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Neurology > 300 Coma > Flashcards

300 Coma Flashcards

1
Q

Defined as deep sleeplike state with eyes closed from which patient cannot be aroused

A

coma

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2
Q

refers to a higher degree of arousability in which the patient can be transiently awakened by vigorous stimuli accompanied by motor behaviour that leads to avoidance or withdrawal from uncomfortable or aggravating stimuli

A

stupor

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3
Q

stimulates light sleep and is characterized by easy arousal and the persistence of alertness for brief periods

A

drowsy

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4
Q

signifies a awake appearing but non responsive state often in a patient who has emerged from coma

A

vegetative state

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5
Q

most common cause of the vegetative and minimally conscious states

A

cardiac arrest with cerebral hypoperfusion and head trauma

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6
Q

refers to a partially or fully awake state in which the patient is able to form impressions and think as demonstrated by later recounting of events but remains virtually immobile and mute

A

akinetic mutism

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7
Q

akinetic mutism results from damage of what

A

the condition results from damage in the regions of the medial thalamic nucle or the frontal lobes, or from extreme hydrocephalus

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8
Q

describes a milder form of akinetic mutism characterized by mental and physical slowness and diminished ability to initiate activity

A

abulia

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9
Q

what part of the brain is damaged when patient presents with abulia

A

medial frontal lobes and their connections

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10
Q

hypomobile and mute syndrome that occurs usually as part of major psychosis typically schizoprenia or major depression

A

catatonia

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11
Q

How is catatonia different from akinetic mutism

A

Catatonia and akinetic mutism are superficially similar but in catatonia clinical evidence of cerebral damage such as hyperreflexia and hypertonicity of the limbs is lacking

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12
Q

describes an important type of pseudocoma in which an awake person has no means of producing speech or volitional limb movement but retains voluntary vertical eye movements and lid elevation thus allowing the patient to signal with a clear mind

A

locked in state

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13
Q

what part of the brain is damaged in patients with locked-in state

A

usual cause is infarction of the basilar artery, hemorrhage of the ventral pons that transects all descendint motor (corticospinal or corticobulbar) pathways

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14
Q

Damage to what systems leads to coma

A

widespread damage to the cerebral hemisphere or reduced activity of the reticular activating system (RAS) which is diffusely located in the brainstem

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15
Q

separates the right and left cerebral hemispheres

A

falx

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16
Q

separates the anterior and posterior fossae

A

tentorium

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17
Q

refers to the displacement of brain tissue by an overlying or adjacent mass into a contiguous compartment that it normally does not occupy

A

herniation

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18
Q

most common form of herniation

A

transtentorial herniation

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19
Q

brain tissue is displaced from the supratentorial to the infratentorial compartment through the tentorial opening

A

transtentorial herniation

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20
Q

refers specifically to the impaction of the anterior medial temporal gyrus (uncus) into the tentorial opening just anterior to and adjacent to the midbrain

A

uncal herniation

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21
Q

first sign of uncal hernation

A

Enlargment of the ipsilateral pupil as the uncus compresses on the third nerved as the nerve transver the subarachnoid space

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22
Q

refers to the hemiparesis contralateral to the hemiparesis and Babinski sign that result the displacement of the cerebral penduncle

A

Kernohan_ Woltman sign

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23
Q

denotes symmetric downward movement of the thalamic structures through the tentorial opening with compression of the upper midbrain

A

central transtentorial herniation

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24
Q

heralding signs of central transtentorial herniation

A

miotic pupils and drowsiness

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25
Q

displacement of the cingulate gyrus under the falx and across the midline

A

transfascial herniation

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26
Q

downward forcing of the cerebellar tonsils into the foramen magnum

A

foraminal herniation

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27
Q

why is forminal herniation deadly

A

it causes early compression of the medulla leading to respiratory arrest

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28
Q

How much horizontal displacement of the pineal gland is associated with drowsiness

A

3-5 mm displacement

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29
Q

How much horizontal displacement of the pineal gland is associated with stupor

A

6-8 mm displacement

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30
Q

how much horizontal displacement of the pineal gland is associated with coma

A

more than 9 mm displacement

31
Q

True or false. Unlike hypoxia- ischemia which causes neuronal destruction, most metabolic disorders such as hypoglycemia, hyponatremia cause only minor neuropathologic changes.

A

True.

32
Q

True or false. Coma and seizures are common accompaniments of large shifts in sodium and water balance in the brain.

A

True.

33
Q

When can temperature cause coma

A

hypothermia itself causes trauma when the temperature is less than 31 degrees Celsius

34
Q

May be the only sign of seizure in comatose patients

A

subtle, intermittent twitching movements of foot, finger, or facial muscle may be the only sign of seizure

35
Q

Sign of metabolic encephalopathy or drug intoxication in a drowsy and confused patient

A

bilateral asterixis

36
Q

What is decorticate posturing and what does it suggest?

A

Decorticate is flexion of the elbows and wrists and supination of the arms which suggests bilateral damage to the rostal to the midbrain

37
Q

what is decerebrate posturing and what does it indicate

A

Decerebrate posuturing is the extension of the elbows and wrists with pronation and indicates damage to the motor tracts caudal to the midbrain

38
Q

posturing in response to noxious stimuli indicates severe damage to what system?

