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Neuro > Coma > Flashcards

Coma Flashcards

1
Q

What is the definition of a coma?

A

A state of unarousable phycological unresponsiveness in which subjects lie with eyes closed and show no psychological understandable response to external stimuli or inner need

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2
Q

What the scoring of a come on the GCS?

A

GCS<8
Eye opening is 2 or less
Verbal response is 2 or less
Motor response is 4 or less

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3
Q

What does consciousness depend on?

A

Intact ascending reticular activating system to act as alerting or awakening element of consciousness
Functioning cerebral cortex of both hemispheres which determines content of that consciousness

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4
Q

What does the reticular activating system in coma control?

A

Arousal

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5
Q

What does the cerebral hemispheres control in coma?

A

Awareness of environment
Determines lethargy, stupurous, obtunded and coma

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6
Q

What are other states of consciousness?

A

Coma and general anaesthetic are least amount of cerebral hemispheres and reticular activating system
Vegetative state is more reticular activating system

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7
Q

What is involved in resuscitation?

A

ABC - airway, breathing and circulation
Blood samples - glucose, biochemistry, haematology, blood gas
Establish BP, pulse, temp., IV access and stabilise neck
Examine for evidence of meningitis

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8
Q

What can cause a change in respiration?

A

Depressed - drug overdose or metabolic disturbance
Increased - hypoxia, hypercapnia and acidosis
Fluctuating respiration - brainstem lesion

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9
Q

What is involved in examination and monitoring?

A

Temp., HR, BP, CVS, resp., skin, breath for ketones, abdomen, meningism, and fundal exam

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10
Q

What is involved in the neurological assessment of coma?

A

GCS
Brainstem function
Motor function and reflexes

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11
Q

What is tested in brainstem function?

A

Pupillary reactions, corneal responses, spontaneous eye movements, oculocephalic responses (doll’s eye), oculovestibular responses, and respiratory pattern in medullary centre

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12
Q

What can show motor function?

A

Motor response
Muscle tone
Tendon response
Seizures

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13
Q

What could be the cause if patient in coma but no meningism or focal brainstem/ lateralising cerebral signs?

A

Toxic, metabolic or systemic problems

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14
Q

What could be the cause if patient in coma with meningism but no focal brainstem or lateralising cerebral signs?

A

Subarachnoid haemorrhage
Meningitis
Encephalitis

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15
Q

What could be the cause if patient in coma with focal brainstem or lateralising cerebral signs?

A

Focal cerebral - tumour or infarct

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16
Q

What are some causes of a coma without focal or lateralising signs or meningism?

A

Anoxic/ ischaemic conditions
Metabolic disturbances
Intoxications
Systemic infections
Hyperthermia/ hypothermia
Epilepsy

17
Q

What investigations are done?

A

Toxicology screen - alcohol level
Measure blood sugar and electrolytes
Assess hepatic and renal function
Acid base assessment
Measure BP
Consider carbon monoxide poisoning

18
Q

What imagining investigations are done?

A

CT head scan
Lumbar puncture
MRI
If CT/MRI not diagnostic then metabolic screen, LP and EEG

19
Q

What are medical causes of a coma lasting more than 5 hours?

A

Mainly drug ingestion or alcohol
Hypoxia
Cerebrovascular event - haemorrhage or infarction
Metabolic - diabetes, hepatic failure, renal failure, sepsis and hypoxia

20
Q

Describe locked in syndrome

A

Patient has total paralysis below level of third nerve nuclei so although eyes are open and can elevate/depress but there is no horizontal movement or or other voluntary eye movement
Patient can open eyes voluntary and signal numerically by eye closure

21
Q

What is involved in continuing care of patients in coma?

A

Maintenance of vital functions
Care of skin
Attention to bladder and bowel function
Control of seizures
Prophylaxis of DVT and peptic ulceration
Prevention of contractures

22
Q

How can head injury lead to focal neurological signs/ epilepsy?

A

Diffuse axonal injury, contusion, intracranial haematoma, extradural haematoma and subdural haematoma

23
Q

Describe a SDH and EDH on CT

A

SDH is ellipse and convex
EDH is concave makes lens shape

24
Q

How is head injury managed?

A

Stabilise cervical spine, ABCs, GCS under 8 then intubation and ventilation, treat raised ICP, cranial imaging and neuro observation

25
Q

How is raised ICP treated?

A

Surgery to relieve pressure, osmotic agents (mannitol), reduce pain, maintain good PO2 and reduce PCO2, and reduce metabolism

26
Q

What are the clinical features of non-epileptic attacks?

A

Sinusoidal tremor not jerking, pelvic thrusting, side to side head movements, eye closed and resist opening and partial responsiveness

27
Q

What is the Rosier scale?

A

From -2 to +5
Assess stroke
If more than 0 then stroke
Seizure and LOC is -1 each

28
Q

Describe hemicraniectomy

A

Decompressive surgery for severe cerebral swelling post stroke

Neuro (40 decks)

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