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Block 6 ( week 1) incomplete > consciousness and brain activity lecture > Flashcards

consciousness and brain activity lecture Flashcards

1
Q

what is consciousness?

A

consciousness is a state of being aware of and responsive to ones surroundings.

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2
Q

What are two ways in which the levels of consciousness can be characterized?

A

consciousness can be characterized by awareness and vigilance.

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3
Q

what are the 14 levels of consciousness?

A
  1. fully conscious
  2. clouding of consciousness
  3. confusional state
  4. delirium
  5. lethargy
  6. obtundation
  7. stupor –> stupor. A state of severely reduced consciousness, short of COMA, from which the affected person can be briefly aroused only by painful stimulation.
  8. hypersomnia
  9. minimally responsive
  10. unresponsive wakefulness syndrome
  11. akinetic mutism
  12. locked-in syndrome
    `3. coma
  13. brain death
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4
Q

What is locked-in syndrome?

A

When a patient has awareness
normal sleep wake cycle
meaningful behavior (eye movement) but is isolated due to facial and body paralysis.

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5
Q

What is minimally conscious state?

A

Patient has intermittent periods of awareness and wakefulness and displays some meaningful behavior.

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6
Q

what is unresponsive wakefulness syndrome?

A

The patient has sleep-wake cycles, but lacks awareness; only reflexive and non-purposeful behavior.

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7
Q

what is a chronic coma?

A

when a patient lacks awareness and sleep-wake cycles; only displays reflexive behaviour

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8
Q

what is brain death?

A

patient lacks awareness, sleep-wake cycles, and brain-mediated reflexive behaviour.

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9
Q

what type of brain imagining test can be done to view areas of the brain and their consciousness activity?

A

PET scanning. PET scanning measures brain metabolism of glucose.

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10
Q

what is a normal loss of consciousness?

A

sleep

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11
Q

what are examples of abnormal loss of consciousness?

A
  • Coma
  • Anaethesia
  • Unresponsive wakefulness syndrome
    and others such as locked in syndrome
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12
Q

is PET scanning invasive or non invasive and why?

A

PET scanning is invasive as it involves the injection of radioactive tracers. They make their way up to the brain and get taken up and that is how we get imaging.

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13
Q

what is another way of talking in brain imaging ?

A

FMRI imaging can be done. It measure the level of oxygenated and deoxygenated blood flowing through the brain. The more oxygen flowing through the region the more active it is. The more CO2 the less.

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14
Q

what is the most common cause of loss of consciousness worldwide?

A

malaria is the most common cause of consciousness worldwide.

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15
Q

what are the 3 the most common cause of loss of consciousness in the uk?

A

Stroke ( haemorrhage/ thrombosis/ embolus)
cardiovascular
diabetes

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16
Q

What’s the first thing you do when you meet an unconscious patient?

A
  • ABC- is immediate intervention needed ( if yes start cpr)
  • history- find out what happened from family of friend.
  • screening- to help clinically assess their behaviour.
  • Glasgow coma scale
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17
Q

what is the Glasgow coma scale?

A

The Glasgow coma scale is a reliable and objective measure of consciousness.

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18
Q

what is assessed in the Glasgow coma scale and what score is given?

A
  • Eye opening (1-4)
  • verbal response (1-5)
  • Motor response (1-6)
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19
Q

what score should a fully conscious person get?

A

A fully conscious person should get a score of 15.

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20
Q

what score would a person with a mild head injury get on the glasgow coma scale?

A

13-15

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21
Q

what score would a person with moderate head injury get on the glasgow coma scale?

A

9-12

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22
Q

what score would a severe head injury get on the glasgow coma scale?

A

3-8

fact- about 60 percent of patients die if they have had a score of 8 for more than 6 hours.

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23
Q

How would you know if a patient is in a Coma?

A 
E= They will not be opening their eyes
V= They wont utter understandable words
M = They will not be obeying commands
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24
Q

What is Brainstem Death? (ignoreee)

A

unconscious and fail to respond to outside stimulation.
heartbeat and breathing can only be maintained using a ventilator.
clear evidence that serious brain damage has occurred and it cant be cured.

