Altered consciousness Flashcards
Acute confusional state/ Delirium- Sx
- Fluctuations of consciousness, rapid onset
- Varying inability to concentrate, maintain attention and sustain purpose
- Hallucinations
- Agitation
- Retro and anterograde amnesia
- Incoherent speech
- Fever, tachycardia, HTN
Acute confusional state/ Delirium- Eti
- Post-op states
- Sensory deprivation
- Multi-system illness
- Psych meds
- Age
Acute confusional state/ Delirium- Dx
- R/O infection, neuro abn or hypoxia
- EEG shows generalized slowing
Acute confusional state/ Delirium- Tx
- Tx underlying cause, discontinue offending meds
Brain death- Eti
- Irriversible coma
- > 6 hrs
Brain death- Sx
- No brainstem reflexes
- No response to external stimulation
- No spontaneous respirations or respirations during apnea test
Brain death- Dx
- Apena test- presence or absence or spontaneuos resp activity at 60 mmhg
- Cerebral angiographu
Brain death- Tx
Palliation
Stupor- Sx
- Response to painful stimuli only
- Purposeful limb withdrawal
- Depressed level of consciousness
- Unilateral absence = corticospinal lesion
- Bilateral absensce = brainstem
Coma- Sx
- Hyperventilation or cheyne-stokes
- Doll head eyes
- Unilateral horner syndrome
- Pinpoint pupils
- Absent sleep-wake cycles
Persistent vegetative state- Sx
- Complete unawareness, doesn’t follow commands
- Spontaneous eye opening but no recognition with envt
- No motor mvmts
- Normal ciculatory, brainstem and resp fxn
Persistant vegetative state- Dx
- Not 1 month after non TBI
- Not 1 year after TBI
Locked in syndrome- Sx
- Paralysis of 4 extremities and lower CN
- Persevered eye mvmts and blinking
- Inablilty to communicate
- Intact resp fxn
- Hearing and somatosensation intact
- Preserved consciousness
Persistant vegetative state- Eti
- Demilentation, stroke, hyponatremia
- Basilar artery occlusion
- Issue at ventral pons
Coma- Eti
- Sleep like unresponsiveness
- Absence awareness of self
- Pathologic mvmts
Locked in syndrome- Eti
- Acute, destructive lesions of ventral pons
- Infarct, hemorrhage, demyelination, encephalitis
Locked in syndrome- Dx
- CT or MRI
Locked in syndrome- Tx
- Poor prognosis
- Allow as much fxn as possible
Minimally conscious state- Eti
- Temporary or permanent
- Following head trauma
- Likelihood of recovery diminishes over time
Minimally conscious state- Sx
- Inconsistent evidence of consciousness
- Basic verb or context appropriate gestures
- Emotional responses to emotional stimuli
- Purposive response to envt stimuli
Minimally conscious state- Dx
- Clinical
- Imaging shows higher conscious awareness than PVS
Minimally conscious state- Tx
- Supportive- ventilation, nutrition
Akinetic mutism- Eti
- Bilateral damage to anterior medial region of cerebral cortex
- Aneurysm of anterior cerebral arteries
Akinetic mutism- Sx
- Attentiveness and vigilance
- Visual tracking
- Slow behavioral response
- Severe memory loss
- Apathetic, listless appearance
