Stupor, Vegetative state, and Coma

Question 0

Coma

Answer 0

Pathologic unconciousness where pt cannot be aroused.

Question 1

Stupor

Answer 1

State of pathologic reduced consciousness. Pt CAN be aroused to purposeful response.

Question 2

Decorticate posturing

Answer 2

Stiff bent arm, clenched fists, legs straight, wrists and fingers on chest.

Due to lesions in cerebral cortex or basal ganglia, but preserved diencephalon (thalamus, hypothalamus, pineal)

Question 3

Decerebrate posturing

Answer 3

pronation of arms, held straight out, toes pointing down, head and neck arched back.

Due to a transection of brainstem at the midbrain or pons.

Question 4

Locked in syndrome

Answer 4

Damage to the base of the pons (usually large infarct) that leaves patient unable to move except of vertical eye movement (because this function is in the midbrain). They can also still hear. They are awake and alert and have normal breathing.

Question 5

Cheyne stokes respirations

Answer 5

Due to damage in the lower diencephalon or midbrain. A crescendo-decrescendo pattern or breathing punctuated by patterns of apnea.

Can also be seen with diffuse bilateral cerebral involvement and depression, and even in some normal pts during sleep.

Question 6

Central Neruogenic Hyperventilation

Answer 6

Due to damage at the lower mesencephalon or upper pons. 20-40 RR with deep breaths enough to cause alkalosis.

Question 7

Ataxic respiration

Answer 7

due to damage at lower pons, results in inconsistently varying rhythm and rate.

Question 8

Diencephalic pupils

Answer 8

if diencephalon is damaged, pupils become constricted due to inhibition of hypothalamic activation of sympathetic dilator function.

However, these pupils will still react to light.

Question 9

Most comas are due to:

But can also be due to :

Answer 9

Most due to diffuse cerebral cortical damage

Can also be from damage to reticular activating system in brain stem (esp midbrain).

Question 10

During diffuse cortical damage/supression the VOR is:

Answer 10

Fully disinhibited; there will be loss of nystagmus and tonic conjugate horizontal deviation during caloric testing.

Question 11

If there is damage to the midbrain the VOR will:

Answer 11

Not be intact and result in disconjugate movements of the eyes.

Question 12

Features of transtentorial herniation (2):

Answer 12

1. During herniation the Uncus is the first to herniate and may entrap CN III -> Ipsilateral Ptosis and Mydriasis (blown pupil)
2. Corticospinal tract is next, causing contralateral weakness/paresis ->may proceed to decorticate/decerebrate.

Question 13

Locked in syndrome

Answer 13

Consciousness preserved
Vertical gaze, eye-opening, and convergence only.
Eye closure is passive

Question 14

T/F: pts can have intact spinal cord reflexes after brain death.

Answer 14

True.

Question 15

Vegetative state

Answer 15

1. Unaware of self/environment
2. no voluntary behavior
3. no comprehension
4. NORMAL SLEEP WAKE CYCLE
5. Preserved autonomic, endocrine, respiratory, CN functions.
6. NOT DEAD