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Flashcards in Higher cerebral functions Deck (45):
1

consciousness

reception
processing
cognition
reactoin
language
memory
foresight

2

Mental status exam

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

3

delirium

acute confusional state
ex: alcohol intoxication

4

dementia

failing memory and impairment of intellectual or cognitive function

5

Alzheimer's disease

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

6

Aphonia/dysphonia

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

7

person will whisper with ______ paralysis

vocal chord paralysis

8

anarthria/dysartharia

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

9

words slurred

dyspraxia of speech involving cerebellum

10

Aphasia/dysphasia

problem with speaking

11

dysphagia

swallowing problem

12

Mini mental status exam

orientation
registration
attention and calculation
recall
language

testing - memory, orientation, concentration, language

13

MMSE scale

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

14

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

15

clouding of consciousness

patient has inattention and reduced wakefulness

16

confusional state

includes disorientation, bewilderment, and difficulty following commands

17

lethargy

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

18

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

19

stupor

pt aroused only by vigorous and repeated stimuli
when left undisturbed, the pt will immediately lapse back o the unresponsive state

20

coma

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

21

dysfunctions of ascending reticular activating system ARAS

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

22

vegetative state

loss of cognition
intact wake/sleep cycle
intact autonomic functions

23

Cause of altered state? evidence to look for

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

24

Hepatic Encephalopathy

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

25

Small reactive pupils

suggest diencephalic localization, freq metabolic basis

26

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

suggest tectal lesion

27

Midposition fixed pupils

lesion of midbrain

28

bilateral pinpoint pupils

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

29

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

30

Hypertensive encephalopathy

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

31

Midbrain RF lesion

EEG appearance of large amplitude
slow waves

32

Pontine RF lesion

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

33

Frontal lobe lesion

somnolent or apathetic
akinetic mutism

34

lower brainstem lesion

produces coma but are usually fatal b/c stops breathing

35

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

36

occiptal ischemia

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

37

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

38

cerebellar lesions compress

brainstem and can cause coma

39

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

40

superconscious

collective unconscious
Jungian psychology
spirituality/religion

41

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

42

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

43

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

44

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

45

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