ALOC

Question 1

What dose almond breath signify

Answer 1

Cyanide

Question 2

Discuss the oculocephalic reflexes and preservation of dolls eyes

Answer 2

Preservation of dolls eyes response indicates an intact medial longitudinal fasciculus and by default and intact brain stem suggesting metabolic cause

Dolls eyes - eyes remain fixated in one point in space so they remain fixed – if they remain midline and dont try to fix it is indicative of medial longitudinal fasiculus impairment and brainstem cause of stroke

Question 3

Discuss ocular responses to cold caloric testing of the oculovestibular reflex

Answer 3

Response to 50 mls of ice cold water to the TM

1) bilateral nystagmus
- Cerebrum - intact
- MLF - intact
- Brainstem -intact

2) bilateral conjugate deviation toward the stimulus
- cerebrum - metabolic dysfunction
- MLF- intact
- brainstem -intact

3) No response
- Brainstem - structural or metabolic dysfunction

4) ipsilateral dysconjugate deviation
- brain stem structural dysfunction

Question 4

Discuss patterns of respiratory dysfunction and site of lesions

Answer 4

1) forebrain
- resp pattern: Cheyne stokes (apnoea followed by increase and then decrease and then apnoea) -
- motor response - localizing to pain
- Pupils - symmetrical small reactive

2) midbrain
- resp pattern - hyperventilation
- motor response - decorticate
- pupils fixed
- upper midbrain CN 3 lower midbrain C4-6

3) Pons - pneumotactic inhibits apeurositic region
resp pattern - apneusis - halts briefly in full inspiration - longer inspiratory breathing with short expiration
-motor response -decerebrate
-symmetrical pinpoint reactive - Uncal herniation ipsilated fixed dilated
-CN 6 loss

4) medulla
- ataxic irregular rate and uneven depth
- apnoea