Coma

Question 1

stupor

Answer 1

nonsleep depresson of consciousness where normal rxns to the environment are blunted

Question 2

coma

Answer 2

nonsleep loss of consciousness where normal rxns to environ are lost

Question 3

delerium

Answer 3

nonsleep depresson of consciousness where normal rxns to environ are blunaed and replaces by agitated responses

Question 4

reticular activating system

Answer 4

retcular system connecting rostral pontine and midbrain through thalamus to cerebral cortex

Question 5

decorticate posture

Answer 5

posture in which lower limbs are extended and upper limbs flexed in response to noxious stimuli

Question 6

locked in

Answer 6

” refers to damage to the base of the pons with preservation of consciousness and vertical eye movements, but loss of all other voluntary movements.

Question 7

Cheyne Stokes

Answer 7

respiration is a pattern of breathing characterized by waxing and waning amplitude of respiration with preserved respriatory frequency.

Question 8

central neurogenic hyperventilation

Answer 8

typically occurs with pontine lesions, with increased depth of respiration.

Question 9

ataxic respiration

Answer 9

is a pattern of respiration with irregular depth and frequency of respirations with pauses.

Question 10

vestibulo occular reflex

Answer 10

is the reflex that keeps eyes directed on a target during head movements. It can be elicited by head movments or caloric tests.

Question 11

diencephalic pupils

Answer 11

bilaterally small pupils with lesions of the thalamus.

Question 12

coma-like states are differentiated from coma by

Answer 12

1) normal and alert ECG
2) presence of nystagmus on caloric irrigation of external auditory canal
3) absence of abnormal neurologic signs

Question 13

what arteries usually cause locked in

Answer 13

paramedian arteries

Question 14

things that lead to coma-like stuff (5)

Answer 14

1) reticular formation (part of brainstem) involvment
2) bilateral hemispheric and reticular formation depresson (usually metabolic)
3) acid/base or ionic abnormalities in CNS environment
4) postictal diffuse depression (after seizure)
4) trauma

Question 15

cerebral cortex and RF, therefore 2 processes that suppress cerebral cortical activity

Answer 15

RF can fx without CC, but CC CANNOT fx without RF

1) damaging RF
2) diffuse suppression of CC

Question 16

most cases of coma due to

Answer 16

diffuse cerebral cortical damage or suppression

Question 17

what is preserved until last

Answer 17

brainstem- hence why you may see cheyne stokes

Question 18

how to determine if any damage to reticular formation

Answer 18

determining whether eye movements are damaged because extraocular nuclei close to reticular formation

• -via caloric testing
• -pupillary rxns

Question 19

what is the first thing that herniates?

Answer 19

uncus of temporal lobe

Question 20

what could the uncus do?

Answer 20

entrap third nerve for CN III palsy

–ptosis, big pupil, lateral deviation of eye

Question 21

what will be preserved in locked in syndrome?

Answer 21

vertical gaze, eye opening, convergence

Question 22

most common damage to CC

Answer 22

metabolic

Question 23

most common damage to RF

Answer 23

ischemia/infarction

Question 24

5 main things to evaluate

Answer 24

level of conscousness
respiration
pupils
oculomotor-vestibular fx
motor fx

Question 25

upper diencephalon

Answer 25

drowsy yawns and sighs small, reactive pupils depression of ocular checking and fast component of nystagmus left hemiparesis, bilateral paratonia

Question 26

lower diencephalon

Answer 26

coma cheyne-stokes small, reactive loss of ocular checkng and fast component of nystagmus left hemiparesis decorticate

Question 27

mesencephalon

Answer 27

coma Cheyne stokes or central neurogenic hyperventilation midposition fixed pupils dysconjugate response, loss of medial rec and maybe lteral rec decerebrate

Question 28

upper pons

Answer 28

coma CNH or ataxia MPF dysconjugate response, loss of medial rec and maybe lteral rec weak decerebrate

Question 29

lower pons

Answer 29

coma ataxia or eupnea MPH no OMV flaccid, areflexic

Question 30

medulla

Answer 30

coma apnea MPF no OMV flaccid, areflexic

Question 31

rostral-caudal deterioration

Answer 31

``` upper diencephalon lower diencephalon mesencephalon upper pons lower pons medulla ```

Question 32

most common cause of stupor and coma

Answer 32

metabolic encephalopathy

Question 33

wakefullness in vegetative state vs minimally conscious state/locked in syndrome

Answer 33

present in vegetative state but not present in minimally conscious/locked in

Question 34

reflexes are gone when

Answer 34

brain dead

Question 35

EEG braindead

Answer 35

brain death

Question 36

EEG coma

Answer 36

polymorphic delta, burst suppression

Question 37

EEG vegetative state

Answer 37

delta, theta, ECS

Question 38

EEG minimally conscious state

Answer 38

nonspecific slowing

Question 39

EEG locked in syndrome

Answer 39

usually normal