5b. NeuroExams - Coma Flashcards
what are 2 requirements of a coma?
- damage to reticular activating system
2. both hemispheres impaired
what are the 4 things you evaluate for a coma?
- cranial nerves (abnormal, consider brainstem)
- pupil reflexes (midbrain)
- breathing patterns (all brain stem)
- posturing
a. de-corticate (midbrain)
b. de-cerebrate (pons)
what are 5 criteria for brain dead?
- no neurological activity above the level of the medulla
- pupils fixed + dilated
- all facial muscles not responding
- no breathing
- no brainstem evoked potential
what are the 5 parts of the mental status exam (assessment of the cerebral cortex)?
- attention
- language
- memory
- visuospatial
- executive function
what anatomy is related to attention?
- focal (cortical or subcortical)
- diffused (metabolic, toxic, infectious)
how is attention examined?
- observe patient
- orientation (person, place, time)
what anatomy is related to memory?
- medial temporal lobes
- thalamus
- basal forebrain
how is memory examined?
- remember 3 words 5 min
- remember 3 shapes 5 min
- past pubic + personal events
- factual knowledge
where is the hippocampus?
medial temporal lobe
what anatomy is related to language?
left hemisphere
what is focused on in language exams?
- fluency
- naming
- repetition
- comprehension
- reading
- writing
what anatomy is associated with visuospatial/perceptual?
right hemisphere
what does Albert’s line cancellation test?
neglect
what anatomy is related to executive function?
frontal lobes
what is examined for executive function?
- affect
- verbal fluency
- sequential motor ability
- delayed alternation
- snout, suck, grasp, rooting
