Flashcards in Module Exam 6: Higher Corticals Deck (113)
The state of patient's awareness of self and environment and his responsiveness to external stimulation and inner need
The state of arousal or the degree of variation from normal alertness as judged by the appearance of facial muscles, fixity of gaze, and body posture.
Level of consciousness
Is by far the more important and dramatic aspect of disordered consciousness
Loss of normal arousal
The condition of person when awake; fully responsive to a thought or perception and indicates by his behavior and speech the same awareness of self and environment as that by the examiner
An inability to think with customary speed, clarity and coherence; marked by some degree of inattentiveness and disorientation; implies a degree of imperceptiveness and distractibility.
An inability to sustain a wakeful state without tye applicationof external stimuli; inattentiveness and mild confusion are the rule both improving with arousal. Indistinguishable from light sleep.m
Results most often from a process that influences the brain globally; can also be from focal __________ in various locations.
Confusion. Cerebral disease.
An inability to sustain a wakeful state without the application of external stimuli. Inattentiveness and mild confusion are the rule both improving with arousal. Indistinguishable from __________.
Drowsiness. Light sleep.
A state in which the patient can be roused only by vigorous and repeated stimuli but the state of arousal cannot be sustained without repeated external stimulation.
In stupor, responses to spoken commands are either ___________ and ________.
In stupor, this is common and there is a reduction or elimination of the natural shifting of body positions.
Restless/Stereotyped motor activity
In stupor, when left ________, these patients quickly drift back into a sleep-like state. The eyes move ______ & ______.
Unstimulated. Outward. Upward.
The patient appears to be asleep and is at the same time incapable of being aroused by external stimuli or inner need.
no reaction of any kind is obtainable: corneal, pupillary, pharyngeal, tendon and plantar reflexes are in abeyance and tone in the limb muscles is diminished.
Deepest stage of coma
Pupillary reactions, reflex ocular movements and corneal and other brainstem reflexes are preserved in varying degree, and muscle tone in the limbs may be increased; respiration may be slow or rapid, periodic, or deranged.
Lesser degrees coma
In lighter stages, sometimes referred to by the ambiguous and unhelpful terms ________ or _______, most of the reflexes can be elicited, and the plantar reflexes may be either flexor or extensor ( ______ sign)
Semicoma/Obtundation. Babinski sign.
Shares a number of other features with the pathologic states of drowsiness, stupor or coma. Include yawning, closure of the eyelids, cessation of blinking and swallowing, upward deviation or divergence or roving movements of the eyes, loss of muscular tone, decrease/loss of tendon reflexes, and even the presence of Babinskinsigns and irregular respirations, sometimes ________ in type.
Upon being awakened from deep sleep, a normal person may be _______ for a few moments.
Sleeping persons may still respond to unaccustomed stimuli and are capable of some mental activity in the form of _______ that leave traces of _______, thus differing from persons in stupor or coma.
The most important difference in relationship of sleep to coma: persons in sleep, when stimulated, can be roused to normal and ________.
Does not decrease during sleep, as it usually does in coma.
Cerebral oxygen uptake
Recordable electrical activity- _____ and cerebral evoked responses- and spontaneous motor activity differ in two states.
The patient remains totally inattentive, does not speak, and shows no signs of awareness of the environment or inner need; responsiveness is limited to primitive postural and reflex movements of the limbs. There is loss of sphincter control. There may be arousal or wakefulness in alternating cycles as reflected in partial eye opening, but the patient regains neither awareness nor purposeful behavior of any kind.
Persistent Vegetative State
In PVS, there is a lack of _______ visual following of objects.
Syndrome of unconscious awakening lasting _______ after nontraumatic and ______ after traumatic injury.
Persistent Vegetative State. 3months. 12months.
In Persistent Vegetative State, most common pathologic bases are _______________ as a result of _________, widespread necrosis of the cortex after cardiac arrest, and thalamic necrosis from a number of causes.
Diffuse Cerebral injury. Closed head trauma.
In Persistent Vegetative State, the most common prominent pathologic changes are usually in the
Thalamic & Subthalamic nuclei
In traumatic cases of PVS, the pathologic findings are of diffuse ___________ ( described as diffuse __________), prominent thalamic degeneration, and ischemic damage in the cortex.
Subcortical white matter degeneration. Axonal injury.
In Persistent Vegetative State, anatomic findings suggest that the ________ is either diffusely injured or effectively disconnected and isolated from the _______ or the ________ are destroyed.
Cortex. Thalamus. Thalamic nuclei.