altered mental status and coma Flashcards
what is delirium
arousal system dysfunction w/the content of consiousness affected as well, transient disorder w/ the impairment of attention and cognition
what is dementia
failure of the content portions of consciousness w/ relatively preserved alerting functions, loss of mental capacity,
define coma
failure of both arousal and content functions, reduced alterness and responsiveness form which the patient can’t be aroused
where are neurons that are responsible for arousal function from?
reticular acitivating system
where are the structures that are responsible for content of consiousness?
cerebral cortex
what are the 4 general causes of delirium?
primary intracranial disease,
systemic disease secondarily affecting CNS,
exogenous toxins,
drug w/ drawal
pathophysiology of dementia
most cases of dementia is caused by Alzheimers followed by vascular dementia
what is diagnostic of delirium?
acute onset of attention deficits and cognitive abilities fluctuating in seeverity throught the day and worsening at night
what is diagnostic of delirium?
acute onset of attention deficits and cognitive abilities fluctuating in seeverity throught the day and worsening at night
what are the clinical features of dementia
impairment of memory, PARTICULARLY RECENT MEMORY, that’s gradual and progressive w/ REMOTE MEMORIES preserved. Motor and Speech are also preserved. Early stage is associated w/ naming problems and forgetting common items, then middle stage people have problems reading and issues in social situations and loss of direction, late stage people are disoriented, and have inabiltiy to self care or have personality changes.
what is the difference between depression and delirium?
depressed patients are oriented and are able to perform commands
what is the difference between depression and delirium?
depressed patients are oriented and are able to perform commands
what is the pharmaceutical treatment for delirium?
haloperidol: 5-10 mg w/ reduced dosing to 1-2 mg in elderly
Benzo: lorazipam .5-2 mg may be used in conjunction w/ haloperidol doses 1-2 mg
what is the follow up for delirum?
admit, and further treatment unless READILY REVERSIBLE CAUSE is discovered
what is the follow up for delirium?
admit, and further treatment unless READILY REVERSIBLE CAUSE is discovered
what is the follow up for delirium?
admit, and further treatment unless READILY REVERSIBLE CAUSE is discovered
what are the signs of vascular dementia?
fluctuating, stepped course
dementia associated w/ stroke has to occur within how long of a stroke?
3 months
when should you consider normal pressure hydrocephalus as a cause of dementia?
urinary incontinence and gait disturbance early in the disease, large ventricles on CT
Glasgow coma scale
motor V6
verbal 5
eyes 4
what is the max and min score in intubated patients?
10 T, 2T
what does GCS of 13-15 mean?
mild head injury
what does GCS of 9-12 mean?
moderate head injury
<= 8 GCS score
severe head injury, needs intubation
can a unilateral hemispheric disease like a stroke cause a coma?
no it needs to be bilateral
what is an uncal herniation syndrome?
medial temporal lobe shifts to compress the upper brainstem which results in progressive drowsiness. Ipsilateral pupil is sluggish then becomes dilated and non reactive, and ipsilateral hemiparesis may occur
what is central herniation syndrome
progressive loss of consiousness, loss of brainstem reflexes, decorticate posturing, irregulat posturing
cerebral blood flow occurs normally at what mean aterial pressures? what can affect MAP?
50-100 mmHg, ICP
what is a sign of pseudocoma?
avoidance gaze, pupillary responses, extraocular mvmts, muscle tone, and reflexes are also intact on examination
abrupt coma suggests what?
catastrophic stroke or seizure
slow progressive coma suggests?
tumor or subdural hematoma
what is the neuroimaging of choice for a coma?
CT
what is nonconvulsive status epilepticus?
generalized seizures and remain unrespsonseve may be in continuing state of seizures, consider if they seize and down wake up after 30 min
what is the treatment for hypoglycemic coma?
dextrose w/ thiamine if alcohol abuse or malnutrition
what should you use in a suspected opiate overdose?
naloxone
