Death, Coma Flashcards
Coma
depression fncs:
of both cerebral hemispheres, ascending arousal systems
Causes: Structural - compressive, destructive
Diffuse intrinsic (epilepsy, infections)
Metabolic
Psych
Locked in syndrome
- damage to caudal pons below arousal
- intact awareness, vertical eye movements, vision - check blinking!
Uncal herniation
cause decreased arousal
Cn 3 palsy - USE THIS TO LOCALIZE
hemiparesis (cerebral peduncle)
cortical blindness (PCAs)
Doll’s eyes test and lesion
- MLF lesion: bilateral INO
- left pontineL 1.5 syndrome
- right lateral pontine gaze paralysis
Pupil size test and lesions
normal:
- parasymp: constricits nd accomodate pupils
- symp: dilates, raise eyebrows, sweat
lesion at uncus: affected side dilated (parasymp)
lesion at midbrain: fixed, midposition (EWnucleus)
lesion at pons: pinpoint (symp)
Glascow Coma Scale
Eye movement: 1 no, 2 open to pain, 3 open to verbal, 4 spon
Motor Response: 1 - no, 2 ext pain, 3 flex pain, 4 withdrw pain, 5 loclizing pain, 6 folows command
Verbal responses: T-intub, 1 no, 2 incomp, 3 inapp, 4 confused, 5 orient
2T - 15
motor signs in coma
- hemiparasis
- flexor
- extended
- cortical
- F: diencephalon
- Ext: midbrain
Clincial crieteria of brain death
- irreversible loss of capacity for consciousness, loss of brainstem fnc, no breathing
- on ventilator
- know etiology
- Absent; gag, cough, spinal, corneal, pupillary, vestibuloocular responses
- Apnea test: no resp effort
- no confounding: shock, hypothermia, metabolic disorders, nerve blockade, intoxications
- ancillary tests for blood flow
Vegetative state
- still breathing spontaneous
- CV stability
- sleep/wake state
- mo-yrs