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B3 CTB > Consciousness > Flashcards

Consciousness Flashcards

1
Q

What are the two key A’s that make up a normal state of consciousness?

A
  • Aware
  • Awake
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2
Q

What part of the brain establishes awareness?

A

The cerebral cortex - it is responsible for the state of awareness and for interaction with the environment

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3
Q

Define ‘Wakefulness’

A

A state of eyes open and active motor arousal

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4
Q

What is wakefulness dependent on?

A

Being alert and attentive

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5
Q

What part of the brain dictates alertness?

A

Controlled by the upper brainstem reticular formation

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6
Q

Which part(s) of the brain regulate attentiveness?

A

Controlled by the limbic system and frontoparietal association areas - responsible for affect, mood, attention and motivation

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7
Q

What is restless leg syndrome?

A

A disorder causing uncontrollable, erratic movemetns or sensations in the legs that normally occur during sleep onset and during the night

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8
Q

In what state does a patient show reduced movement and consciousness, which can be readily reversed by external stimulation?

A

Sleep

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9
Q

How does the thalamus influence states of consciousness?

A

Close connections between the thalamus and the cerebral cortex ensure the maintenance of consciousness and particularly the modulation of arousal

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10
Q

How does the hypothalamus influence states of consciousness?

A

It is linked to the brain stem and to the basal forebrain and is involved in the sleep-wake transition and in maintaining the awake state

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11
Q

How does the basal forebrain influence states of consicousness?

A

It receives cholinergic projections from the ARAS and plays a major role in supporting arousal during REM sleep

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12
Q

How does the amygdala influence states of consciousness?

A

The amygdala is involved in emotional arousal and modulates the threshold for awareness of emotional stimuli

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13
Q

When controlling arousal and consciousness levels, what nuclei are activated in the brainstem reticular formation?

A
  • Raphe nuclei (release 5HT)
  • Locus coeruleus (release NA)
  • Pendunculopontine nucleus (release ACh)
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14
Q

Outline the basic principles regarding control of arousal

A

Activation of certain nuclei in the brainstem reticular formation allows or suppresses flow to the thalamus (and hypothalamus). If information flow is reduced, there is nothing to process in the cortex and limbic system and the autonomic nervous system remains passive, so consciousness is reduced. If information flow is high, sensory information can enter, movement can be initiated and the autonomic nervous system is active, giving a high level of awareness and wakefulness

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15
Q

What is the reticular formation (RF)?

A

The reticular formation is a mix of cells, nuclei and networks that lie within the brainstem and extends to the upper cervical regions of the spinal cord

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16
Q

What is the function of the reticular formation?

A

The RF plays a significant role in the control of arousal levels, or alertness, and consciousness

17
Q

What are the two main tracts of the reticular formation?

A
  • Ascending Reticular Activating System (ARAS)
  • Descending Reticulospinal tracts
18
Q

What is the function of the 2 tracts of the reticular formation?

A

ARAS - arousal and alertness

Descending reticulospinal tracts - control of movement

19
Q

What are the two main scales used to measure consciousness in the clinic?

A
  • Glasgow Coma Scale/Score
  • AVPU
20
Q

The best performance in what three elements makes up the GCS?

A
  • Eye
  • Verbal
  • Motor
21
Q

What does the AVPU scale measure?

A

A - Alert and orientated in place/time/person

V - Responsiveness to verbal stimulation

P - Responsive to pain

U - Unresponsive

22
Q

Give examples of disorders of consciousness

A
  • (Persistent) Vegetative state
  • Coma
  • ‘Locked in’ syndrome
  • Minimally conscious state
23
Q

What regions of the brain are usually damaged in disorders involved in consciousness?

A
  • Bilateral damage to the reticular formation
  • Bilateral lesions to intralaminar thalamic nuclei
  • Bilateral involvement of cerebral hemispheres
  • Major involvement of dominant hemisphere
  • Generalised depression of nervous system
24
Q

What are the classes of activity frequencies in an EEG?

A
  • Alpha (8-13Hz)
  • Beta (>14Hz)
  • Gamma (40Hz)
  • Delta (<3.5Hz)
  • Theta (4-7Hz)

Delta frequency is the slowest, associated with deep sleep and coma

25
Q

How does the patient present in a vegetative state?

A

The patient is awake, ie. eyes are open and move around and sleep-awake cycles are present, but awareness is absent. Meaningful response to verbal command or pain is absent and the EEG contains rhythmic activity resembling sleep cycles

26
Q

What part of the brain is damaged in a vegetative state?

A

The reticular formation is intact but the cerebral cortex is non-functional

27
Q

How does the patient present in a coma?

A

The patient is unresponsive and unrousable. Meaningful response to stimulation is absent and the EEG contains slow, rhythmic activity resembling those of the deep sleep cycles. Refleces are also greatly reduced. Coma is indicated by GCS score of 8 or less

28
Q

Damage to which parts of the brain usually results in Locked-in syndrome?

A

Usually resulting from damage to the ventral pons, involving corticobulbar and corticospinal tracts

29
Q

How does the patient present in locked-in syndrome?

A

In LIS sensation, reticular formation and cortical function are intact. The patient is fully conscious, awake and aware, however, motor function is absent meaning that consciousness cannot be communicated. Sometimes vertical eye movements and eyelid elevation may be spared, enabling communication

30
Q

How does the patient present with a minimally conscious state?

A

The patients exhibit inconsistent, discernable periods of consciousness where they may respond to command, verbalise, or you may notice visual pursuit (where the eyes follow movement). This may be temporary or permanent, but overall prognosis is more favourable than that of vegetative state

31
Q

Put REM sleep, light sleep, conscious, locked in, vegetative state, sleepwalking, coma and general anaesthesia in the correct place on a ‘awareness vs wakefulness’ graph

A
32
Q

What are some disturbances of consciousness?

A

B3 CTB (13 decks)

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