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BMB Test 3 > B7.049 Prework: Disorders of Consciousness > Flashcards

B7.049 Prework: Disorders of Consciousness Flashcards

1
Q

coma

A

pathological absence of consciousness

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2
Q

determination of levels of consciousness

A

stimulus required for eye opening

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3
Q

awake

A

spontaneous eye opening

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4
Q

lethargic

A

speech stimulus required for eye opening

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5
Q

stupor

A

pain stimulus required for eye opening

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6
Q

coma

A

no stimuli can open eyes

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7
Q

which systems can be affected to cause coma

A

cortical systems

RAS

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8
Q

lesion categories that can lead to coma

A

midline (RAS)
-this section more resistant to toxic/metabolic stimuli than cortical neurons
diffuse (cortex)

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9
Q

diencephalic lesion

A

affects RAS at level of thalamus
possible basilar occlusion
sudden onset

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10
Q

subtentorial lesion

A

affects RAS at level of brainstem

sudden onset of coma

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11
Q

supratentorial lesion

A

early: diencephalic
late: brainstem
caused by space occupying lesion that distorts the RAS due to herniation
focal signs can precede coma

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12
Q

metabolic lesion

A

diffuse throughout the cortex

delirium can precede coma

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13
Q

psychogenic lesion

A

psychological stressors precede coma

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14
Q

why is a neurologic examination useful in coma

A
  • anatomic proximity of pupillary and oculomotor subsystems to RAS
  • selective susceptibility of neurologic subsystems to metabolic insults (cortex susceptible, pupillary system resistant)
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15
Q

components of neuro exam in coma

A

level of consciousness
pupils
extraocular movements
motor function

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16
Q

parasympathetic pupillary system susceptibility

A

resistant to toxic-metabolic processes

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17
Q

sympathetic pupillary system susceptibility

A

sensitive to toxic-metabolic processes

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18
Q

psychogenic pupil

A

mid range

reactive

19
Q

metabolic pupils

A

small (sym knocked out)

reactive (para ok)

20
Q

diencephalic pupils

A

small (sym knocked out in anatomic region)

reactive (para region not affected)

21
Q

supratentorial pupils

A

early: small, reactive
late: mid range, unreactive

22
Q

subtentorial pupils

A 
mid range (no para or sym function)
unreactive
23
Q

fast eye movements in coma

A

if intact: cortex intact

sensitive to toxic-metabolic processes

24
Q

slow eye movements in coma

A

if intact: brainstem intact

moderately sensitive to toxic-metabolic processes

25
Q

how to assess eye movements in coma

A 
oculocephalic reflex (move neck and see if eyes stay centered)
cold calorics (show slow deviation to the side that is being irrigated, should not see nystagmus if in a real coma)
26
Q

psychogenic eye movements

A

intact fast

intact slow

27
Q

metabolic eye movements

A

absent fast

intact or abnormal slow

28
Q

diencephalic eye movements

A

absent fast

intact slow

29
Q

supratentorial eye movements

A

early: absent fast, intact slow
late: absent fast, abnormal slow

30
Q

subtentorial eye movements

A

absent fast

abnormal slow

31
Q

motor function in coma

A

bilateral, symmetric motor abnormalities characterize most patients including these with metabolic coma
bilateral corticospinal tract findings

32
Q

different types of motor responses in coma

A

decorticate: abnormal flexion (lesion between cortex and red nucleus)
decerebrate: abnormal extension (lesion between red and vestibular nuclei)

33
Q

usefulness of motor response in localizing source of coma

A

not very

34
Q

usefulness of CT in localizing source of coma

A

used to evaluate for supratentorial mass

helps distinguish between diencephalic, supratentorial, or subtentorial based on findings

35
Q

brainstem intact lesions

A 
psychogenic
metabolic
diencephalic
early supratentorial
have intact slow eye movements and pupillary response
36
Q

brainstem not intact lesions

A

late supratentorial
subtentorial
pupils unreactive
abnormal slow eye movements

37
Q

cortex intact lesions

A

psychogenic

pupils reactive and fast eye movements can be present

38
Q

coma algorithm

A
  1. check if cortex or brainstem intact (eye movements and pupils)
  2. check for mass (CT)
39
Q

psychogenic coma prevalence

A

5%

40
Q

metabolic/diencephalic coma prevalence

A

60%

41
Q

supratentorial coma prevalence

A

25%

42
Q

subtentorial coma prevalence

A

10%

43
Q

further workup for toxic metabolic comas

A

routine labs (kidney failure, liver failure, etc)
stat lumbar puncture
EEG if history or signs of seizures (uncommon)
MRI

BMB Test 3 (21 decks)

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