Altered Mental Status and Coma Flashcards
Ascending reticular activating system (RAS) located in ____ and ascends (unilateral/bilateral) to _____ (3)
midline upper pons/midbrain
bilateral
hypothalamus, medial thalamus, cortical hemisphere
Alteration of consciousness localized to only 2 scenarios
Midline brainstem (pons/midbrain) Bilateral cortical hemispheres (unilateral will not suffice to induce coma)
Name the type of lesion that causes the following pupillary and eye movement findings in coma:
Large, “fixed”
Tectal
Name the type of lesion that causes the following pupillary and eye movement findings in coma:
Pinpoint
Pons
Name the type of lesion that causes the following pupillary and eye movement findings in coma:
Mid position, fixed
Midbrain
Name the type of lesion that causes the following pupillary and eye movement findings in coma:
Dialated, fixed
CN3 Uncal
Name the type of lesion that causes the following pupillary and eye movement findings in coma:
Small reactive
Diencephalic
A comatose patient will have tonic eye deviation to side of (hot/cold) water
cold
No nystagus
Diencephalic lesion causes ____ posturing
Decorticate (involuntary flexion arms and legs)
Brainstem lesion causes ____ posturing
Decerebrate (involuntary extension of upper extremities in response to external stimuli)
Brudzinski sign =
neck flexion causes flexion in hips
Kernig sign =
flex hip and knee while pt is lying flat, subsequent leg extension causes severe pain
Cushing’s triad =
Reflects ___
Increased BP, Pulse variability, Respiratory change
Brainstem is getting crushed from increased intracranial pressure
Mannitol, hypertonic saline used for ____
brain volume control in herniation
Propofol, thiopental (neuroanesthetics) used for ____
brain metabolism control in herniation