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25
Q

what is the definition of death?

A

irreversible loss of consciousness combined with irreversible loss of the capacity to breath.

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26
Q

what are the criteria’s to confirm death?

A
  • cause of irreversible brain damage
  • patient is deeply unresponsive and requires artificial ventilation
  • not caused by depressant drugs
  • not caused by primary hypothermia
  • not caused by potentially reversible circulatory, metabolic and endocrine disturbances
  • not caused by potentially reversible causes of apnoea (dependance on ventilator) such as muscle relaxants
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27
Q

how is brainstem death tested?

A

brainstem death is tested by testing the cranial nerve reflexes. cranial nerves all innervate the brainstem so death leads to their loss of function.
for instance shining a torch in the eyes.

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28
Q

why are the brain stem areas essential for consciousness?

A

The brainstem is important for consciousness as it has the reticular activating system ( RAS).
The RAS communicates with the cerebral cortex- The cerebral cortex is important for many attributes of consciousness.

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29
Q

What is the reticular activating system?

A

The reticular activating system is a collection of nuclei found throughout the midbrain and extends into the hindbrain and the spinal cord.

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30
Q

How many nuclei does the RAS include?

A

The RAS has 4 principal sets of nuclei.

and these 4 sends outputs to many parts of the CNS.

31
Q

What are the 4 principle nuclei in the reticular activating system?

A
  • Locus Coeruleus
  • Ralph nuclei
  • Ventral tegmental nuclei
  • Cholinergic nuclei
32
Q

What can be inferred from the nuclei name locus coeruleus?

A

In Latin the name locus coeruleus means blue spot. The locus coeruleus is given this name as its a pigmented collection of cells.
It’s pigmented because the locus coeruleus contains melanin which gives it, its pigmented colour.

33
Q

What neurotransmitter is released by the locus coeruleus?

A

Noradrenaline aka norepinephrine

34
Q

Where is the locus coeruleus located?

A

The Locus coreuleus is located in the pons.

35
Q

What activates the locus coeruleus?

A

The locus coeruleus is activated during by a novel stimuli and its most active during states of arousal.

36
Q

When is the locus coeruleus hypoactive?

A

The locus coeruleus is hypoactive in depressive patients.

37
Q

What is the consequence of the locus coeruleus being removed?

A

If removed you get rid of REM( Rapid eye movements) - which is important for sleep wake cycles.

38
Q

What are the second most important nuclei in the reticular activating system?

A

The Raphe nuclei

39
Q

Where is the Raphe nuclei located?

A

Located higher up in the pons, midbrain and medulla.

40
Q

When is the Raphe nuclei active?

A

The Raphe nuclei are active during wakefulness

41
Q

What neurotransmitter is released by the Raphe nuclei?

A

Serotonin (5-HT) is the neurotransmitter released

42
Q

What area does the Raphe nuclei project to?

A

The Raphe Nuclei projects to large areas of the central nervous system.

43
Q

Where is the ventral tegmental nuclei located?

A

The ventral tegmental nuclei is located in the ventral areas of the midbrain.

44
Q

Where does the ventral tegmental area nuclei mainly project?

A

The ventral tegmental nuclei projects into the frontal cortex and lambic system.

45
Q

Whats the function of the ventral tegmental nuclei ?

A

It modulates frontal activity and reinforces pleasurable sensations. Therefore this area is said to have involvement in drug addictions.

46
Q

What neurotransmitter is released by the ventral tegmental nuclei?

A

Dopamine neurotransmitter is released.

47
Q

The cholinergic nuclei consists of two clusters of nuclei, what are they and their function ?

A
  • The basal forebrain nuclei—>projects to all cortical areas
  • Dorsolateral pontine nuclei—> located in the brain stem. It’s active during states of arousal, contribute to synaptic plasticity , involved in learning and memory.
48
Q

What happens if theres damage to the dorsolateral pontine nuclei which is part of the cholinergic Nuclei ?

