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AIM - The Brain > Consciousness > Flashcards

Consciousness Flashcards

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The Brain flashcards
1
Q

consciousness

A

an active process often defined as awareness of the self and the environment

2 components:
arousal (wakefulness)
awareness (content)

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2
Q

arousal (wakefulness)

A

level of alertness

result of information arising from the reticular activating system

Other structures included: rostral pontine, mesencephalic tegmentum, midline, and intralaminar thalamic nuclei

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3
Q

awareness (content)

A

requires an intact cerebral cortex and its connections to other subcortical structures

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4
Q

cognition

A
  • involves attention, sensation/perception, explicit memory, executive function and motivation
  • depends on cerebral cortical activity
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5
Q

physiological vs. pathological unconsciousness

A

sleep is reversible with stimulation

pathological unconsciousness is due to structural or functional disturbances

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6
Q

ascending reticular activating system (ARAS)

A
  • rostral brainstem tegmentum and diencephalon and associated cortical projections.
  • signals related to level of arousal and awareness pass through the ARAS, are carried to the two thalami bilaterally, and then ascend to the rest of the cortex.
  • signals are important for sleep- wake transitions and attention.
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7
Q

somnolence

A

drowsiness/near-sleep

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8
Q

lethargy

A

extreme fatigue or drowsiness

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9
Q

obtundation

A

mild to moderate reduction in alertness, w/ a lesser interest in environment

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10
Q

stupor

A

condition of deep sleep or similar behavioral unresponsiveness from which subject can be aroused only w/ vigorous and continuous stimulation

responds to VOICE, PAIN

-like obtundation, but to a greater degree

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11
Q

coma

A
  • unresponsive, sleep-like (but no cycles) state lacking arousal/awareness for 1+ hour
  • movements=pathologic or do not exist
  • eyes do not open
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12
Q

encephalopathy

A
  • syndrome of global brain dysfunction

- states of altered consciousness caused by damage or suppression of the ARAS or of both cerebral hemispheres

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13
Q

Persistent Vegetative State:

A

+30days of complete unawareness with no localizing motor activity, no ability to follow commands (cortex NOT functioning)

  • intact circulatory, brainstem, and respiratory function, normal sleep-wake cycles
  • may spontaneously open eyes to stimuli but without recognition.
  • often follows a pd of coma
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14
Q

Non-traumatic vegatative state 1+ month = _____ chance of recovery beyond severe disability.

A

Non-traumatic vegatative state 1+ month = NO chance of recovery beyond severe disability.

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15
Q

Traumatic state 1-6 months = _____ chance of recovery of good-moderate disability.

A

Traumatic state 1-6 months = 25% chance of recovery of good-moderate disability.

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16
Q

Minimally Conscious State (MCS)

A
  • between PVS and normal consciousness
  • can follow simple commands (yes/no responses via gestures or verbally)
  • intelligible verbalization
  • purposeful behavior (rather than reflexive)
17
Q

which type of coma presents w/ NO eye movements

A

subcortical coma

18
Q

brainstem is working but cortex is not –> which disturbance of consciousness?

A

persistent vegetative state

19
Q

After TBI, MCS or PVS has a greater recovery?

A

MCS

20
Q

locked-in syndrome

A

state of selective “de-efferentation” of all 4 extremities and lower CN

  • pt is awake, can hear
  • NO movement and speech
  • vertical eye movements/blinking possible (oculomotor spared)
  • ventral pontine lesion
21
Q

possible sites of lesions that compress the ARAS (compressive, cause coma)

A

cerebral: bilateral subdural hematomas
diencephalon: thalamus (hemorrhage), hypothalamus (tumor)
brainstem: uncal herniation, cerebellum

22
Q

possible sites of lesions that directly damage the ARAS (destructive)

A

cortex (acute anoxia)

subcortical (delayed anoxia)

diencephalon (thalamus infarct)

brainstem (midbrain, pons stroke)

23
Q

multifocal and diffuse disease that may also lead to coma

A
  • Ischemia or hypoxia
  • glucose disorders
  • organ system diseases
  • intoxication
  • ionic or acid/base imbalances
  • thermoregulation disorders -infections
  • cerebral vasculitis
  • other (prion…)
24
Q

how does intracranial HTN lead to altered consciousness?

