Coma

Question 1

define coma

Answer 1

state of unresponsiveness in which patient lies with eyes closed and cannot be aroused even with vigorous stim

Question 2

what is consciousness a combination of and what defines them

Answer 2

arousal - level of consciousness

awareness - content of consciousness

Question 3

4 levels of arousal

Answer 3

1. alert
2. obtunded - reduced but easily stimed
3. stupor - reduced alert, and hard to arouse
4. coma - eyes remain closed

Question 4

where must a lesion occur to cause coma

Answer 4

either extensive areas of both hemispheres or the ascending arousal system including paramedian upper brainstem BILATTERALY

Question 5

what is locked-in syndrome

Answer 5

destruction of pontine base - have awareness, vertical eye movements, and blinking, but otherwise totally paralysed

Question 6

3 general classes of coma etiology

Answer 6

1. structural
2. metabolic
3. intrinsic

Question 7

2 types of structural brain issues

Answer 7

1. compressive lesions - supra and infratentorial

2. destructive lesion - supra and infra

Question 8

examples of metabolic cause of coma

Answer 8

1. glucose
2. anorexia
3. lytes
4. acid-base
5. organ dysfunction

Question 9

2 types of intrinisic cause of coma

Answer 9

1. epilepsy

2. infection

Question 10

what is a false localizing sign

Answer 10

sign shows a lesion on one side, but on another

Question 11

what happens in uncal herniation

Answer 11

uncus herniates and compresses stem

Question 12

signs in right uncal herniation

Answer 12

1. R 3rd nerve palsy (localize with this)
2. depressed consciousness
3. left hemiparesis - pressing against stem
   OR right hemiparesis (kernohan’) pressing against opp. tentorium

Question 13

what happens to eyes in right lateral pontine lesion

Answer 13

gaze paralysis - eyes don’t turn when move head left

Question 14

what happens to eyes in left paramedian pontine lesion

Answer 14

1.5 syndrome - eyes don’t move when move head right and L eye doesn’t adduct when turn head left

Question 15

what happens to eyes in MLF lesion

Answer 15

neither eye will adduct

Question 16

2 main eye function of para system

Answer 16

1. contricts pupil

2. accomodates

Question 17

3 main functions of symp. system

Answer 17

1. dilate pupils
2. raise eyelids
3. acitvate sweat glands

Question 18

what happens to pupils when lesion CN3

Answer 18

dilated and fixed

Question 19

what happens to pupils when lesion midbrain EWN

Answer 19

midposition, fixed

Question 20

what happens to pupils when lesion pons and desceding sym tract

Answer 20

pinpoint pupils

Question 21

key questions in a coma Hx

Answer 21

1. onset
2. seizure?
3. recent trauma
4. febrile illness
5. premontory signs
6. PMHx
7. Meds

Question 22

3 categories of glasgow coma scale

Answer 22

1. eye response
2. motor response
3. verbal reponse