A

Damage to the dorsolateral pontine nuclei can contribute to dementia.

49
Q

What neurotransmitter is released by the cholinergic Nuclei?

A

Acetylcholine

50
Q

Besides the 4 principle areas of the reticular activating system there are two other areas involved in consciousness and sleep, what are they?

A

The anterior hypothalamus and The posterior hypothalamus.

51
Q

What neurotransmitter is released by the anterior hypothalamus?

A

The neurotransmitter released is GABA.

52
Q

What neurotransmitter is released by the posterior hypothalamus?

A

Neurotransmitter histamine is released

53
Q

If theres damage to the anterior hypothalamus what can occur?

A

Damage to the area is associated with insomnia.

54
Q

What can damage to the posterior hypothalamus cause?

A

This can cause encephalitic damage which is associated with too much sleep.

55
Q

What can occur as a result of damage to the reticular activating system?

A

Loss of consciousness and coma

56
Q

The Sleep wake cycle is associated with three main areas what are they?

A
  • cerebral cortex
  • Reticular thalamic nuclei ( not the same as the RAS)
  • Thalamus
57
Q

Explain what happens when your awake using the 3 main areas associated with sleep?

A

When your awake- cholinergic fibres ascending from the midbrain fire more acetylcholine - this leads to the sensory thalamus being facilitated, the reticular nucleus being inhibited and the thalamocortical neuornes becoming activated. (The thalamuocrotical neurones go to the cerebral cortex.)

58
Q

What is the EEG like for someone who’s awake?

A

The EEG is desynchronous.

59
Q

What happens when a person is asleep, explain using the 3 main areas associated with sleep?

A

When a person is a sleep the cholinergic fibres that ascend from the midbrain fire less acetylcholine - this results in the sensory thalamus being inhibited , the reticular thalamus becoming activated and the thalamocortical neurones slowing down in activity. (The thalamuocrotical neurones go to the cerebral cortex.)

60
Q

What is the EEG like for someone who’s alseep?

A

The EEG is synchronous

61
Q

What is REM?

A

REM stands for Rapid Eye Movements.

62
Q

What is the EGG like for REM SLEEP.

A

The EGG for rem sleep is desynchronised.

63
Q

What is REM also known as and name an effect that occurs during rem sleep ?

A

REM is also known as Paradoxical sleep and during rem sleep theres a loss of muscle tone.

64
Q

How much of the uk population suffers from some form of sleep disorder?

A

25 % of the uk population suffers from some form of sleep disorder.

65
Q

What are the most common form of sleep disorders ?

A
  • Snoring
  • insomnia
  • sleep walking —> 15% in children and 2.5% in adults
66
Q

What is the least common type of sleep disorder?

A

Hypersomnia (when you sleep too much)

67
Q

What is sleep apnoea ?

A

Sleep apnoea is the temporary cessation of breathing

68
Q

What two issues may also lead to insomnia ?

A

Enuresis ( bladder control)

Epilepsy (neuronal seizures )

69
Q

What is narcolepsy?

A

Spontaneous transition form wakefulness to REM sleep and it can be caused by alterations in orexin levels.

70
Q

Short term concequences of sleep?

A

Slower reflexes, memory disorders, muscle fatigue

71
Q

Long term consequences of sleep ?

A

Diabetes, obesity, high blood pressure and cardiovascular disease

72
Q

What is the circadian rhythm

A

The circadian Rey them is the internal body clock which regulates the sleep wake cycle and can be regulated by sunlight and genetically.

73
Q

Where is the circadian rhythm located?

A

The retina neurones project to the suprachiasmatic nucleus ( SCN) of the hypothalamus( where its mainly located). The SCN innervates multiple nearby structures which set up a biological clock.

  • The SCN. Secretes neuropeptide vasopressin local to the brain
  • SCN also modulates the pineal glad which releases melatonin.
74
Q

Which gland releases melatonin and whats the function of melatonin?

A

Pineal gland and melatonin is a neurohormone which is a sleep promoting chemical.

Block 6 ( week 1) incomplete (5 decks)

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