Coma, PVS & head injury Flashcards
what is the GCS for a coma?
below or equal to 8
if someone is in a coma but has no focal or lateral signs or meningism, what are the likely causes?
metabolic drug/alcohol intoxications systemic infections hyperthermia/hypothermia epilepsy (status epilepticus)
if someone is in a coma and has no focal or lateral signs but has meningism what are the likely causes?
meningitis
encephalitis
sub arachnoid haemorrhage
if someone is in a coma and has lateral and focal brainstem signs but no meningism what are the likely causes?
cerebral tumour cerebral abscess intracranial haemorrhage cerebral infection focal infarct
what factors affect the outcome of a coma?
age depth of coma duration of coma cause of coma certain clinical signs i.e. most important are brainstem reflexes
what cause of stroke has the highest percentage of a good outcome?
metabolic cause
how do you test for brainstem function?
and what nerves etc are they testing?
pupillary reflexes (CN II & III)
corneal reflexes (CN V & VII)
spontaneous eye movements (CN III, IV, VI)
occulocephalic & occulovestibular responses (CN III, IV, VI, VIII)
respiratory pattern (medullary centre)
what is involved in the neurological assessment of a patient in a coma?
GCS
brainstem function
motor reflexes & function
what is locked in syndrome?
totally paralysed below the level of the 3rd cranial nerve
what movements can someone perform in locked in syndrome?
move eyes up and down
blink
constrict pupils (refraction)
alter curvature of the lens (accommodation)
what is the difference between coma and persistant vegetative state?
a coma is a condition where the patient lacks both awareness and wakefulness
a patient in PVS may have their eyes open (be awake) but may not have regained awareness
what is persistant vegetative state?
a state in which the brain stem recovers to a considerable extent but there is no evidence of recovery of cortical function
is there wakefulness in someone in PVS?
yes but they don’t have awareness
damage to hat part of the brain won’t alter consciousness?
focal damage to the cortex doesn’t affect consciousness
what does consciousness depend on?
an intact ascending reticular activating system for arousal
cerebral hemisphere for awareness of our environment
