Consciousness

Question 1

What is consciousness?

Answer 1

The state of wakefulness and awareness of self and environoment

Question 2

Wakefulness

Answer 2

a sleep wake cycle, eyes open, motor activity

Question 3

Awareness

Answer 3

knowing one exists, the feeling of I am, the mind’s a subjective experience

Question 4

Coma is a state of

Answer 4

unrousable unresponsiveness lasting for more than 6 hours

Question 5

What constitutes consciousness:

Answer 5

• brain arousal/activation: eyes open, motor
  arousal
• connected thought patterns
• ability to sense sensory inputs: external,
  interoception (sense of internal state of the
  body), emotion
• ability to affect controlled outputs: motor,
  attention, cognition, emotional

Question 6

Interoception is located in

Answer 6

the anterior insular cortex and von economo neurons

Question 7

Different States of Consciousness:

Answer 7

insert slide

Question 8

Coma:

Answer 8

• pathological
• fails to respond normally to painful stimuli,
  light or sound
• lacks a normal sleep-wake cycle
• does not initiate voluntary actions
• eyes are usually controlled: visual threat,
  pupillary reactions
• may be reversible or irreversible

Question 9

Causes of Impaired Consciousness:

Answer 9

insert table
hypoglycaemia = not enough glucose
dka = hyperglycaemia

Question 10

Tools to Measure Consciousness:

Answer 10

• glasgow coma scale
• mmse
• alert, verbal, pain, unresponsive AVPU
• the 4As Test

Question 11

Most coma tools are

Answer 11

sensori-motor stimulus and response tests

Question 12

Glasgow Coma Scale:

Answer 12

insert

Never have less than 3; even if dead

Question 13

GCS<8 is concerning because

Answer 13

can not protect their airway
correlated with outcome in brain injury

Question 14

MMSE, CAM, 4As Test overview:

Answer 14

• multiple questionnaires used to measure
  cognitive impairment, screen for dementia,
  delirium and confusion
• longer than GCS and AVPU but can be
  performed easily at bedside

Question 15

Questions to consider when seeing a confused patient:

Answer 15

• acute or chronic?
• fluctuations?
• agitation?
• hyperactive, hypoactive or mixed?
• therapeutic interventions have any effect?

Question 16

Blackout and syncope are a transient loss of

Answer 16

consciousness

Question 17

Global Neuronal Workspace:

Answer 17

particular type of information processing whereby multiple cognitive systems have simultaneous access to the same information

Question 17

Blackout and Syncope:

Answer 17

insert table

Question 17

What structures of the brain correlate to conscious experiences?

Answer 17

• cerebral cortex, posterior cortical hot zone
• parietal, occipital and temporal regions

Question 18

Integrated Information Theory

Answer 18

consciousness is a product of the highly complex and integrated nature of the brain’s structure

Question 19

What is the highlighted area referred to as?

Answer 19

insert diagram

Question 20

Veon Economo Neurons:

Answer 20

• found in anterior insular cortex in humans,
  apes etc
• specific neuronal component of
  consciousness

Question 21

Claustrum:

Answer 21

• most densely connected structures in the
  brain
• specific component of consciousness

Question 22

Intralaminar Thalamic Nuclei:

Answer 22

• general anesthetics suppress activity in this
  region
• specific component of consciousness

Question 23

Reticular Activating System:

Answer 23

- located in the brain stem - regulates sleep-wake cycles and behaviour - specific component of consciousness

Question 24

Minimally Conscious State:

Answer 24

- wakeful (preserved sleep/wake cycle) with minimal awareness - inconsistent but reproducible responses

Question 25

Vegetative State:

Answer 25

- wakefulness with absent awareness - capacity for spontaneous or stimulus- induced arousal evidenced by a rang of reflexive and spontaneous behaviours

Question 26

Locked in Syndrome

Answer 26

- loss of voluntary control of movement - normal wakefulness and awareness - conscious but unable to respond

Question 27

Brainstem Death

Answer 27

- permanent and irrevocable loss of all brainstem functions - confirmed by the absence of brainstem reflexes: pupils, cornea, gag, oculovestibular - equated to death of an individual - if any are present then the person is not dead Pre-conditions: - cause of coma must be established as irreversible and structural - deep coma, apnoeic and ventilation dependent - pharmacological causes of the above must be excluded - reversible causes of coma (temp) must be excluded