Coma

Question 1

* touch cornea with a tissue –> test CN 5 and 7

• dead = no response in either eye

Answer 1

the corneal reflex test

Question 2

About ____% of those coming into the NICU with coma with die within the first month.

Answer 2

50%

Question 3

Understand the criteria for establishing brain death.

Answer 3

1. unresponsiveness; GCS = 3
2. Cerebrally modulated motor responses are absent during application of painful stimulus
3. Brainstem reflexes are absent:

• Pupillary light reflex
• Corneal reflex
• Oculocephalic reflex (doll’s eyes)
• Oculovestibular reflex (cold calorics)
• Cough reflex
• Gag reflex
• Respiratory effort (apnea test)

Question 4

This is a sleep-like state from which the patient can be aroused only by vigorous stimuli.

Answer 4

stupor

Question 5

Describe the anatomical pathways tested with the cough reflex.

Answer 5

* Suction the trachea at the carina –> tests CN 10

• dead = no cough response

Question 6

This is a sleep-like state where the patient is unresponsive to external stimuli, and there are no sleep-wake cycles. Usually lasts no more than 4 weeks. GCS 8 or less.

Answer 6

coma

Question 7

Which sign is worse: decerebrate or decorticate posturing?

Answer 7

decerebrate (extension)

Question 8

Describe the anatomical pathways tested with the corneal blink reflex.

Answer 8

* touch cornea with a tissue –> tests CN 5 and 7

• dead = no response in either eye

Question 9

This is fluctuating confusion, inattention, misperceptions (illusions or hallucinations).

Answer 9

delirium

Question 10

decerbrate posturing

Answer 10

*extension*

• upper and lower extremity extension (suggests lesion at upper brainstem)

Question 11

stupor

Answer 11

a sleep-like state from which the patient can be aroused only by vigorous stimuli

Question 12

Consciousness derives from the activation of the _____ by the RAS, which project from the reticular formation of the brainstem.

Answer 12

intralaminar nuclei of the thalamus

Question 13

Discuss ethical, legal, and cultural issues related to brain death and organ transplantation.

Answer 13

• surgeon that harvests may not be involved in determining death
• proper documentation

Question 14

What is a vegetative state?

Answer 14

sleep-wake cycles re-establish but there is no sign of cognitive function

Question 15

This is upper extremity flexion with lower extremity extension (suggests lesion at hemispheres).

Answer 15

decorticate posturing

Question 16

This is when sleep-wake cycles re-establish, but there is no sign of cognitive function.

Answer 16

vegetative state

Question 17

What are the 3 areas tested by the Glascow-coma scale?

Answer 17

1. motor
2. verbalization
3. eye opening

Question 18

decortiate posturing

Answer 18

*flexion*

• upper extremity flexion with lower extremity extension (suggests lesion at hemispheres)

Question 19

*touch the oropharynx with Q-tip –> test CN 9 and 10

• dead = no movement of oral structures

Answer 19

the gag reflex test

Question 20

* Suction the trachea at the carina –> tests CN 10

• dead = no cough response

Answer 20

the cough reflex test

Question 21

Dx?

• eyes open spontaneously
• sleep-wake cycles resume
• no evidence of perception, communication, or purposeful motor activity

Answer 21

vegetative state

Question 22

Dx?

• eyes open spontaneously
• sleep-wake cycles resume
• arousal level may be normal at times
• reproducible, though inconsistent, behavioral displays of perception, communication, or purposeful motor activity

Answer 22

minimally conscious state

Question 23

This is upper extremity extension with lower extremity extension (suggests lesion at upper brainstem).

Answer 23

decerebrate posturing

Question 24

Describe the anatomical pathways tested with the cold water calorics.

Answer 24

• aka oculovestibular reflex
• * flush each external auditory canal with 20mL ice water x2 –> test CN 3, 4, 6, 8
• dead = no eye movements

Question 25

delirium

Answer 25

fluctuating confusion, inattention, misperceptions (illusions or hallucinations)

Question 26

Consciousness derives from the activation of the intralaminar nuclei of the thalamus by the ____, which project from the _______ of the brainstem.

Answer 26

RAS; reticular formation

Question 27

coma

Answer 27

• a sleep-like state where the patient is unresponsive to external stimuli
• no sleep-wake cycles
• usually lasts no more than 4 weeks
• GCS 8 or less

Question 28

Describe the anatomical pathways tested with the gag reflex.

Answer 28

* touch the oropharynx with Q-tip –> test CN 9 and 10

• dead = no movement of oral structures

Question 29

What is the outcome from a vegetative state?

Answer 29

• 1% chance of recovery in 12 mos
• esp. bad if non-traumatic cause