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Neuroanatomy > Consciousness (Lecture 19) > Flashcards

Consciousness (Lecture 19) Flashcards

1
Q

4 major components of brainstem

A

cranial nerve nuclei & related structures
long tracts
cerebellar circuitry
reticular formation and related structures

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2
Q

long tracts

A

dorsal column medial lemniscal pathway
lateral corticospinal tract
spinothalamic

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3
Q

clinical consequences of damage to CN nuclei and related structures

A

cranial nerve abnormalities

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4
Q

clinical consequences of damage to long tracts

A

hemiparesis and/or hemianesthesia

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5
Q

clinical consequences of damage to cerebellar circuitry

A

ataxia

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6
Q

clinical consequences of damage to reticular formation and related structures

A

impaired level of consciousness

impairment in autonomic functions (BP, HR)

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7
Q

what is the reticular formation

A

core of cell bodies loosely grouped into nuclei that run throughout the entire length of the brainstem tegmentum (above the basis)

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8
Q

function of reticular formation

A

rostral 1/2: maintenance of alert, consciousl state in the cerebrum
caudal 1/2: autonomic reflexes (HR, BP, respiration, digestion), motor (origin of reticulospinal tract), reflexes involving the head (coughing, sneezing, swallowing, sucking, etc)

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9
Q

where is rostral 1/2 of reticular formation found

A

midbrain and rostral pons

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10
Q

where caudal 1/2 of reticular formation found

A

caudal pons and medulla; continuous with grey matter of spinal cord

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11
Q

purpose of reticular activating system

A

sends info from pontomesencephalic reticular formation to the thalamus and finally the cerebral cortex

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12
Q

requirements of consciousness

A

alertness (RAS)
attention (RAS, limbic system, frontal & parietal lobes)
awareness of surroundings (primary sensory cortices and sensory association cortex)

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13
Q

Coma

A

unarousable unresponsiveness

  • pt lies with eyes closed
  • brainstem reflexes still present
  • no sleep wake cycles
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14
Q

brainstem reflexes

A 
blink to threat
pupillary light response
oculocephalic reflex
corneal reflex
gag reflex
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15
Q

how to test blink to threat (CN II, VII)

A

hold eyes open and come toward pt with hand. both eyes should blink

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16
Q

how to test pupillary light response (CN II, III)

A

shine light in eye, pupil constricts

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17
Q

how to test oculocephalic reflex (CN VIII, III, VI)

A

hold eyes open, turn head to left, eyes should move right

18
Q

how to test corneal reflex (CN V, VII)

A

touch cornea with wisp of cotton, both eyes should blink

19
Q

how to test gag reflex (CN IX, X)

A

touch back of throat with tongue depressor, pt should gag

20
Q

continuum between consciousness and coma

A 
awake and alert
drowsy
stuporous
comatose
brain death
21
Q

glasgow coma scale

A

helps determine progonsis in TBI, measures level of consciousness

22
Q

highest possible score on glasgow coma scale

A

15

23
Q

worst possible score on glasgow coma scale

A

3

24
Q

what score on the glasgow coma scale indicates a good prognosis

A

8 or higher

25
Q

bilateral damage to these structures leads to a permanent comatose state

A

cerebral hemispheres
medial aspect of thalami bilaterally
reticular formation of the pons and midbrain

26
Q

how to perform neurologic exam with someone with decreased level of consciousness

A

cranial nerve reflexes
observe for motor activity
reflexes
response to pain (sternal rub, nail bed pressure)

27
Q

decorticate posture

A

LE extended, UE flexed

rubrospinal tract

28
Q

decerebrate posture

A

UE and LE ext

reticulospinal tract/vestibulospinal tract

29
Q

most common general cause of decreased level of consciousness

A

bilateral cerebral hemisphere dysfunction (due to trauma or toxic/metabolic causes)

30
Q

what can cause bilateral cerebral hemisphere dysfunction

A 
medications
illicit drugs
liver failure
kidney failure
hypoxia
trauma
31
Q

why do pts with a decreased LOC often require an imaging study of the brain

A

determine if there is anything that can be fixed

32
Q 
Which of the following are present in brain death?
purposeful response to stimuli
sleep-wake cycles
cranial nerve reflexes
cortical electrical activity
cortical blood flow
A 
purposeful response to stimuli- no
sleep-wake cycles- no 
cranial nerve reflexes- no
cortical electrical activity- no
cortical blood flow- no
33
Q 
Which of the following are present in coma
purposeful response to stimuli
sleep-wake cycles
cranial nerve reflexes
cortical electrical activity
cortical blood flow
A 
purposeful response to stimuli- no
sleep-wake cycles- no
cranial nerve reflexes- yes
cortical electrical activity-abnormal
cortical blood flow-yes
34
Q 
Which of the following are present in persistent vegetative state?
purposeful response to stimuli
sleep-wake cycles
cranial nerve reflexes
cortical electrical activity
cortical blood flow
A 
purposeful response to stimuli- no
sleep-wake cycles- yes
cranial nerve reflexes- yes
cortical electrical activity- yes
cortical blood flow- yes
35
Q 
Which of the following are present in minimally conscious state
purposeful response to stimuli
sleep-wake cycles
cranial nerve reflexes
cortical electrical activity
cortical blood flow
A 
purposeful response to stimuli- inconsistent
sleep-wake cycles- yes
cranial nerve reflexes- some
cortical electrical activity- yes
cortical blood flow- yes
36
Q

criteria for brain death

A 
no purposeful response to painful stimuli
no CN reflexed
no spontaneous respirations
no reversible cause for coma
EEG or angiogram
2 separate exams required
37
Q

difference between persistent vegetative state and minimally conscious state

A

they are the same except minimally conscious state my intermittently and inconsistently perform any of the following:

  • visual tracking
  • follow simple commands
  • signal yes/no
  • intelligible verbalizations
  • restricted purposeful behavior
38
Q

what causes locked-in syndrome

A

bilateral damage to basis of pons (typically bilateral infarct)

39
Q

symptoms of brain ischemia

A
  • face motor/sensory loss on one side and body motor/sensory loss on the other side
  • eye movement abnormalities
  • pupillary abnormalities
  • nystagmus
40
Q

lateral medullary syndrome caused by

A

PICA thrombosis

Neuroanatomy (20 decks)

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