Consciousness to Coma Flashcards
2 components of consciousness
Arousal and contnet
Consciousness continuum
Clouding - aware of surroudnigns?
Delirium - misperceive stimuli
Stupor - need noxious stimuli
Obtundation - mental turbifity
Reversible causes
Dextrose
Oxygen
Naloxone
Thiamine
Cushing reflex
HTN, bradycardia, and irregular resp…look in posterior cranial fossa
Cerebral cortex
Conscious behavior
SPeech, purposeful movement
Brianstem sensory paths
Sleep-wake cycle
Eye opening
Brainstem motor paths
Reflex limb movements
Decerebrate/decorticate
Midbrain CN 3
Ciliary/extraocular muscles
Pupillary reactivity
Upper pons
CN5/7
Corneal reflex
Lower pons
CN 7
relfex eye movements
Doll’s eyes/caloric respon ses
Medulla
Breathing/blood pressure
SPinal cord
Deep tendon/babinski reflexes
Glasgow coma scale
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
What does each part of glasgow coma scale test
Eye - sensory pathwyas
Motor - brainstem motor paths
Verbal - cerberal cortex
Cheyne-stokes and central neurogenic
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
Apneusis
Cluster breathing
Ataxic breathing
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)
Types of pupils
Small reactive (metabolic or diencephalic) Tectal (large "fixed" with hippus) Hypothalamic damage (ipsilaterla pupillary constriction, ptsosis, anhydrosis) Pons (pinpoint) Midbrain nuclear (fixed at midposition)
EYelids
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
If blinking present
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
Corneal responses
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
Occulocephalic responses
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
COWS responses
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
Decerebrate rigidity
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
Decorticate rigidity
Slow flexion of arm
Adduction in UE
Extensoion, internal roation, and plantar flexion of LE
Lesion in cerebral WM, internal cpasule or thalamus
Diagonal posturing
Flexion of one arm and extensionj of other arm and leg
Supratentorial lesion
Forcefull extneison of UE and weak flexor of LE
Level of vestbiular nucleus at medulla
Flaccidity
Lesion below vestbiular nucleus
