Ch 2 - TBI: Disorders of Consciousness Flashcards
What is Consciousness a function of?
Ascending reticular activating system (RAS) and the cerebral cortex
How does coma appear on EEG?
Lack of wakefulness as evidenced by the lack of sleep wake cycles
What is the clinical presentation of a patient in a coma?
Eyes closed
No spon purposeful movement
No ability to localize noxious stim
No language comprehension or expression
What is the neuropathology of a coma?
Damage to the RAS in the brainstem or its connections to the thalami or hemispheres
How does vegetative state appear on EEG?
Resumption of the sleep–wake cycle
What is the clinical presentation of a patient in a vegetated state?
No awareness No purposeful behavior Verbal or auditory startle No localization or tracking Opens eyes
What is the neuropathology of a vegetated state?
Diffuse cortical injury
Bilateral thalamic lesions
What is timing of a persistent vegetated state?
> 1 month after a traumatic or non-traumatic brain injury
What is timing of a permanent vegetated state?
> 3 mo after non-traumatic brain injury
>12 mo after TBI
What is a minimally conscious state?
Minimal evidence of self or environment awareness
What is the clinical presentation of a patient in a minimally conscious state?
Simple command following
Object manipulation
Intelligible verbalization
Gestural or verbal yes/no responses
What medications can be used for emergence of consciousness?
Methylphenidate Dextroamphetamine Dopamine agonists Amantadine Bromocriptine Acetylcholinesterase inhibitors TCAs SSRIs
What is Deceberate posturing?
Extension of UE and LE
What is Decorticate posturing?
Flexion in UE
Extension in LE
