Coma, PVS & head injury Flashcards Preview

Neurology Clinical > Coma, PVS & head injury > Flashcards

Flashcards in Coma, PVS & head injury Deck (22)
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1
Q

what is the GCS for a coma?

A

below or equal to 8

2
Q

if someone is in a coma but has no focal or lateral signs or meningism, what are the likely causes?

A
metabolic 
drug/alcohol intoxications
systemic infections
hyperthermia/hypothermia
epilepsy (status epilepticus)
3
Q

if someone is in a coma and has no focal or lateral signs but has meningism what are the likely causes?

A

meningitis
encephalitis
sub arachnoid haemorrhage

4
Q

if someone is in a coma and has lateral and focal brainstem signs but no meningism what are the likely causes?

A
cerebral tumour
cerebral abscess
intracranial haemorrhage 
cerebral infection
focal infarct
5
Q

what factors affect the outcome of a coma?

A
age
depth of coma
duration of coma
cause of coma
certain clinical signs i.e. most important are brainstem reflexes
6
Q

what cause of stroke has the highest percentage of a good outcome?

A

metabolic cause

7
Q

how do you test for brainstem function?

and what nerves etc are they testing?

A

pupillary reflexes (CN II & III)
corneal reflexes (CN V & VII)
spontaneous eye movements (CN III, IV, VI)
occulocephalic & occulovestibular responses (CN III, IV, VI, VIII)
respiratory pattern (medullary centre)

8
Q

what is involved in the neurological assessment of a patient in a coma?

A

GCS
brainstem function
motor reflexes & function

9
Q

what is locked in syndrome?

A

totally paralysed below the level of the 3rd cranial nerve

10
Q

what movements can someone perform in locked in syndrome?

A

move eyes up and down
blink
constrict pupils (refraction)
alter curvature of the lens (accommodation)

11
Q

what is the difference between coma and persistant vegetative state?

A

a coma is a condition where the patient lacks both awareness and wakefulness
a patient in PVS may have their eyes open (be awake) but may not have regained awareness

12
Q

what is persistant vegetative state?

A

a state in which the brain stem recovers to a considerable extent but there is no evidence of recovery of cortical function

13
Q

is there wakefulness in someone in PVS?

A

yes but they don’t have awareness

14
Q

damage to hat part of the brain won’t alter consciousness?

A

focal damage to the cortex doesn’t affect consciousness

15
Q

what does consciousness depend on?

A

an intact ascending reticular activating system for arousal

cerebral hemisphere for awareness of our environment

16
Q

what is responsible for arousal?

A

ascending reticular activating system

17
Q

what is responsible for our awareness of our environment?

A

functioning cerebral hemispheres

18
Q

how would you initially assess someone who was in a coma and you didn’t know the cause yet?

A
temperature
BP, heart rate
respiration
skin
ketones
abdomen 
meningism
fundal examination
brain CT/MRI
lumbar puncture
19
Q

what neves does the corneal reflexes test?

A

trigeminal CN V

facial CN VII

20
Q

what nerves does the pupillary reflexes test?

A

CN II & III

21
Q

what does a patients respiratory pattern test?

A

the medullary centre

22
Q

how would you test motor function?

A

motor response
muscle tone
tendon reflexes
seizures