Higher cerebral functions Flashcards by gopi patel

consciousness

reception 
processing 
cognition 
reactoin 
language 
memory 
foresight

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Mental status exam

memory 
orientation 
concentration 
language 
performance of learned skilled movements - apraxia
recognition of stimuli - agnosia

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delirium

acute confusional state

ex: alcohol intoxication

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dementia

failing memory and impairment of intellectual or cognitive function

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Alzheimer’s disease

degeneration and loss of nerve cells in the cortical association areas and medial temporal lobes

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Aphonia/dysphonia

less to do with brain and more to do with voice disturbance due to larynx or innervation issues

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person will whisper with ______ paralysis

vocal chord paralysis

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anarthria/dysartharia

more issue with using tongue, jaw, breathing to say words

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words slurred

dyspraxia of speech involving cerebellum

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Aphasia/dysphasia

problem with speaking

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dysphagia

swallowing problem

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Mini mental status exam

orientation 
registration 
attention and calculation 
recall 
language

testing - memory, orientation, concentration, language

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MMSE scale

30 total possible 
28-30 normal 
21-27 Mild cognitive 
10-20 Moderate cognitive 
0-9 severe impairment

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standardized min mental state examination (SMMSE)

if memory, orientation, concentration and language are intact, the performance of learned skilled movements and recognition of stimuli will also be intact

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clouding of consciousness

patient has inattention and reduced wakefulness

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confusional state

includes disorientation, bewilderment, and difficulty following commands

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lethargy

severe drowsiness

patient can be aroused by moderate stimuli and then drifts back to sleep

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obtundation

similar to lethargy
patient has little interest in the environment, slowed responses to stimulation and tends to sleep more than normal with drowsiness in between sleep states

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stupor

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pt aroused only by vigorous and repeated stimuli

when left undisturbed, the pt will immediately lapse back o the unresponsive state

coma

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state of unarousable unresponsiveness
deep - no reflex activity
light - reflex activity
no voluntary movement

dysfunctions of ascending reticular activating system ARAS

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clouding of consciousness
confusional state 
delirium 
lethargy 
obtundation 
stupor 
dementia 
hypersomnia 
vegetative state 
akinetic mutism - frontal cortex problem, semi conscious , cant talk, move -> no motor planning 
locked in syndrome 
coma

vegetative state

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loss of cognition
intact wake/sleep cycle
intact autonomic functions

Cause of altered state? evidence to look for

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infection, HTN, shock, increased intracranial pressure with bradycardia, trauma (check for periorbital or retroauricular ecchymosis or blood behind tympanic membrane to suggest basilar skull fracture
is there papilledema or intraocular hemorrhage?
Icteric conjunctiva
stiff neck
intoxication

Hepatic Encephalopathy

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Portal systemic encephalopathy 
due to chronic hepatic insuff/cirrhosis, intolerance of dietary protein, raised ammonia levels 
confusion, drowsiness, coma 
icteric conjuntiva 
develops over days to weeks

Small reactive pupils

suggest diencephalic localization, freq metabolic basis

large pupils that dilate and contract automatically but do not react to direct light stimulus

suggest tectal lesion

Midposition fixed pupils

lesion of midbrain

bilateral pinpoint pupils

indicative of opioid toxicity, pontine lesion, organophosphate toxicity (excess Ach)

Most common cause of decreased state of consciousness

metabolic/toxic disturbance - acid-base disequilibrium, oxygen or glucose metabolism disorder, uremic and hepatic encephalopathy, drug overdose, poisoning epilepsy cerebrovascular issue - ischemia, hemorrhage

Hypertensive encephalopathy

malignant HTN, hypertensive emergency severe headache, nausea with vomiting, visual disturbance,confusion, coma findings: Retinal hemorrhage, papilledema

Midbrain RF lesion

EEG appearance of large amplitude | slow waves

Pontine RF lesion

EEG alpha rhythm (vertical gaze palsy) normal autonomic and somatomotor reflexes are present almost like a normal drowsy

Frontal lobe lesion

somnolent or apathetic | akinetic mutism

lower brainstem lesion

produces coma but are usually fatal b/c stops breathing

confusion, faitgue, lethargy, sleepiness, SOB, tachypnea, may be caused by

respiratory acidosis, hypercapnia: Low O2 respiratory alkalosis: cerebrovascular constriction metabolic acidosis: ketoacidosis, dehydration, loss of bicarb (diarrhea, vomitting) renal disease aspirin, methanol, ehtylene glycol poisoning lactic acid

occiptal ischemia

due to compression of ipsilateral posterior cerebral artery at the tentorial edge

Boxer takes punch to face, twists head on neck

twists the brainstem and contorted in tentorial hiatus, small areas of hemorrhage or ischemia may develop within it, resulting in alterations in level of consciousness

cerebellar lesions compress

brainstem and can cause coma

subconscious mind

composite of everything one sees, hears and any info the mind collects that it cannot otherwise consciously process to make meaningful sense stores info for the conscious mind to retrieve

superconscious

collective unconscious Jungian psychology spirituality/religion

Pt doesnt eat, drinks excessive liquids, drops potassium dangerously low,

CT shows black area that is liquid, indicating hydrocephalus ex vacuo. Thalamus was ok but cortex was damaged leaving pt in vegetative state which is a loss of cognition with intact sleep/wake cycle and intact autonomic functions

Pt unconscious after consuming diazepam, detropropoxyphene, and alcohol. After collapsed and stopped breathing twice for 15 mins was brought to hospital

pt lapsed into persistent vegetative state Pt is in COMA - unconsciousness, unresponsive to stimuli Cerebral cortex has moderate scarring Thalamus was extensively damaged bilaterallly brain stem undamaged - leaving cardiac and respiratory function intact suggests thalamus plays role in consciousness

Pt has has locked in syndrome for long time, what is he at risk for?

developing pneumonia because he cannot breath deeply | had a basal pontine stroke

COMA

state of unconsciousness in which person cannot be awakened fails to respond normally to painful stimuli, light or sound lacks a normal wake-sleep cycle and doesnt intiate voluntary movement no eye opening, speech/communication

VEGETATIVE STATE

return of sleep/wake cycle with periods of eye opening and eye closing may moan or make sounds esp when tight muscles are stretched may cry or smile or make other facial expressions -may briefly move eyes towards persons or objects -may react to a loud sound w/ a startle -unable to follow intstructions -no speech or communication -no purposeful movement

Higher cerebral functions Flashcards

(45 cards)