Coma

Question 1

What is tested in a Coma Examination?

Answer 1

• Level of Consciousness
• Vital Signs
• Respiratory Patterns
• Pupils
• Ocular Movements
• Motor Responses

Question 2

What are the possible findings of a Neurological Examination of Altered Consciousness?

Answer 2

Patient will be at a particular level of consciousness:

• Normal : No external stimulation necessary
• Somnolent: External stimulation > N1 wakefulness
• Obtunded: External stimulation > Abnormal waking
• Coma: No wakefulness

Question 3

Name the 4 abnormal respiration patterns

Answer 3

1. Cheyne- Stokes
2. Central Neurogenic Hyperventilation
3. Apneustic Respirations
4. Ataxic Respirations

Question 4

What pattern is seen in Cheyne-Stokes breathing? caused by a lesion in what area of brain?

Answer 4

waxing and waning caused by lesions of diancephalon and cortex

Question 5

What pattern is seen in Central Nuerogenic Hyperventilation

Answer 5

Deep and Regular with no waxing and waning

Question 6

What respiration pattern is seen by lesion at the midbrain (colliculi)?

Answer 6

Central Neurogenic Hyperventilation

Question 7

What pattern is seen in Apneustic Respirations?

Answer 7

Inspiration is followed by prolonged inspiration pause and expiration is followed by prolonged expiration pause

Question 8

What level cut leads to apneustic respirations?

Answer 8

pontine (Often upper pons) and tegmentum

Question 9

Describe Ataxic Respirations

Answer 9

Incoordinated breathing with inspiratory spasm

Question 10

What level lesion may cause ataxic breathing?

Answer 10

medulla oblongta

Question 11

Big pupil with coma indicates? no coma?

Answer 11

Midbrain; 3rd nerve

Question 12

What pupillary reaction is seen in a patient with a damaged diancephelon?

Answer 12

small reactive

Question 13

What pupillary reaction is seen in a patient with a damaged tectum?

Answer 13

large fixed pupils; hippus

Question 14

Describe decorticate Posturing

Answer 14

Abnormal flexor response of the arm (fully developed includes wrist and fingers with upper extremity adduction) with extension of the legs (internal rotation and plantar flexion of the lower extremity is seen when fully developed)

Question 15

Disconnecting cortex from brainstem will yield what motor response?

Answer 15

Spastic Hemiparesis- similar to deorticate posturing

Question 16

What level of midbrain is suspected in Spastic Hemiparesis?

Answer 16

Above the Red Nucleus

Question 17

Describe decerebrate posturing

Answer 17

When more cerebrum is lost, there is an abnormal extensor response of arm and leg. When fully developed, opisthotonos, clenching of the jaws, stiff extension of the limbs, internal rotation of teh arms, and plantar flexion of the feet occurs.

Question 18

Extension of trunk and neck is known as

Answer 18

opisthotonos

Question 19

Decerebrate posturing indicates what level lesion?

Answer 19

caudal to red nucleus in maid brain. Also thought to indicates release of vestibulospinal outputs.

Question 20

What respiratory pattern is seen in a lesion of thee bilateral midbrain?

Answer 20

Sustained regular hyperventilation

Rarely, chayne-Strokes

Question 21

Doll’s Head Maneuver (Oculocephalic) findings in Bilateral midbrain stage:

Answer 21

impaired, may be dysconjugate

midbrain is damaged and thus cant drive 1 eye movements when head is turned to right or left

Question 22

How does the ice water calorics maneuver test the eye?

Answer 22

It is an oculovestibular test. Adding ice water to ear drives the vestiubular nuclei by setting up a convection current in the lateral circular canal just like when you move your head

Question 23

Oculocephalic findings in bilateral diancephalic stage

Answer 23

midprain , pons, MLF work fine. Absent nystagmus

Question 24

Bilateral Diencephalic Stage; Motor response at rest? to stimulation?

Answer 24

no response aka motionless; decorticate posture

Question 25

Bilateral Midbrain Stage; Motor response at rest? to stimulation?

Answer 25

Motionless; decerebrate (particularly o nside oppposite primary lesion)

Question 26

Saccade includes what eye movements?

Answer 26

quick phase of nystagmus and tracking eye movements