A

Damaged cortisospinal system

39
Q

Abduction-avoidance movement of a limb denotes what?

A

intact corticospinal system

40
Q

True or false. Given that the nuclei of the cranial nerves and the RAS are both located in the brainstem, assessment of brainstem function is essential to localization of the lesion in coma

A

True.

41
Q

Most important brainstem reflexes

A

pupillary size and reaction to light; spontaneous and elicited eye movements, corneal responses and the respiratory system

42
Q

Pupillary sign that essentially exclude upper midbrain damage

A

reactive and round pupils of midsize 2.5-5 mm

43
Q

Most extreme pupillary signs

A

bilaterally dilated and unreactive pupils indicated severe midbrain damage from compression by a supratentorial mass

44
Q

Finding exonerates extensive damage in the midbrain and pons

A

spotaneous eye movements in coma in a form of conjugate horizontal roving

45
Q

How does seizure involving the frontal lobe look like

A

seizures involving the frontal lobe drive the eyes to the opposite side, simulating a pontine destructive lesion

46
Q

True or false. Eyes look toward a hemispheral lesion and away from a brainstem lesion.

A

True. Maxim

47
Q

Eyes may occassionally turn paradoxically away from the side of a deep hemispheral lesion. What do you can this phenomenon

A

wrong way eyes

48
Q

What is the eye position in thalamic and upper midbrain lesions

A

eyes turn downward and inward

49
Q

described as brisk downward and slow upwards movement of the eyes associated with loss of horizontal eye movements and where is the lesion

A

ocular bobbing; diagnostic of bilateral pontine damage

50
Q

described as slower arrythmic downward movement followed by faster upward movement? Where is the lesion

A

ocular dipping; indicates diffuse cortical anoxic damage

51
Q

True or false. Doll’s eye is normally suppressed in awake patients

A

True. It is suppressed in awake person and intact frontal lobe

52
Q

What does a positive dolls eye mean?

A

reflects both reduced cortical influence on the brainstem and intact brainstem pathways

53
Q

provides more intense stimulus for the oculocephalic relfex but provides essentially the same information

A

thermal or caloric stimulation of the vertibular apparatus

54
Q

what it the normal result to caloric stimulation

A

tonic deviation of both eyes to the cold water irrigation

55
Q

what is the caloric stimulation response in comatose patient?

A

nystagmus in the opposite direction of the cold water irrigation

56
Q

what is the normal corneal reflex

A

brief bilateral lid closure when cornea is touched with wisp of cotton

57
Q

what does the corneal reflex mean

A

corneal reflex depend on the integrity of pontine pathways between the fifth (afferent) and seventh (efferent) cranial nerves

58
Q

True or false, respiratory patterns are less of localizing value in comparison to other brainstem signs

A

True.

59
Q

Respiratory pattern. Typically cyclic form , ending with brief apneic period. What does this signify?

A

Cheyne Stokes respirations signifies bihemispheric damage or metabolic suppression with pontomesencephalic lesions

60
Q

Respiratory pattern. Rapid deep breathing. What does this signify?

A

Kussmaul breathing. Implies metabolic acidosis but may also occur with pontomesencephalic lesions

61
Q

Agonal grasps are due to what

A

lower brainstem (medullary damage) and recognized as terminal respiratory pattern of severe brain damage

62
Q

EEG finding. Widespread fast beta activity

A

coma from sedative drugs

63
Q

EEG finding. Predominant high voltage slowing (triphasic waves) the frontal region

A

metabolic encephalopathy

64
Q

What is alpha coma

A

widespread variale 8 to 12- hz activity resembling normal alpha rhythm of waking but it is not altered by environmental stimuli

65
Q

when do you see alpha coma

A

alpha coma results from pontine or diffuse cortical damage and is associated with poor prognosis

66
Q

EEG finding. Normal alpha activity suppressed by stimulating the patient.

A

locked in syndrome, hysteria or catatonia

67
Q

3 broad categories of coma

A

coma without focal neurologic signs as in metabolic and toxic encephaties; coma with prominent focal signs as in stroke and cerebral hemorrhage; meningitis syndrome characterized by fever or stiff neck

68
Q

cerebrovascular disease that can lead to coma

A

basal ganglia and thalamic hemorrahge (acute but no instantaneous), pontine hemorrhage (sudden onset); cerebellar hemorrhage; basilar artery thrombosis, subarachnoid hemorrhage

69
Q

True or false. Infarction in the MCA territory leads to instantenous coma.

A

False. But large infractions causing edema can have mass effect leading to coma

70
Q

True or false. Children and young adults may have ominous early clinical findings such as brainstem reflexes and yet recover so ultra early prognistication is unwise.

A

True.

71
Q

How is the observation prior to declaring a patient is brain dead

A

observation of 6-24 hour is recommended

72
Q

refers to ta state of irreversible cessation of all cerebral and brainstem function with preservation of cardiac activity and maintenance of respiratory and somatic function by artificial means

A

brain death

73
Q

is the only type of damage recognized as morally, ethically and legally equivalent to death

A

brain death

Neurology (14 decks)

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