? (10)

A
  • Abnormal Glucose Levels
  • Trauma
  • Renal Failure
  • CO Poisoning
  • Infection
  • Hepatic Failure
  • Hypoxia
  • Drugs
  • Seizures
  • Abscess
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10
Q

What is a Extra/Epidural Haemorrhage?

A

Haemotoma between between inner table of skull and dura

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11
Q

What is the most common source of bleeding in an Extra/Epidural Haemorrhage?

A

A torn middle meningeal artery (90%)

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12
Q

What is the less common source of bleeding in an Extra/Epidural Haemorrhage?

A

Venous EDH from dural venous sinus

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13
Q

What is the most common cause of a EDH?

A

Typically young patient following sport or RTA

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14
Q

How does a EDH present?

A
  • May or may not lose consciousness
  • Lucid interval
  • Ongoing headache
  • Collapse few hours later
  • Urgent neurosurgical input
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15
Q

What is the shape of an EDH?

A

Typically biconvex in shape and can cause a mass effect

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16
Q

What is the shape of a Subdural Haemorrhage?

A
  • Typically crescentic (crescent moonshaped)
  • More extensive than EDH
  • Internal margin paralleling the cortical margin of
    the adjacent brain
17
Q

What is the source of bleeding in a Subdural Haemorrhage?

A

Venous: torn bridging veins that cross the Dural sinuses

18
Q

How do Subarachnoid Haemorrhages present?

A
  • Patients typically present with a thunderclap.
    headache
  • Usually the worst headache of their lives
  • It is associated with collapse and loss of
    consciousness
19
Q

What can cause a Subarachnoid Haemorrhages? (2)

A
  • Trauma (with associated cerebral contusion)
  • Spontaneous: ruptured berry aneurysm (85%)
20
Q

Base of Skull Fracture Signs (6)

A
  • Raccoon Eyes
  • CSF Rhinorrhea
  • CSF otorrhea
  • Battle Sign (bruising over the mastoid process)
  • Haemotympanum
  • Bump
21
Q

Signs of a Skull Fractures (11)

A
  • Bleeding
  • Bruising
  • Altered Consciousness
  • Neurological Signs
  • Battle’s Sign
  • Racoon Eyes
  • CSF Rhinorrhoea
  • Cranial Nerve Palsy
  • Hemotympanum
  • Deafness
  • Nystagmus
22
Q

What can cause raised ICP? (3)

A
  • Mass – intrinsic = tumour, extrinsic = haematoma
  • Diffuse brain swelling
  • Impaired circulation/absorption of CSF
23
Q

What is Cushing’s Triad? (3)

A
  • Hypertension
  • Bradycardia
  • Decreased Respirations
24
Q

What can raised ICP cause to happen to the brain?

A

Herniations

25
Q

What is Cingulate Herniation Under Falx?

A
  • Aka midline shift hernia
  • The most common type of cerebral hernia
  • Generally caused by unilateral frontal, parietal, or
    temporal lobe disease that creates a mass effect
    with medial direction, pushing the ipsilateral
    cingulate gyrus down and under the falx cerebri
26
Q

What is Tentoral Herniation (symmetrical)? Symptoms?

A
  • The movement of brain tissue from one intracranial
    compartment to another
  • Compresses midbrain
  • Bilateral dilated pupils
  • Coma & tetraparesis
27
Q

What is Uncal Herniation Over Tentoral? Symptoms?

A
  • Subtype of descending transtentorial herniation
    that involves the uncus, caused by raised ICP
  • Asymmetrical
  • Unilateral 3rd nerve palsy
  • Tetraparesis
28
Q

What is Tetraparesis?

A

A condition in which the patient’s four limbs suffer from muscle weakness

29
Q

What is Cerebellar Tonsil Herniation?

A
  • Descent of the cerebellar tonsils through the
    foramen magnum
  • This compresses the medulla against the clivus/
    odontoid process
  • Leads to Death
30
Q

ABCDD

A
  • Airway (catastrophic haemorrhage)
  • Breathing
  • Circulation
  • Disability - baseline observations, pupils, BM, AVPU,
    GCS
  • DontEverForgetGlucose

Nervous System (18 decks)

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