Death, Coma

Question 1

Coma

Answer 1

depression fncs:
of both cerebral hemispheres, ascending arousal systems

Causes: Structural - compressive, destructive
Diffuse intrinsic (epilepsy, infections)
Metabolic
Psych

Question 2

Locked in syndrome

Answer 2

• damage to caudal pons below arousal

- intact awareness, vertical eye movements, vision - check blinking!

Question 3

Uncal herniation

Answer 3

cause decreased arousal
Cn 3 palsy - USE THIS TO LOCALIZE
hemiparesis (cerebral peduncle)
cortical blindness (PCAs)

Question 4

Doll’s eyes test and lesion

Answer 4

• MLF lesion: bilateral INO
• left pontineL 1.5 syndrome
• right lateral pontine gaze paralysis

Question 5

Pupil size test and lesions

Answer 5

normal:

• parasymp: constricits nd accomodate pupils
• symp: dilates, raise eyebrows, sweat

lesion at uncus: affected side dilated (parasymp)
lesion at midbrain: fixed, midposition (EWnucleus)
lesion at pons: pinpoint (symp)

Question 6

Glascow Coma Scale

Answer 6

Eye movement: 1 no, 2 open to pain, 3 open to verbal, 4 spon
Motor Response: 1 - no, 2 ext pain, 3 flex pain, 4 withdrw pain, 5 loclizing pain, 6 folows command
Verbal responses: T-intub, 1 no, 2 incomp, 3 inapp, 4 confused, 5 orient

2T - 15

Question 7

motor signs in coma

• hemiparasis
• flexor
• extended

Answer 7

• cortical
• F: diencephalon
• Ext: midbrain

Question 8

Clincial crieteria of brain death

Answer 8

• irreversible loss of capacity for consciousness, loss of brainstem fnc, no breathing
• on ventilator
• know etiology
• Absent; gag, cough, spinal, corneal, pupillary, vestibuloocular responses
• Apnea test: no resp effort
• no confounding: shock, hypothermia, metabolic disorders, nerve blockade, intoxications
• ancillary tests for blood flow

Question 9

Vegetative state

Answer 9

• still breathing spontaneous
• CV stability
• sleep/wake state
• mo-yrs