Coma Flashcards
what pathway keeps us awake
ascending reticular activating system in the brainstem
what is locked-in syndrome
paralysis below the level of the 3rd cranial nerve nuclei
able to move eyes in some ways but cannot move, speak or any of the rest of it
what is a persistent vegetative state
brainstem is recovered but not cortical function. Able to maintain basic survival processes.
They are wakeful but not aware
causes of a low GCS (i.e. low consciousness)
hypoxia/hypercapnia drug intoxication hypoglycaemia ketoacidosis seizure stroke hydrocephalus subarachnoid haemorrhage meningitis encephalitis tumour (raised ICP) damage to reticular activating system
which part of the brainstem does the 3rd nerve emerge from (i.e. where is it’s nucleus)
midbrain
investigation of a coma
GCS and AVPU assess cranial nerves and neuro exam vitals blood glucose blood gases all the blood things urinalysis blood culture toxicology ECG CT head LP EEG
where is respiration regulated
in the medulla
a coma with meningism but without focal or lateralising signs may be caused by what 3 main things
encephalitis, meningitis and SAH
4 causes of a coma with meningism and focal brainstem or lateralising signs
tumour, haemorrhage, infarction or abscess
what is meningism
neck stiffness, photophobia and a headache
causes of a coma with no meningism of focal/lateralising signs
toxic, metabolic or systemic (hypoxia, alcohol, drugs, hypoglycaemia etc)
what secondary complication of an MI may cause a coma
hypoxia
proportion of comas that are drug+/-alcohol caused
40%
proportion of comas that are due to hypoxia
25%
proportion of comas that are due to a metabolic prbolem
15%
