Consciousness to Coma

Question 1

2 components of consciousness

Answer 1

Arousal and contnet

Question 2

Consciousness continuum

Answer 2

Clouding - aware of surroudnigns?
Delirium - misperceive stimuli
Stupor - need noxious stimuli
Obtundation - mental turbifity

Question 3

Reversible causes

Answer 3

Dextrose
Oxygen
Naloxone
Thiamine

Question 4

Cushing reflex

Answer 4

HTN, bradycardia, and irregular resp…look in posterior cranial fossa

Question 5

Cerebral cortex

Answer 5

Conscious behavior

SPeech, purposeful movement

Question 6

Brianstem sensory paths

Answer 6

Sleep-wake cycle

Eye opening

Question 7

Brainstem motor paths

Answer 7

Reflex limb movements

Decerebrate/decorticate

Question 8

Midbrain CN 3

Answer 8

Ciliary/extraocular muscles

Pupillary reactivity

Question 9

Upper pons

Answer 9

CN5/7

Corneal reflex

Question 10

Lower pons

Answer 10

CN 7

relfex eye movements

Doll’s eyes/caloric respon ses

Question 11

Medulla

Answer 11

Breathing/blood pressure

Question 12

SPinal cord

Answer 12

Deep tendon/babinski reflexes

Question 13

Glasgow coma scale

Answer 13

Eye - spontaneous, to voice, to pain, none

Motor - obey commands, localize pain (use extremeity to releive pain and facial grimace), withdraw to pain (hip or shoulder adduction), felxion to pain, extension to pain, none

Verbal - orientaed, confused, inappropriate, incomprehensible, none

Question 14

What does each part of glasgow coma scale test

Answer 14

Eye - sensory pathwyas

Motor - brainstem motor paths

Verbal - cerberal cortex

Question 15

Cheyne-stokes and central neurogenic

Answer 15

1) oscillates between hyper and hypoventilation…B/l hemispheric or diencephalic
2) Rapid breathing (40-70)…central tegmental pontine lesion ventral to aqueduct or 4th ventricle

Question 16

Apneusis
Cluster breathing
Ataxic breathing

Answer 16

Apneusis - prolonged inspiratory gasp with pause (dorsolateral lower half of pons)

Irregular periodic respirations (High medullary)

Irregular in rate and rhythm (RF of dorsomedial medulla)

Question 17

Types of pupils

Answer 17

Small reactive (metabolic or diencephalic)
Tectal (large "fixed" with hippus)
Hypothalamic damage (ipsilaterla pupillary constriction, ptsosis, anhydrosis)
Pons (pinpoint)
Midbrain nuclear (fixed at midposition)

Question 18

EYelids

Answer 18

Unconscious patient will close lids gradually
Absence of tone or failure to close suggests ipsilateral facial weakness
Strong resitance to opening could be voluntayr or blepharospadsm

Question 19

If blinking present

Answer 19

Spontaneous - pontine RF in tact
To light or sound says that special sesnory affarents in tact
Absnece of one side implies CN 7 dysfunction
BIlateral absence suggests dysfunction of RF

Question 20

Corneal responses

Answer 20

Positive response implies normal fun ction from CN3 to CN7

Damage above CN5 means no Bell’s phenomenon but jaw may deviate to oppositive side

Positive Bell’s but absnet eye clousre means CN7

Question 21

Occulocephalic responses

Answer 21

No movement in either - branstem lesion

Eyes in one direction but not other - B/l labrynth dysfunction

One eye abducts but other does not adduct - drugs, anesthesia, PPRF, 3rd, 4th, INO

Question 22

COWS responses

Answer 22

Normal - slow fast towards ear and fast away

Unconcious but okay BS…deviation to irrgated ear with no nystagmus

Midbrain or pontine lesion - neither eye will adduct

Lower BS lesion - no response

Question 23

Decerebrate rigidity

Answer 23

Opisthotonus with teeth clenched
UEs extended
Adduct and hyperpronated
LE stiffly extended and feet plantar flexed

Lesion at midbrianand upper pons but also maybe metabolic

Question 24

Decorticate rigidity

Answer 24

Slow flexion of arm
Adduction in UE
Extensoion, internal roation, and plantar flexion of LE

Lesion in cerebral WM, internal cpasule or thalamus

Question 25

Diagonal posturing

Answer 25

Flexion of one arm and extensionj of other arm and leg

Supratentorial lesion

Question 26

Forcefull extneison of UE and weak flexor of LE

Answer 26

Level of vestbiular nucleus at medulla

Question 27

Flaccidity

Answer 27

Lesion below vestbiular nucleus