disorders of consciousness and death

Question 1

arousal (wakefulness) requires the

Answer 1

ascending reticular activating system

Question 2

awareness (content) requires

Answer 2

cerebral cortex and its connections to the subcortical structures

Question 3

An active process often defined as the state of awareness of the self and the environment

Answer 3

consciouseness

Question 4

loss consciousness is always pathological

Answer 4

nope; it can be normal as part of the sleep-wake cycle

Question 5

state of drowsiness or near-sleep

Answer 5

somnolence

Question 6

extreme fatigue or drowsiness

Answer 6

lethargy

Question 7

syndrome of global brain dysfunction

Answer 7

encephalopathy

Question 8

encephalopathy Caused by damage or suppression of the

Answer 8

brainstem ARAS or of both cerebral hemispheres

Question 9

is the sleep-wake cycle absent in people on a coma?

Answer 9

yep

Question 10

unarouseable unresponsiveness

Answer 10

coma

Question 11

apallic syndrome

Answer 11

persistent vegetative state

Question 12

State of complete unawareness in which the patient may open eyes spontaneously or to verbal stimuli, but without recognition of the environment

Answer 12

PVS

Question 13

lights on but no one is home

Answer 13

PVS

Question 14

PVS unlike coma is associated with sleep-wake cycles

Answer 14

yep

Question 15

when to dx. PVS?

Answer 15

not before one month for non-traumatic and before 1 yr after traumatic

Question 16

prognosis for PVS poor?

Answer 16

yea; generally adults have a 50% of recovery while children have a 60% from PVS w/in 6 months

Question 17

Minimally conscious state is between

Answer 17

PVS and normal

Question 18

MCS have a better prognosis than PVS

Answer 18

yea

Question 19

Locked in syndrome typically caused by a

Answer 19

pontine infarction

can also be caused by:

• ALS
• Guillain Barre
• MS
• snake bites

Question 20

intact occulomot system but otherwise complete paralysis

Answer 20

locked in syndrome

Question 21

central pontine myelinolysis is caused

Answer 21

by a dymyealination in the pons

• can cause Locked in syndrome

Question 22

what chemoreceptors are spared in locked in syndrome leading to intact respiratory function

Answer 22

ventral medulla

Question 23

what other features are left intact with locked in syndrome

Answer 23

RAS and Hearing

Question 24

Directly compressing the ascending arousal system or distorting brain tissue (shift) so it secondarily compresses components of the ascending arousal system.

Answer 24

compressive lesions

Question 25

Directly cause damage to the ascending arousal system through tumor, hemorrhage, stroke, trauma and infection

Answer 25

destructive lesions

Question 26

multifocal, diffuse disease causing coma (just name a few)

Answer 26

- ischemia, hypoxia | - glucose disorders

Question 27

Doll's eyes afferent and efferent

Answer 27

afferent: CN 8 Efferent: CN 6 and 3

Question 28

Caloric reflex afferent and effect what relfex is this?

Answer 28

afferent: CN 8 efferent: CN 3, 6, 4 cold water in ear and to see if head/eyes turns to the ipsilateral

Question 29

nystagmus in contralateral in caloric reflex?

Answer 29

normal

Question 30

hypertension and Bradycardia should be setting off warning bells for

Answer 30

intracranial hypertension

Question 31

FOUR

Answer 31

dull outline of unresponsivenss score of 16

Question 32

Poor prognostic signs in post-anoxic coma Absent pupillary responses = _____ Absent corneal respons= ____ Absent motor responses= ____ Absent Somatosensory Evoked Potentia= ____

Answer 32

Absent pupillary responses, Day 1 Absent corneal responses, Day 1 Absent motor responses, Day 3 Absent Somatosensory Evoked Potentials within the first week

Question 33

sepsite sophisticated techniques is TIME still the most uselful tool to prognosticate?

Answer 33

yes

Question 34

determination of Death by

Answer 34

neurologic criteria

Question 35

Brain death determined by what criteria?

Answer 35

1. total cessation of hemispheric and brainstem neuronal functioning 2. irreversible brain injury

Question 36

cardinal features of brain death

Answer 36

1. unresponsive 2. no brainstem reflexes 3. apnea test; absence of respiratory reflex

Question 37

brain death ancillary testing

Answer 37

1. cerebral blood flow 2. EEG 3. ultrasound 4. nuclear flow study SPECT- no uptake of isotope in the brain