The Brainstem and Consciousness (Reticular Formation) Flashcards

1
Q

Define arousal

A

the emotional state associated with some kind of goal or avoidance of something noxious

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2
Q

Define consciousness

A

difficult to define but:

something to do with ‘awareness’ of both the external world and internal states

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3
Q

What two areas of the brain are requried for consciousness?

A

Cerebral Cortex + Reticular Formation

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4
Q

Where is the reticular formation located?

A

Located in the Brainstem

(diffuse structure/area)

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5
Q

What is the nature of the feedback loop between the cerebral cortex and reticular formation?

A

Positive Feedback Loop

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6
Q

Damage or lesions to which 3 areas of the brain can cause an altered level of consciousness?

A

Cerebral Cortex

Brainstem (reticular formation)

  • *Conenctions Between Both**
  • (e.g. in diffuse axonal injury)*
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7
Q

Which neurotransmitter is used by the excitatory neurones originating from the reticular formation to stimulate the subcortical nuclei?

A

Acetylcholine

(cirlces left to right:
basal F/B nuclei, hypothalamus, thalamus)

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8
Q

Which neurotransmitter is used from the neurones of the basal nuclei to excite the coertex?

A

Acetylcholine

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9
Q

Which neurotransmitter is used by the hypothalamic neuronal projections to the cortex, which help maintain consciousiness?

A

Histamine

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10
Q

What neurotransmitter is used by the thalamic projections to the cerebral cortex to help maintain consciousness?

A

Glutamate

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11
Q

How can anticholinergic drugs and anti-histamines cause drowsiness?

A

inhbit the positive/excitatory inputs from the reticular formation to the cerebral cortex

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12
Q

What scale is used to assess a patients level of consciousness?

A

Glasgow Coma Scale

(GCS)

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13
Q

What is measured by an electroencephalogram (EEG)?

A

combined activity of thousands of neurones

located to different geographical regions of the brain

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14
Q

What happens to the EEG waveform as you progress into deeper sleep?

A

decreasing frequency in firing

increasing amplitude as neuronal populations become synchronous

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15
Q

Which types of waves are found on an EEG when a person is awake?

A

Beta Waves

Irregular - up to 50Hz

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16
Q

When do alpha waves appear on an EEG?

A

Once eyes are closed and visual stimuli are removed

pattern becomes more synchronous

around 10Hz

17
Q

How many stages of sleep are there on an EEG?

A

5 Stages (including REM)

18
Q

What are sleep spindles seen during stage 2 of sleep cycles on an EEG?

A

rapid neuronal firing from the thalamus in an effort to maintain consciousness

19
Q

Which type of waves are predominant during stage 2/3 of the sleep cycle on an EEG?

A

Theta Waves

around 5Hz

20
Q

Why does REM sleep appear similar to the beta waves seen when patients are awake?

A

period when patients are dreaming

visual simulation from brain generated images > stimulated cortex

21
Q

What changes in the brain occur to allow you to sleep?

A

deactivation of the reticular activating system (and therefore thalamus), to allow decreased cortical activity

achieved by removal of sensory inputs
e.g. closing eyes

22
Q

Which area of the brain is responsible for initiating REM sleep?

A

neurones in the pons

23
Q

Why are patinets in the REM phase of sleep difficult to rouse?

A

strong inhibition of the thalamus

24
Q

Patients in the REM phase of sleep have very little muscle tone, outline the neruonal mechanism of this phenomenon

A

descending inhibition of LMNs by glycinergic fibres arising in the reticular formation

25
What autonomic effects are seen during the REM phase of sleep?
Penile Erection Loss of Thermoregulation
26
What are 2 functions of sleep?
Energy Conservation & Bodily Repair Memory Consolidation Clearance of Extracellular Debris
27
What are the two most common causes of insomnia?
Depression Anxiety
28
What causes narcolepsy?
issues with neurotransmitters patients are unable to maintain the positive feedback between reticular activating system and cortex patients are unable to stay awake
29
How can sleep apnoea cause sleep disturbances?
soft tissues compress the neck during sleep and cause obstruction to airflow common in obese patients obstruction results in hypoxia and awakening to change position and remove obstructon
30
Outline the EEG findings in a patient with brain death?
flat EEG widespread cortical and brainstem damage
31
Outline the features of a patient in coma (including EEG findings)
widespread brainstem & cortical damage unarousable and unresponsible to psychologically meaningful stimuli EEG - various disorganised patterns no sleep-wake cycle detectable
32
How do patients with permenant vegetative state differ from those in a coma?
some sponteanous eye opening is possible some patients can localise to stimuli via brainstem reflexes sleep-wake cycle detectable
33
What is a cause of locked in syndrome and how do patients present?
caused by basilar/pontine artery occlusion eye movements can be preserved but loss of ALL somatic motor functions from pons down