Quiz 1 - definitions, substrates, evaluation of consciousness Flashcards Preview

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Flashcards in Quiz 1 - definitions, substrates, evaluation of consciousness Deck (53)
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1

coma definition

- pathological
- unconscious
- cannot be aroused
- deep vs light - in light reflex motor response can be aroused by noxious stimulus

2

stupor definition

- pathological
- reduced consciousness
- can be aroused with intense or purposeful stimulation

3

range of stupor

drowsiness to deep stupor

4

sleep definition

- non-pathological
- active and reversible state of consciousness

5

hysterical coma definition, how differentiated?

- feigned or subconsciously assumed depression of consciousness
- will have normal EEG, nystagmus on irrigation of auditory canal, no abnormal neurologic signs

6

explain the base of the pons exception

- most of the time when someone is conscious yet unresponsive it is obvious what (GB syndrome, MG, porphyria)
- damage to base of pons - patient becomes acutely unresponsive but will keep vertical and convergent eye movement, sight, and hearing
- LOCKED IN syndrome

7

reticular vs hemispheric involvement in depression of consciousness

- reticular involves mass lesions above or below the tentorium affecting reticular function (less common)
- hemispheric involvement is almost always metabolic and depresses the reticular formation indirectly

8

importance of cortical hemispheres in consciousness

- anything causing diffuse dysfunction of the cortex, whether destruction or encephalopathy, will cause stupor and/or coma

9

relationship between cortex and rostral reticular formation

- rostral reticular formation is termed the reticular activating system and the cortex can't function without it
- reticular activating system can work without cortex and maintain a crude sleep-wake vegetative state
- cortex is much more sensitive to toxic stimuli

10

common causes of direct damage to reticular formation

- hemorrhage
- neoplasm
- abscess
- trauma
- inschemia/infarction

11

what part of the temporal lobe usually herniates the tentorial notch?

uncus

12

what pattern of deterioration is caused by tentorial notch herniation

rostrocaudal deterioration

13

order of brain deterioration in rostrocaudal process

- diencephalon
- mesencephalon
- pons/medulla

14

evaluation of coma is primarily to differentiate between which two things?

- coma caused by diffuse cortical damage vs that caused by damage for reticular activating system

15

components of neuro eval of coma patient

- LOC
- resp pattern
- pupil size
- oculomotor vestibular function
- motor function

16

what does drowsy look like?

opens eyes to stimulation but goes back to eyes closed when not stimulated

17

what does deep stupor look like?

needs vigorous stimulation to get response

18

what does deep coma look like?

no reaction even to noxious stimuli

19

if best motor response is withdrawal or posturing...

patient is not conscious

20

respiration in diffuse cerebral cortical dysfunction

- drowsiness, sighing respirations, yawning

21

when is a Cheyne Stokes resp pattern seen?

- damage to diencephalon or mesencephalon
- sometimes in diffuse cerebral cortical dysfunction

22

what is Cheyne Stokes respiration?

- crescendo-decrescendo pattern
- periods of apnea of variable length

23

when is Cheyne Stokes respiration most apparent?

during sleep

24

respiration in damage to lower mesencephalon/upper pons

- central neurogenic hyperventilation, 20-40 rpm
- danger of respiratory alkalosis
- deep breathing

25

respiration in damage to lower pons

- irregularly irregular breathing
- inconstantly varying rhythm and rate
- may be hyperventilation
- may be apneustic breaths (hold after inspiration)

26

respiration in damage to medulla

- depression and ultimately apnea

27

pupils in isolated damage or diffuse damage to cerebral cortex

no change

28

pupils in damage to diencephalon and why?

- constricted pupils because damage to thalamic pathways that carry sympathetic dilators
- still reactive to light

29

pupils in damage to caudal diencephalon/upper mesencephalon

- constricted
- pupils sluggish in reacting to light

30

pupils in mesencephalon damage

- CNIII damage (loss of parasympathetics)
- pupils widely dilated (7-9mm)
- no reaction to light