Disorders of consciousness

Question 1

ARAS input

Answer 1

visual, auditory, sensory

Question 2

arousal

Answer 2

overall state of activity

Question 3

lethargy

Answer 3

slight reduction in alertness

Question 4

obtunation

Answer 4

moderate reduction in alertness

Question 5

delirium

Answer 5

sudden disturbance in consciousness and mental function

Question 6

stupor

Answer 6

respond only to vigorous stimuli

Question 7

altered mental status

Answer 7

imprecise term for any of the descriptors

Question 8

2 main mechanisms of coma

Answer 8

diffuse insult to both cerebral hemispheres
disruption on the ARAS in the midbrain and pons

Question 9

coma characteristics

Answer 9

no awareness, no sleep cycle or purposeful behavior

Question 10

vegetive state characteristics

Answer 10

sleep wake cycles only

Question 11

minimally conscious state

Answer 11

sleep wake cycles, partial fluctuating awareness, reproducible purposeful behavior

Question 12

locked-in syndrome

Answer 12

sleep wake cycles, awareness and movement is limited to eye movements

Question 13

diagnostic workup for disorder of consciousness

Answer 13

blood tests, IV access, hook up to monitor, administer oxygen

Question 14

which things should be checked and treated immediately

Answer 14

hypoglycemia: dextrose 50% IV
thiamine for alcoholic
Naloxone for drug overdose

Question 15

small pupils

Answer 15

opioid toxicity and pontine lesion

Question 16

midsize pupils, unresponsive to light

Answer 16

midbrain lesion

Question 17

maximally dilated pupils

Answer 17

drug toxicity- anti-cholinergic overdose

Question 18

mixed and dilated pupils

Answer 18

CN III lesion from uncle herniation

Question 19

Decorticate posturing

Answer 19

flexor posturing (flex UE, ex LE)
lesion of the internal capsule and rostral cerebral peduncle

Question 20

causes of decorticate posturing

Answer 20

brain tumor, stroke, drug use, poisoning, infection or liver failure

Question 21

decerebrate posturing

Answer 21

Extensor posturing
midbrain and rostral pons

Question 22

causes of decerebrate posturing

Answer 22

can be reversible metabolic dysfunction
hypoglycemia and hepatic encephalopathy

Question 23

causes of abrupt onset unconsciousness

Answer 23

SA hemorrhage, brainstem stroke, intercerebral hemorrhage

Question 24

what does papilledema on fundoscopic exam point towards

Answer 24

subhyaloid hemorrhage

Question 25

corneal sensitivity bilateral loss

Answer 25

large pontine lesion or deep coma

Question 26

corneal sensitivity unilateral loss

Answer 26

ipsilateral pons or trigeminal defect

Question 27

positive oculocephalic reflex

Answer 27

eyes move opposite the rotation of the head

Question 28

negative oculocephalic reflex

Answer 28

eyes stay midline

Question 29

negative oculocephalic reflex points toward

Answer 29

severe brainstem dysfunction

Question 30

Cheyne stokes respiration

Answer 30

deep breathing alternate with periods of apnea

Question 31

Cheyne stokes respiration meaning

Answer 31

bihemispheric or diencephalic disease or metabolic disorders

Question 32

Central neurogenic hyperventilation meaning

Answer 32

lesions of brainstem tegmentum

Question 33

apneustic breathing

Answer 33

prominent end-inspiratory pauses

Question 34

apneustic breathing meaning

Answer 34

damage at pontine level, basilar artery occlusion

Question 35

ataxic breathing

Answer 35

irregular/deep and shallow breathing randomly occurring

Question 36

ataxic breathing means

Answer 36

lesions of lower pontine tegmenjtum and medulla

Question 37

Kussmaul breathing

Answer 37

deep labored breathing

Question 38

Kussmaul breathing means what

Answer 38

severe DKA

Question 39

CT of the head

Answer 39

urgent, non-contrast

Question 40

immediate neurosurgical intervention is needed for ____

Answer 40

intracranial hemorrhage, brain herniation, structural lesions

Question 41

CT angiogram is used to

Answer 41

rule of basilar artery occlusion

Question 42

when is EEG performed

Answer 42

suspected non-convulsive status epilepticus