16: Stupor and Coma Flashcards
two requirements for consciousness
arousal + awareness
elements of a neuro exam for stupor and coma
- pupillary responses
- corneal reflex
- extraocular movements
- cough/gag reflex
- motor responses
- respiratory pattern
- semi-essential to check: neck stiffness, carotid auscultation, fundoscope
how to tell which pupil is abnormal (large or small)
large pupil: should fail to constrict to light
dilated pupil: should fail to dilate in dark
two major causes of ipsilateral CN3 damage
ruptured PCA, uncal herniation
if you suspect a bleed but see no acute blood on CT…
get an LP
dolls eye maneuver (oculocephalic maneuver)
move head around - eyes should move opposite and stay basically straight ahead when in coma
cold water in ear of coma pt causes
eyes to deviate to irrigated side (or downward if water in both ears)
decerebrate vs decorticate posture
decerebrate: all extremities extended
decorticate: arms flexed into chest, legs extended
decorticate vs decerebrate: where is the damage?
decorticate = hemispheres decerebrate = brainstem
supratentorial mass lesions: progression of signs goes which way?
rostral to caudal
what can cause bizarre respiratory patterns?
subtentorial mass lesions
how long during a global ischemia does it take for permanent damage to set in?
6 minutes
persistent vegetative state
awake but functionally decorticate, unaware of surroundings, eyes open and move, sleep-wake cycles, +/- brainstem and SC reflexes
three things implied by “brain death”
- irreversibility
- complete cessation of respirations
- persistence
gold standard to test for brain death**
apnea test
