Consciousness Flashcards
Describe decerebrate and decorticate posturing. What causes them? Which is worse?
Decerebrate - arms adducted and extended, pronated wrists, fingers flexed, extended legs and plantar flexed ankles - damage above the red nucleus
Decorticate - arms adducted, elbows flexed, wrists and fingers flexed - damage below the red nucleus
Decerebrate is worse
What should you look for on near exam?
Abnormal movmeent Posture Meningism - headache, photophobia, neck stiffness, fever Tone and reflexes Lateralising signs Pupillary reflexes and fundoscopy
What might RICP show on fundoscopy?
Papilloedema - blurred margins of optic disc
what may small , reactive pupils indicate?
Lesions of diencephalon and opiate ingestion
What may mid-position fixed pupils indicate?
Lesions of the midbrain
What do large fixed pupils indicate?
Lesions of the tectum, cocaine ingestion, brainstem death
What do pinpoint pupils indicated?
Pontine lesions
What do fixed, dilated pupils and ptosis indicate?
Occulomotor nerve (3) palsy
How can consciousness be assessed?
AVPU
GCS
What is AVPU?
Alert
To voice
To pain
Unresponsive
Describe the glasgow coma scale.
Eye opening (4) 1 no eye opening 2 to pain 3 to voie 4 spontaneous
Verbal (5) 1 no verbal response 2 incomprehensible sound 3 inappropriate words 4 confused speech 5 orientated
Motor (6) 1 No motor response 2 extension to pain 3 flexion to pain 4 withdrawal from pain 5 localising pain 6 obeys commands
How can you test brainstem function?
Pupillary reactions
Corneal response
Spontaneous eye movmeent
Oculocephalic reflex - move head from side to side - do eyes follow or correct gaze (normal)
What is the vestibulo-occular reflexes?
Put water in ear to trick the currents in the semi-lunar canals that the head is moving
Eyes will move opposite direction of the movement
Eyes move in opposite direction to watered ear if warm
Same direction to watered ear if cold
