Coma

Question 1

which are the 2 main types of coma

Answer 1

morphologic:

• lesion in upper brainstem and lower diencephalon
• bilateral damage to cortex and subcortical white matter

submicroscopic:
- suppression of nervous activity: metabolic, drugs, toxins

Question 2

which types of mass lesions can cause coma

Answer 2

direct extension into the diencephalon and midbrain

lateral displacement of deep central structures

Question 3

which vital sign changes occur in coma?

Answer 3

temperature
respiratory rate
pulse rate
blood pressure
odor of breath
changes on skin

Question 4

neurological examination in coma patients

Answer 4

• posture of limbs and body
• presence or absence of spontanous movements
• ocular movements, no pupillary reaction, no eyelid or corneal response
• kussmaul or cheyne-stoke breathing

Question 5

which neurological conditions can simulate coma?

Answer 5

vegetative state
akinetic mutism
locked in state
psychogenic coma

Question 6

causes of coma

Answer 6

trauma
stroke
infection
metabolic
blood sugar
O2 depriviation
swelling

Question 7

treatment in coma

Answer 7

tracheal intubation
IV naloxone, dextrose thiamine
etiological treatment

Question 8

criteria for brain death

Answer 8

coma of known cause
no motor response
no brainstem reflexes
no coughing, when trachea stimulated
no respiratory drive at apnea test

conformation test via cerebral angiography and EEG

Question 9

causes of coma associated with meningeal syndrome

Answer 9

subarachnoidan hemorrhage
acute bacterial menigitis
viral encephalitis

Question 10

causes of coma associated with focal brainstem or lateral cerebral signs

Answer 10

hemisphreal hemorrhage
brainstem infarction
abscess
epidural and subdural hematoma
tumor