A

elevated ICP –> decreases global cerebral blood flow –> compartmental changes in pressure –> herniation syndromes –> anatomical distortion of adjacent structures OR compression of vasculature causing infarcts

25
Q

vestibulo-ocular reflex (Doll’s Eyes)

afferent/efferent limbs

A
  • tests VIII, VI, III
  • normally, when head turned, eyes move in opp dir
  • overcome in awake pt

afferent: semicircular canals –> CN VIII
efferent: abducens and oculomotor nuclei to respective contralateral and ipsilateral EOMs

26
Q

caloric reflex testing

A
  • surrogate for doll’s eyes maneuver, performed w/ severe brainstem injuries
  • cold water is irrigated into the external auditory canal, sensed by semicircular canals
  • NOT performed in awake pt (vertigo + vomiting)
27
Q

cold water in L ear to test caloric reflex, what happens?

A

cold water in L ear –> endolymph falls –> convective current (circular movement of endolymph, same thing that happens as if moving head away from stimulus)

decreases rate of CN VIII firing on that side –> eyes turn toward IPSILATERAL ear

if awake to correct –> fast-paced nystagmus back to midline (twd CONTRALATERAL ear)

28
Q

Glasgow Coma Score

A

objective score with three categories

  1. eye opening
  2. verbal response
  3. motor response

best score: fifteen
worst score: three (comatose, completely unresponsive)

severe brain injury <8-9

moderate with 8 or 9-12

minor with greater or equal to 13

29
Q

FOUR score

A

Full Outline of UnResponsiveness

  • incorporates respiration and brainstem reflexes in generating Glasgow Coma score

1) eye response
2) motor response
3) brainstem reflexes
4) respiration

30
Q

HTN and Bradycardia set off warning bells for…

A

INTRACRANIAL HTN

31
Q

brain death

A
  • total cessation of all brain and brainstem function with a known, irreversible, demonstrable cause
  • NO drug intoxication, no severe overlying condition, no hypothermia
  • Failed apnea test (absence of respiration with PaCO2 > 60mmHg)
  • Absent reflexes, absent response to pain
32
Q

confirmatory tests for brain death

A

EEG (electro cerebralsilence)
Angiography (no filling at level of circle of Willis)
Nuclear flow study (SPECT. No isotope uptake in brain)
Transcranial Doppler (no blood flow)

not necessary to do; only if severe facial trauma, drug intoxication, severe metabolic disturbances, apnea test cannot be performed safely

33
Q

non-brain death causes of fixed pupils

A
  • Anti-cholinergic drugs
  • Tri-cyclic antidepressants
  • Neuromuscular blocking agents
  • Pre-existing eye disease
34
Q

non-brain death causes of lack of vestibulocular reflexes

A

Ototoxic agents
Vestibular suppression
Pre-existing disease
Basilar skull fracture

35
Q

non-brain death causes of lack of no motor activity

A
  • Neuromuscular blocking agents
  • Locked in state
  • Sedative drugs
36
Q

non-brain death causes of lack of isoelectric EEG

A 
Sedative drugs
Anoxia
Hypothermia
Encephalitis
Trauma
37
Q

poor prognosis signs in post-anoxic coma:

  • absent pupillary responses, day ___
  • absent corneal responses, day ___
  • absent motor responses, day ___
  • absent somatosensory evoked potentials in week ___
A

poor prognosis signs in post-anoxic coma:

  • absent pupillary responses, DAY 1
  • absent corneal responses, DAY 1
  • absent motor responses, DAY 3
  • absent somatosensory evoked potentials in WEEK 1
38
Q

brain death cardinal features

A
  • unresponsive, comatose
  • no brainstem reflexes (pupillary light, corneal, vestibuloocular, gag, cough)
  • apnea test

AIM - The Brain (105 decks)

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