Coma

Question 1

What are the 2 requirements of consciousness? How can you lose consciousness?

Answer 1

reticular formation (arousal) and cortex (content). Turn off either one by the main switch (RF) or by many switches (diffuse cortical dysfx)

Question 2

Assessment of cortical and brainstem Fx (5)?

Answer 2

Glasgow coma
respiratory
pupils
ocular reflex
motor

Question 3

Glasgow Coma scale

Answer 3

EYE, MOTOR, VERBAL

Question 4

Window to brainstem and reticular formation?

Answer 4

Reflexes: Pupillary light reflex (II-III)
Dolls-eyes (VIII to VI and III)
Corneal blink reflex (V to VII)
Respiration centers in medulla

Question 5

rising and falling hyperventilations follwed by apnea and restarting

Answer 5

Cheyne-stokes lesion: diffuse cortical lesion

Question 6

constant, rapid hyperventilation

Answer 6

cental neurogenic hyperventilation-midbrain lesion

Question 7

hyperpnea followed by apnea is known by two names:

Answer 7

Cluster or Biot’s breathing-pons lesion…death if not ventilated.

Question 8

small pupils with normal reaction

Answer 8

metabolic

Question 9

mid-position pupils and non-reactive

Answer 9

midbrain dysfx

Question 10

large pupils and non-reactive

Answer 10

anoxic injury (MI) or severe brainstem injury

Question 11

unilateral large non-reactive pupil

Answer 11

ipsilateral uncal herniation

Question 12

upper limbs flexed and lower limbs extended

Answer 12

DECORTICATE. Possible lesion in cerebral hemispheres, the internal capsule, and the thalamus.

Question 13

upper and lower limbs extended

Answer 13

DECEREBRATE. indicates brain stem damage. Progression from decorticate posturing to decerebrate posturing is often indicative of uncal (transtentorial) or tonsilar brain herniation.

Question 14

Ipsilateral 3rd nerve palsy and contralateral decorticate posturing.

Answer 14

Uncal herniation

Question 15

Blood flow in central herniation?

Answer 15

arteriers stretched and kinked decreasing perfusion to brainstem

Question 16

rostal to caudal deteriortation of central herniation. Describe PE of Diencephalic to midbrain demise for: respiratory, pupils, ocular, motor.

Answer 16

Respiratory: Cheyne-stokes TO hypervent
Pupilis: Sm, reactive TO fixed, mid-position
Ocular: + Dolls to impaired Dolls
Motor: Decorticate to decerebrate

Question 17

4 main causes of Coma

Answer 17

supratentorial lesions, infratentorial lesion, rare psychiatric, and MOSTLY TOXIC or METABOLIC dysfunction (diffuse cortical damage)

Question 18

1 DDX for diffuse cortical damage (pupils small but reactive and no focal neurogic deficit)

Answer 18

toxic or metabolic disease