Altered consciousness

Question 1

Acute confusional state/ Delirium- Sx

Answer 1

• 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

Question 2

Acute confusional state/ Delirium- Eti

Answer 2

• Post-op states
• Sensory deprivation
• Multi-system illness
• Psych meds
• Age

Question 3

Acute confusional state/ Delirium- Dx

Answer 3

• R/O infection, neuro abn or hypoxia

- EEG shows generalized slowing

Question 4

Acute confusional state/ Delirium- Tx

Answer 4

• Tx underlying cause, discontinue offending meds

Question 5

Brain death- Eti

Answer 5

• Irriversible coma

- > 6 hrs

Question 6

Brain death- Sx

Answer 6

• No brainstem reflexes
• No response to external stimulation
• No spontaneous respirations or respirations during apnea test

Question 7

Brain death- Dx

Answer 7

• Apena test- presence or absence or spontaneuos resp activity at 60 mmhg
• Cerebral angiographu

Question 8

Brain death- Tx

Answer 8

Palliation

Question 9

Stupor- Sx

Answer 9

• Response to painful stimuli only
• Purposeful limb withdrawal
• Depressed level of consciousness
• Unilateral absence = corticospinal lesion
• Bilateral absensce = brainstem

Question 10

Coma- Sx

Answer 10

• Hyperventilation or cheyne-stokes
• Doll head eyes
• Unilateral horner syndrome
• Pinpoint pupils
• Absent sleep-wake cycles

Question 11

Persistent vegetative state- Sx

Answer 11

• Complete unawareness, doesn’t follow commands
• Spontaneous eye opening but no recognition with envt
• No motor mvmts
• Normal ciculatory, brainstem and resp fxn

Question 12

Persistant vegetative state- Dx

Answer 12

• Not 1 month after non TBI

- Not 1 year after TBI

Question 13

Locked in syndrome- Sx

Answer 13

• Paralysis of 4 extremities and lower CN
• Persevered eye mvmts and blinking
• Inablilty to communicate
• Intact resp fxn
• Hearing and somatosensation intact
• Preserved consciousness

Question 14

Persistant vegetative state- Eti

Answer 14

• Demilentation, stroke, hyponatremia
• Basilar artery occlusion
• Issue at ventral pons

Question 15

Coma- Eti

Answer 15

• Sleep like unresponsiveness
• Absence awareness of self
• Pathologic mvmts

Question 16

Locked in syndrome- Eti

Answer 16

• Acute, destructive lesions of ventral pons

- Infarct, hemorrhage, demyelination, encephalitis

Question 17

Locked in syndrome- Dx

Answer 17

• CT or MRI

Question 18

Locked in syndrome- Tx

Answer 18

• Poor prognosis

- Allow as much fxn as possible

Question 19

Minimally conscious state- Eti

Answer 19

• Temporary or permanent
• Following head trauma
• Likelihood of recovery diminishes over time

Question 20

Minimally conscious state- Sx

Answer 20

• Inconsistent evidence of consciousness
• Basic verb or context appropriate gestures
• Emotional responses to emotional stimuli
• Purposive response to envt stimuli

Question 21

Minimally conscious state- Dx

Answer 21

• Clinical

- Imaging shows higher conscious awareness than PVS

Question 22

Minimally conscious state- Tx

Answer 22

• Supportive- ventilation, nutrition

Question 23

Akinetic mutism- Eti

Answer 23

• Bilateral damage to anterior medial region of cerebral cortex
• Aneurysm of anterior cerebral arteries

Question 24

Akinetic mutism- Sx

Answer 24

• Attentiveness and vigilance
• Visual tracking
• Slow behavioral response
• Severe memory loss
• Apathetic, listless appearance