Module Exam 6: Higher Corticals Flashcards
The state of arousal or the degree of variation from normal alertness as judged by the appearance of facial muscles, fixity of gaze, and body posture.
Level of consciousness
The state of patient’s awareness of self and environment and his responsiveness to external stimulation and inner need
Consciousness
Is by far the more important and dramatic aspect of disordered consciousness
Loss of normal arousal
The condition of person when awake; fully responsive to a thought or perception and indicates by his behavior and speech the same awareness of self and environment as that by the examiner
Normal
An inability to think with customary speed, clarity and coherence; marked by some degree of inattentiveness and disorientation; implies a degree of imperceptiveness and distractibility.
Confusion
An inability to sustain a wakeful state without tye applicationof external stimuli; inattentiveness and mild confusion are the rule both improving with arousal. Indistinguishable from light sleep.m
Drowsiness
Results most often from a process that influences the brain globally; can also be from focal __________ in various locations.
Confusion. Cerebral disease.
An inability to sustain a wakeful state without the application of external stimuli. Inattentiveness and mild confusion are the rule both improving with arousal. Indistinguishable from __________.
Drowsiness. Light sleep.
A state in which the patient can be roused only by vigorous and repeated stimuli but the state of arousal cannot be sustained without repeated external stimulation.
Stupor
In stupor, responses to spoken commands are either ___________ and ________.
Absent/low. Inadequate.
In stupor, this is common and there is a reduction or elimination of the natural shifting of body positions.
Restless/Stereotyped motor activity
In stupor, when left ________, these patients quickly drift back into a sleep-like state. The eyes move ______ & ______.
Unstimulated. Outward. Upward.
The patient appears to be asleep and is at the same time incapable of being aroused by external stimuli or inner need.
Coma
no reaction of any kind is obtainable: corneal, pupillary, pharyngeal, tendon and plantar reflexes are in abeyance and tone in the limb muscles is diminished.
Deepest stage of coma
Pupillary reactions, reflex ocular movements and corneal and other brainstem reflexes are preserved in varying degree, and muscle tone in the limbs may be increased; respiration may be slow or rapid, periodic, or deranged.
Lesser degrees coma
In lighter stages, sometimes referred to by the ambiguous and unhelpful terms ________ or _______, most of the reflexes can be elicited, and the plantar reflexes may be either flexor or extensor ( ______ sign)
Semicoma/Obtundation. Babinski sign.
Shares a number of other features with the pathologic states of drowsiness, stupor or coma. Include yawning, closure of the eyelids, cessation of blinking and swallowing, upward deviation or divergence or roving movements of the eyes, loss of muscular tone, decrease/loss of tendon reflexes, and even the presence of Babinskinsigns and irregular respirations, sometimes ________ in type.
Sleep. Cheyne-Stokes.
Upon being awakened from deep sleep, a normal person may be _______ for a few moments.
Confused
Sleeping persons may still respond to unaccustomed stimuli and are capable of some mental activity in the form of _______ that leave traces of _______, thus differing from persons in stupor or coma.
Dreams. Memory.
The most important difference in relationship of sleep to coma: persons in sleep, when stimulated, can be roused to normal and ________.
Persistent consciousness
Does not decrease during sleep, as it usually does in coma.
Cerebral oxygen uptake
Recordable electrical activity- _____ and cerebral evoked responses- and spontaneous motor activity differ in two states.
EEG
The patient remains totally inattentive, does not speak, and shows no signs of awareness of the environment or inner need; responsiveness is limited to primitive postural and reflex movements of the limbs. There is loss of sphincter control. There may be arousal or wakefulness in alternating cycles as reflected in partial eye opening, but the patient regains neither awareness nor purposeful behavior of any kind.
Persistent Vegetative State
In PVS, there is a lack of _______ visual following of objects.
Consistent
Syndrome of unconscious awakening lasting _______ after nontraumatic and ______ after traumatic injury.
Persistent Vegetative State. 3months. 12months.
In Persistent Vegetative State, most common pathologic bases are _______________ as a result of _________, widespread necrosis of the cortex after cardiac arrest, and thalamic necrosis from a number of causes.
Diffuse Cerebral injury. Closed head trauma.
In Persistent Vegetative State, the most common prominent pathologic changes are usually in the
Thalamic & Subthalamic nuclei
In traumatic cases of PVS, the pathologic findings are of diffuse ___________ ( described as diffuse __________), prominent thalamic degeneration, and ischemic damage in the cortex.
Subcortical white matter degeneration. Axonal injury.
In Persistent Vegetative State, anatomic findings suggest that the ________ is either diffusely injured or effectively disconnected and isolated from the _______ or the ________ are destroyed.
Cortex. Thalamus. Thalamic nuclei.
In either the traumatic or anoxic types of PVS, atrophy of the cerebral white matter may lead to _________ enlargement and thinning of the _______.
Ventricular. Corpus Callosum.
The patient is capable of some rudimentary behavior such as following a simple command, gesturing, or producing single words or brief phrases, always in an inconsistent way from one examiner to another.
Minimally Conscious State
In MCS, there is preservation of the ability to carry out basic _________ that demonstrate a degree of ______, at least at some times.
Motor behaviors. Alertness.
In Minimally Conscious State, the causes and pathologic changes are identical to those of vegetative state, including frequent finding of __________ and __________.
Thalamic. Multiple cerebral lesions.
There is little or no disturbance of awareness but only an inability of the patient to respond adequately. Is most often caused by a lesion of the _________ as a result of basilar artery occlusion.
Locked-in syndrome. Ventral pons (basis pontis).
In Locked-in Syndrome, such an infarction spares both _________ pathways and the ___________ responsible for arousal and wakefulness, as well as certain midbrain elements that allow the eyelids to be raised and give the appearance of wakefulness.
Somatosensory. Ascending neuronal systems.
The lesion in Locked-in syndrome essentially interrupts the _________ & _________ pathways, depriving the patient of speech and the capacity to respond in any way except by _______ & _______.
Corticobulbar. Corticospinal. Vertical gaze. Blinking.
Patients who are silent and inert as a result of bilateral lesions usually of the anterior parts of the _________, leaving intact the motor and sensory pathways. The patient is profoundly apathetic, lacking to an extreme degree the psychic drive or impulse to action (_______)
Akinetic mutism. Frontal lobe. Abulia.
The patient appears unresponsive, in a state that stimulates stupor, light coma, or akinetic mutism. There are no signs of structural brain disease such as pupillary or reflex abnormalities.
Catatonia
In catatonia, these are preserved, as in the awake state; there is usually resistance to eye opening, and some patients display a waxy flexibility of passive limb movement that gives the examiner a feeling of bending a wax rod; there is also the retention for a long period of seemingly uncomfortable limb postures.
Oculocephalic responses
Retention for a long period of seemingly uncomfortable limb postures.
Catalepsy
Display a waxy flexibility of passive limb movement that gives the examiner a feeling of bending a wax rod.
Flexibilitas cerea
Absence of all cerebral & brainstem functions, including spontaneous respiratiin. Irreversibility of the state.
Brain Death
Absence of cerebral function: presence of __________ and total lack of __________ and of motor and vocal responses to all visual, auditory, and cutaneous stimulation.
Deep coma. Spontaneous movement.
Absence of cerebral function: may persist, and the toes often flex slowly in response to plantar stimulation. But a well developed _______ is unusual.
Spinal reflexes. Babinski sign.
Absence of cerebral function: is seen from time to time as a transitional phenomenon just after brain death becomes evident.
Extensor or flexor posturing
