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neuro > Coma > Flashcards

Coma Flashcards

1
Q

stupor

A

nonsleep depresson of consciousness where normal rxns to the environment are blunted

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2
Q

coma

A

nonsleep loss of consciousness where normal rxns to environ are lost

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3
Q

delerium

A

nonsleep depresson of consciousness where normal rxns to environ are blunaed and replaces by agitated responses

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4
Q

reticular activating system

A

retcular system connecting rostral pontine and midbrain through thalamus to cerebral cortex

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5
Q

decorticate posture

A

posture in which lower limbs are extended and upper limbs flexed in response to noxious stimuli

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6
Q

locked in

A

” refers to damage to the base of the pons with preservation of consciousness and vertical eye movements, but loss of all other voluntary movements.

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7
Q

Cheyne Stokes

A

respiration is a pattern of breathing characterized by waxing and waning amplitude of respiration with preserved respriatory frequency.

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8
Q

central neurogenic hyperventilation

A

typically occurs with pontine lesions, with increased depth of respiration.

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9
Q

ataxic respiration

A

is a pattern of respiration with irregular depth and frequency of respirations with pauses.

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10
Q

vestibulo occular reflex

A

is the reflex that keeps eyes directed on a target during head movements. It can be elicited by head movments or caloric tests.

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11
Q

diencephalic pupils

A

bilaterally small pupils with lesions of the thalamus.

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12
Q

coma-like states are differentiated from coma by

A

1) normal and alert ECG
2) presence of nystagmus on caloric irrigation of external auditory canal
3) absence of abnormal neurologic signs

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13
Q

what arteries usually cause locked in

A

paramedian arteries

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14
Q

things that lead to coma-like stuff (5)

A

1) reticular formation (part of brainstem) involvment
2) bilateral hemispheric and reticular formation depresson (usually metabolic)
3) acid/base or ionic abnormalities in CNS environment
4) postictal diffuse depression (after seizure)
4) trauma

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15
Q

cerebral cortex and RF, therefore 2 processes that suppress cerebral cortical activity

A

RF can fx without CC, but CC CANNOT fx without RF

1) damaging RF
2) diffuse suppression of CC

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16
Q

most cases of coma due to

A

diffuse cerebral cortical damage or suppression

17
Q

what is preserved until last

A

brainstem- hence why you may see cheyne stokes

18
Q

how to determine if any damage to reticular formation

A

determining whether eye movements are damaged because extraocular nuclei close to reticular formation

  • -via caloric testing
  • -pupillary rxns
19
Q

what is the first thing that herniates?

A

uncus of temporal lobe

20
Q

what could the uncus do?

A

entrap third nerve for CN III palsy

–ptosis, big pupil, lateral deviation of eye

21
Q

what will be preserved in locked in syndrome?

A

vertical gaze, eye opening, convergence

22
Q

most common damage to CC

A

metabolic

23
Q

most common damage to RF

A

ischemia/infarction

24
Q

5 main things to evaluate

A 
level of conscousness
respiration
pupils
oculomotor-vestibular fx
motor fx
25
Q

upper diencephalon

A

drowsy

yawns and sighs

small, reactive pupils

depression of ocular checking and fast component of nystagmus

left hemiparesis, bilateral paratonia

26
Q

lower diencephalon

A

coma

cheyne-stokes

small, reactive

loss of ocular checkng and fast component of nystagmus

left hemiparesis
decorticate

27
Q

mesencephalon

A

coma

Cheyne stokes or central neurogenic hyperventilation

midposition fixed pupils

dysconjugate response, loss of medial rec and maybe lteral rec

decerebrate

28
Q

upper pons

A

coma

CNH or ataxia

MPF

dysconjugate response, loss of medial rec and maybe lteral rec

weak decerebrate

29
Q

lower pons

A

coma

ataxia or eupnea

MPH

no OMV

flaccid, areflexic

30
Q

medulla

A

coma

apnea

MPF

no OMV

flaccid, areflexic

31
Q

rostral-caudal deterioration

A 
upper diencephalon
lower diencephalon
mesencephalon
upper pons
lower pons
medulla
32
Q

most common cause of stupor and coma

A

metabolic encephalopathy

33
Q

wakefullness in vegetative state vs minimally conscious state/locked in syndrome

A

present in vegetative state but not present in minimally conscious/locked in

34
Q

reflexes are gone when

A

brain dead

35
Q

EEG braindead

A

brain death

36
Q

EEG coma

A

polymorphic delta, burst suppression

37
Q

EEG vegetative state

A

delta, theta, ECS

38
Q

EEG minimally conscious state

A

nonspecific slowing

39
Q

EEG locked in syndrome

A

usually normal

neuro (23 decks)

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