Control symposium 1: Brain death Flashcards Preview

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Flashcards in Control symposium 1: Brain death Deck (10):

What is Miller Fisher syndrome?

Peripheral/cranial nerve disorder that results in demyelination - 'locked in like syndrome'


What are the different states of consciousness?

Alertness - normal state of awareness

Somnolence - drowsy, pre-sleep state with decreased attention

Sopor (obtundation) - transition between drowsy and stupor, the patient is confused and cannot easily be alerted

Stupor - can be semi-roused only by vigorous stimulation

Coma - cannot be roused, reflexes diminished or absent


What are the features of locked in syndrome?

Aware and awake, able to breathe

Cannot move or speak

Damage to the ventral pons

Communicate by blinking or eye movement

Feel pain and touch, positions of limbs


What is brain stem death?

Unable to breathe and unconscious.  Destroyed reticular formation (brain stem).  No electrical activity.   No clinical evidence of brain function

• Preconditions: diagnosis compatible with brain stem death; presence of irreversible structural brain damage; apnoeic

• Exclusions: drug effects; hypothermia; metabolic abnormalities; endocrine abnormalities; intoxification


What clinical tests are used to establish brainstem death?

Absent brain stem reflexes (pupils, corneal, no motor response in the cranial nerves, gag, cough, vestibulo-ocular) persistent apnoea

Two practitioners (one consultant) on two occasions


What is a persistant vegetative state?

Unconscious and unaware.

Unresponsive to external stimuli except possibly pain.

Eyes open, can track, dysconjugate.

Sleep wake cycle or chronic wakefulness.

May smile, cry, moan, scream without stimulus


Diagnosis if not recovered from a vegetative state after 30 days.  50% chance of recovery of consciousness in 6 months.  Of those who do most are severely disabled.

Old terminology - now refer to 'prolonged disorders of consciousness'



What is a minimally conscious state?

Severely altered unconsciousness with limited self or environmental awareness which may be episodic, demonstrable by one or more of:

Following simple commands

purposeful response to stimuli (not reflexive): smiling or crying to linguistic or visual cues from emotional stimuli

gestures or vocalisations inc yes or no and regardless of accuracy in response to questions

reaching for objects with clear relation of location and direction of reach; handing objects accommodating size and shape

eye movement or fixation in response to moving or salient stimuli


What is a continuing vs a permanent vegetative state?

Continuing - more than 4 weeks

Permanent - more than 6 months


What is the cause of a vegetative state?

A lesion in the cortex - brain stem still functioning.


For how many years must a patient be in an MCS before it is considered permanent?

3-4 years