Coma facts

Question 1

Unilateral large pupil

Answer 1

CN III compression

Question 2

What comes first for pupil change w/ edema - loss of reactivity or enlargement

Answer 2

Loss of reactivity first, then pupil enlarges

Question 3

What is happening with bilateral pupillary dilation in edema situation?

Answer 3

Midbrain displacement from mass lesion probably from compression of the OCULOMOTOR NUCLEI in the ROSTRAL MIDBRAIN

Question 4

Pupils with pons lesions

Answer 4

Miosis w/ loss of reactivity

Question 5

Horner syndrome etiologies

Answer 5

Ipsilateral brainstem lesion, ICA dissection, lesion in hypothalamus

Question 6

Pupils in TCA OD?

Answer 6

TCAs have atropine - pupils dilate

Question 7

What can cause hippus?

Answer 7

Metabolic encephalopathy

Question 8

Deep coma roving eye movements - eyes then start to become…

Answer 8

Motionless and mildly exotropic

Question 9

When does dysconjugate gaze face AWAY from the side w/ the lesion?

Answer 9

Unilateral pontine, upper brainstem, thalamic “wrong way eyes”, focal seizure

Question 10

Ocular bobbing

Answer 10

Pons damage

Question 11

Locked in syndrome

Answer 11

Bilateral base of pons

Question 12

Locked in syndrome + bilateral ptosis and CN III palsy

Answer 12

Also w/ midbrain involvement

Question 13

Vegetative state

Answer 13

Sleep/wake cycles but not consciousness. Open eyes in response to painful stim or spontaneously. Eyes may fixate on a person, can moan, but REMAINS INATTENTIVE. Loss of sphincter control.

Question 14

Minimally conscious state

Answer 14

Retains minor and often intermittent function - moves limb to command, makes facial expression, tracks visually (sometimes to command, other times spon).

Question 15

Where are the sympathetic outflow tracts in the spinal cord

Answer 15

T1 to L2

Question 16

Loss of sympathetic nervous system ctl over peripheral vascular tone at what spinal level

Answer 16

T6 or above. Bc of sympathetic outflow tracts being in T1-L2 with significant proportion above T6.

Question 17

EEG criteria for brain death

Answer 17

30 min recording, 16 or 18 channel instrument, electrical activity absent at > 2 microvolts w/ instrument set at sensitivity of 2 microvolts.

Question 18

Contents w/ in skull and relative %’s

Answer 18

Brain matter 80%, CSF 10%, intravascular blood 10%

Question 19

Normal ICP

Answer 19

3-15 mmHg, 5-20 cm H2O

Question 20

Akinetic mutism - localization

Answer 20

Lesions of the anterior cingulate gyri

Question 21

Akinetic mutism - exam findings

Answer 21

Shares clinical features with the minimally conscious state. These patients are strikingly abulic (they are emotionless and neither speak nor initiate spontaneous movements) but maintain eye-tracking movements, facial grimacing, and blinking to threat.

Question 22

Cheyne-stokes respirations

Answer 22

phases of hyperpnea alternating with apnea.

Seen w/ bihemispheric injury—either diffuse or bilateral structural damage—with preserved brainstem reflexes.
Patients with heart failure may also exhibit Cheyne-Stokes respiration because of prolonged blood transit time from the lungs to chemoreceptors.

Question 23

Apneustic breathing - description & localization

Answer 23

Prolonged pauses of 2 to 3 seconds between inspiration and expiration.

PONS damage

Apneuistic sounds like a yoga term

Question 24

Kussmaul respirations

Answer 24

Rapid, gasping, and very deep breathing that appears agonal

Metabolic acidosis