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neuroscience > Coma CC5 > Flashcards

Coma CC5 Flashcards

1
Q

Name an example of a normal alteration of consciousness?

A

sleep

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2
Q

If someone has a coma, you know what locations are impaired?

A

bilateral cortex or reticular activating system

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3
Q

What are the steps of COMA exam?

A
  1. Neuro exam of altered consciousness
  2. vital signs
  3. respiratory pattern
  4. Level of Consciousness
  5. Pupils
  6. Ocular movements
  7. Motor responses
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4
Q

What is cheyne-stokes respiration? Where is the lesion?

A

compressed time frame with waxing and waning character

-disrupted bilateral diencephalon or cortex

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5
Q

What are apneustic respirations? where is the lesion?

A

deep and fairly regular

lesions of midbrain near RAS by colliculus
-cut off voluntary breathing centers

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6
Q

What are ataxic respirations? Where is the lesion?

A

breathing is uncoordinated, but diaphragm is innervated
“breathing from their medulla”

-lesion in pontine tegmentum

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7
Q

What are the four levels of consciousness?

A
  1. normal - no external stim needed
  2. somnolent - external stim–> normal waking
  3. obtunded - external stim–>abnormal waking
  4. COMA - no wakefulness
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8
Q

What are metabolic pupils?

A

small and reactive

-downers

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9
Q

What are pupils like after lesion to diencephalon?

A

small and reactive

-no sympathetic stimulation

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10
Q

What are pupils like after a lesion to the tectum?

A

large and fixed - no pupillary light reaction

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11
Q

What are the pupils like after a lesion to the right oculomotor nerve?

A

Right eye is Dilated and fixed

  • shine light in either eye, right wont constrict
  • shine light in right eye, left will constrict (consensual of right in tact)
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12
Q

What are the pupils like after a lesion to the midbrain?

A

midposition, fixed and in a coma

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13
Q

What are the pupils like after a lesion to the pons?

A

pinpoint pupils

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14
Q

Where is the nuclei of the abducens nerves?

A

Pons

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15
Q

Where is the nuclei of the III cranial nerve?

A

midbrain

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16
Q

What is decorticate posturing?

A

abnormal flexor response of arms with extension of legs —- antigravity muscles

-lesion above the red nucleus

17
Q

What is spastic hemiparesis?

A

disconnection of cortex from motor centers
-lesion above the level of red nucleus
(same as decorticate posturing)

18
Q

What is decerebrate posturing?

A

abnormal extensor response of arm and legs
-antigravity mechanism for quads

-lesions caudal to red nucleus -release of vestibulospinal output

19
Q

If there is a progressive lesion bilaterally in the diencephalons, what is the:

  1. respiratory pattern
  2. pupil status
  3. oculocephalic response
  4. motor response
A
  1. cheyne stokes
  2. small pupils with small range of contraction
  3. normal oculocephalic response, no nystagmus
  4. motionless or decorticate rigidity
20
Q

If there is a progressive downward lesion that hits bilaterally in the midbrain, what is the:

  1. respiratory pattern
  2. pupil status
  3. oculocephalic response
  4. motor response
A
  1. sustained regular hyperventilations
  2. fixed pupils in midposition and irregular shape
  3. dysconjugate oculocephalic response
    - medial rectus isnt functioning
  4. motionless or decerebrate
21
Q

If there is a progressive downward lesion that hits bilaterally in the pons, what is the:

  1. respiratory pattern
  2. pupil status
  3. oculocephalic response
  4. motor response
A
  1. more shallow and rapid, or slow and irregular
  2. pupils at midposition and fixed
  3. no oculocephalic response
  4. no motor response to stimulus, bilateral babinski
22
Q

If there is a progressive downward lesion that hits unilaterally in the diencephalon, what is the:

  1. respiratory pattern
  2. pupil status
  3. oculocephalic response
  4. motor response
A
  1. eupneic with deep sighs or cheyne stokes
  2. small pupils, but react
  3. oculocephalic response is normal
  4. unilateral motor response to noxious orbital roof pressure, unilateral babinski
23
Q

If there is a progressive downward lesion that is in the late third nerve stage, what is the:

  1. respiratory pattern
  2. pupil status
  3. oculocephalic response
  4. motor response
A
  1. regular sustained hyperventilation
  2. no direct pupil response, consensual intact
  3. ipsilateral eye doesnt move medially, contralateral eye retains full lateral movement
  4. decorticate or decerebrate
24
Q

Central hyperventilation indicates a lesion where?

A

midbrain

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