Coma

Question 1

Components of conscioussness

Answer 1

1) Awareness - sum of mental functions

2) Arousal - behaviorally linked to appearance of wakefulness

Question 2

Components of mental status?

Answer 2

Mental status = arousal (ARAS) + content (cerebral hemispheres) –> interaction between these two components

Ascending reticular activating system: set of nuclei/pathways located on medulla, pons, midbrain, posterior hypothalamus, and thalamus that projects to cerebral cortex. Regulates level of arousal and sleep-wake transitions

Question 3

Levels of arousal

Answer 3

“ALOS of Consciousness”

1) Alert - fully conscious, awake/aware of self environment
2) Lethargy - mild alertness reduction
3) Obtundation - moderate alertness reduction; increased respond time to stimuli
4) Stupor - can be aroused ONLY by vigorous/repetitive stimulation; returns to sleep when not stimulated
5) Coma - no arousal despite painful stimulation; reflexive movements only

Question 4

Three components of Glasgow scale

Answer 4

Motor response - 6 points
Verbal response - 5 points
Eye opening - 4 points

15 points total, check all 4 extremities

Question 5

Persistent vegetative state

Answer 5

Patient is completely unconscious but have spontaneous eye opening during cyclical periods of arousal.

Awake with eyes open but not reactive/responsive to environment.

Maintain respiration/other autonomic functions.

Question 6

“Locked In” Syndrome

Answer 6

Usually secondary to lesion affecting upper pons and leaving midbrain intact.

AWAKE AND CONSCIOUS but no motor or sensory function.

CN exam shows spared upward/downward gaze and intact blinking (midbrain spared).

Question 7

Brain Death

Answer 7

Legally defined as:

1) Irreversible cessation of cardiopulmonary function OR
2) Irreversible cessation of brain functions (entire brain, including brainstem)

MUST BE CONFIRMED BY 2 PHYSICIANS, one of them must be in neuroscience.

Question 8

Brain Death Apnea Test

Answer 8

Disconnect ventilator and provide oxygen through small catheter.

Watch for spontaneous respiration or chest rise.

Check ABGs: PCO2 > 60 or > 20 points from baseline is positive test, supporting dx of brain death.

Question 9

Lazarus Reflex

Answer 9

Reflex in brain dead patients.

Raising head results in reflexive arm raise then cross over body (like mummy).