L12: Aurosal Coma And Unconsciousness

Question 1

What is consciousness

Answer 1

Awareness of sleep and environment

Question 2

What is arousal

Answer 2

Part of consciousness and it the level of consciousness i.e responding to predictable reflexes

Question 3

Is arousal and awareness the same

Answer 3

No

Question 4

What is awareness

Answer 4

The content of consciousness i.e to perceive to specific environmental stimuli to relate to yourself and the rest of the world

Question 5

What can disorders of consciousness affect

Answer 5

Arousal

Awareness

Question 6

What are the neural substrates of consciousness

Answer 6

The brainstem nuclei of reticular activating system

Question 7

What does the reticular activating system switch on

Answer 7

The cortex

Question 8

Where does the cortex send the information back to

Answer 8

Reticular activating system

Question 9

Where does the frontal cortex send a signal to

Answer 9

Striatum

Question 10

Where does the striatum send a signal to

Answer 10

Globus pallidus interna to inhibit it

Question 11

When the stimulation of the striatum decreases what happens to the globus pallidus interna

Answer 11

Released which inhibits the reticular acitvating system

Question 12

When the reticular acitvating system is inhibited what happens

Answer 12

Consciousness decreases and you fall into sleep

If pathological you go into coma

Question 13

Therefore what is keeping is awake

Answer 13

The striatum inhibiting the globus pallidus interna

Question 14

Therefore if there is an injury to the striatum what can we do to inhibit the globus pallidus interna and stimulate the cortex

Answer 14

Use inhibitor neurotransmitters that inhibit the globus pallidus interna

Question 15

What is the cortex responsible for

Answer 15

Awareness

Question 16

What is the brainstem responsible for

Answer 16

Arousal

Question 17

What is brain stem death

Answer 17

Person has no brainstem function, permanent loss of consciousness and capacity to breathe but heart is beating

Question 18

What is coma

Answer 18

Failure of arousal and awareness

Question 19

What can coma be assessed with

Answer 19

Glasgow coma scale

Question 20

What score indicates coma

Answer 20

Less than 8

Question 21

What is vegetative state

Answer 21

When the brainstem is maintained due to preserved arousal but complete absence of self and environment awareness

Question 22

What is minimally conscious state

Answer 22

Cognitive mediated behaviour occurs inconsistently but it reproducible that is different from a reflex and there is arousal

Question 23

What is the presentation of minimally conscious state

Answer 23

Person can follow a simple command
Gestural or verbal yes or no
Purposeful behaviour such as moving eyes with a mirror

Question 24

What are the 2 levels of minimal conscious state

Answer 24

With language

Without language

Question 25

What is moving on from minimally conscious state characterised by

Answer 25

Functional communication of yes or no | Functional object use e.g brining comb to head

Question 26

What is akinetic mutism

Answer 26

A subtype of minimally conscious state

Question 27

What is akinetic mutism

Answer 27

Everything is reduced but then you suddenly give high intensity sensory stimulus and things change

Question 28

Give an example of a high intensity stimulus in akinetic mutism

Answer 28

Giving a phone to their and they speak to someone meaningful

Question 29

What is locked in syndrome

Answer 29

Arousal and awareness are preserved but motor outflow is blocked

Question 30

What are the causes of locked in syndrome

Answer 30

Brain stem pathology

Question 31

What are the 3 subtypes of locked in syndrome

Answer 31

Classical Incomplete Complete

Question 32

How does classical locked in syndrome present

Answer 32

Upgaze Blinking only with anarthria Tetra paresis Preserved consciousness

Question 33

How does incomplete locked in syndrome present

Answer 33

Minimal movements in other limb with upgaze and blinking

Question 34

What is complete locked in syndrome

Answer 34

No limb or eye movement but preserved consciousness

Question 35

What is cognitive motor dissociation

Answer 35

Unconscious awareness detected by MRI and EEG

Question 36

What can be seen on an MRI for someone who has cognitive motor dissociation

Answer 36

Reproducible brain repsonce as if a task is being carried out if you ask them to

Question 37

In an hyper acute situation what scale do we use to asses

Answer 37

Glasgow coma scale

Question 38

What does the Glasgow coma scale look for

Answer 38

Eye opening Verbal response Best motor response

Question 39

What are the physical finding that we also assess for

Answer 39

Pupils Motor functions Autonomic features

Question 40

If pupils are fixed and unresponsive what does this indicate

Answer 40

Brain stem damage

Question 41

As intracranial pressure increases and brainstem becomes under pressure what do we get

Answer 41

A Cushing’s triad

Question 42

What is the Cushing triad

Answer 42

Hypertension Bradycardia Respiratory irregularity

Question 43

In a post acute assessment what do we establish

Answer 43

Diagnosis Trajectory: are things changing over time Prognosis

Question 44

When does survival decrease

Answer 44

From traumatic injury to non traumatic