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Neurology System > Coma > Flashcards

Coma Flashcards

1
Q

What is coma?

A

A state of unrousable psychological unresponsiveness in which the subjects lie with eyes closed and show no psychologically understandable response to external stimulus or inner need”

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2
Q

What does consciousness depend on?

A

Intact ascending reticular activating system - to give arousal
A functioning cerebral cortex of both hemispheres - to give awareness of environment

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3
Q

What can cause low GCS?

A

Toxic/metabolic states
Seizures
Damage to reticular activating system
Causes of raised ICP

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4
Q

What can cause raised ICP?

A 
Tumour 
Stroke 
Epidural heamtoma 
Subdural haemorrhage 
Subarachnoid haemorrhage 
Hydrocephalus
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5
Q

What is persistent vegetative state?

A

vegetative state is absence of responsiveness and awareness due to overwhelming dysfunction of the cerebral hemispheres, with sufficient sparing of the diencephalon and brain stem to preserve autonomic and motor reflexes and sleep-wake cycles

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6
Q

What recovers in persistent vegetative state?

A

Brain stem

So there is arousal and wakefulness

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7
Q

What is locked in syndrome?

A

Condition where damages part of the brainstem, in which the body and most of the facial muscles are paralysed but consciousness remains and the ability to perform certain eye movements is preserved

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8
Q

Where does paralysis begin in locked in syndrome?

A

Below the level of CN III

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9
Q

What can a patient do in locked in syndrome?

A

Has consciousness

and can perform certain eye movements

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10
Q

What are the steps for resuscitation?

A

Airway
Breathing
Circulation

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11
Q

What can depressed respiration tell you about coma?

A

Drug overdose

Metabolic disturbance

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12
Q

What can increased respiration tell you about a patient?

A

Potential
hypoxia
Hypercapnia
acidosis

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13
Q

What can fluctuating respiration tell you about a patient?

A

Potential brainstem lesion

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14
Q

What blood samples should be done on admission?

A

glucose, biochemistry, haematology, blood gas

toxicology

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15
Q

What should a coma patient be examined for?

A

Evidence of meningitis

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16
Q

What basic tests should be carried out on a coma patient on admission (very basic)?

A

Baseline BP
Pulse
Temperature
IV access

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17
Q

What should be monitored in a potential coma patient?

A 
Temperature
Heart rate, Blood Pressure, CVS
Respiration
Skin, breath
Abdomen
Meningism potential 
Fundal examination
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18
Q

How do you examine and assess a coma patient?

A

GCS
Brainstem function
Motor function and reflexes

19
Q

What are the 4 level of eye opening in GCS?

A

Spontaneous - 4
To speech - 3
To pain - 2
None - 1

20
Q

What are the 5 levels of verbal response in GCS?

A 
Orientated - 5 
Confused - 4 
Inappropriate words - 3 
Incomprehensible sounds - 2 
None - 1
21
Q

What are the 6 levels of motor response for GCS?

A 
Obeying commands - 6
Localising to pain - 5 
Withdrawing from pain - 4 
Flexing to pain - 3 
Extending to pain - 2 
None - 1
22
Q

What is the GCS for coma?

A

< or equal to 8

23
Q

What is eye opening score in coma?

A

2 or less

24
Q

What is verbal response score in coma?

A

2 or less

25
Q

What is motor response in coma?

A

4 or less

26
Q

Which cranial nerves control pupillary reactions?

A

II and III

27
Q

Which cranial nerves control corneal responses?

A

V and VII

28
Q

Which cranial nerves control eye movements?

A

CN III, IV, VI

29
Q

Which cranial nerves control oculovestibular responses?

A

III, IV, VI , VII

30
Q

Which factors affecting the prediction outcome for coma?

A 
Age 
Cause of coma 
Depth of coma 
Duration of coma 
Certain clinical signs the most important of which are brainstem reflexes
31
Q

What care need to continued for a patient in a coma?

A 
Maintenance of vital functions
Care of skin - avoidance of pressure sores
Attention to bladder and bowel function
Control of seizures
Prophylaxis of DVT, peptic ulceration	
Prevention of contractures
Consider the “Locked - in” Syndrome
32
Q

Which head injuries can lead to focal neurological signs/epilepsy?

A 
Diffuse axonal injury
	Contusion
	Intracerebral haematoma
	Extra-cerebral haematoma 
Extra-dural haematoma
Sub-dural haematoma
33
Q

How do you treat raised ICP?

A

Surgery to relieve the pressure
Osmotic agents
Maintain good PO2 and reduce PCO2
Reduce the pain

34
Q

What investigations are obligatory for coma/

A

CT or MRI

35
Q

Which other investigations can be done for coma patients?

A

Metabolic screens
LP
EEG

36
Q

What can cause a coma without focal or lateralising signs and without meningism?

A

Anoxic/ ischaemic conditions
Metabolic disturbances
Intoxications
Systemic infections

Epilepsy

37
Q

What investigations should be done forcoma without focal or lateralising signs and without meningism?

A 
Toxicology screen including alcohol level
Measure blood sugar and electrolytes
Assess hepatic and renal function
Acid - base assessment and blood gases
Measure blood pressure
Consider carbon monoxide poisoning
38
Q

What are some causes of coma without focal or lateralising signs but with meningism?

A

SAH
Meningitis
Encephalitis

39
Q

What investigations should be done forcoma without focal or lateralising signs but with meningism?

A

CT

LP

40
Q

What things should be assessed on LP?

A

Appearance
Cell count
Glucose level
Capsular antigen test

41
Q

What can cause Coma with focal brainstem or lateralising cerebral signs?

A

Cerebral tumour
Cerebral haemorrhage
Cerebral infarction
Cerebral abscess

42
Q

What investigations should be done for coma with focal brainstem or lateralising cerebral signs?

A 
CT or MRI obligatory 
If not diagnostic investigate:
Metabolic screens 
LP 
EEG
43
Q

What % of patients in non-traumatic coma >6 hours will make a good recovery?

A

15%

Other 85% will die or remain in a state of vegetative/severe disability

Neurology System (35 decks)

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