Disorders of consciousness Flashcards

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1
Q

ARAS input

A

visual, auditory, sensory

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2
Q

arousal

A

overall state of activity

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3
Q

lethargy

A

slight reduction in alertness

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4
Q

obtunation

A

moderate reduction in alertness

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5
Q

delirium

A

sudden disturbance in consciousness and mental function

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6
Q

stupor

A

respond only to vigorous stimuli

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7
Q

altered mental status

A

imprecise term for any of the descriptors

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8
Q

2 main mechanisms of coma

A

diffuse insult to both cerebral hemispheres
disruption on the ARAS in the midbrain and pons

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9
Q

coma characteristics

A

no awareness, no sleep cycle or purposeful behavior

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10
Q

vegetive state characteristics

A

sleep wake cycles only

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11
Q

minimally conscious state

A

sleep wake cycles, partial fluctuating awareness, reproducible purposeful behavior

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12
Q

locked-in syndrome

A

sleep wake cycles, awareness and movement is limited to eye movements

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13
Q

diagnostic workup for disorder of consciousness

A

blood tests, IV access, hook up to monitor, administer oxygen

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14
Q

which things should be checked and treated immediately

A

hypoglycemia: dextrose 50% IV
thiamine for alcoholic
Naloxone for drug overdose

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15
Q

small pupils

A

opioid toxicity and pontine lesion

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16
Q

midsize pupils, unresponsive to light

A

midbrain lesion

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17
Q

maximally dilated pupils

A

drug toxicity- anti-cholinergic overdose

18
Q

mixed and dilated pupils

A

CN III lesion from uncle herniation

19
Q

Decorticate posturing

A

flexor posturing (flex UE, ex LE)
lesion of the internal capsule and rostral cerebral peduncle

20
Q

causes of decorticate posturing

A

brain tumor, stroke, drug use, poisoning, infection or liver failure

21
Q

decerebrate posturing

A

Extensor posturing
midbrain and rostral pons

22
Q

causes of decerebrate posturing

A

can be reversible metabolic dysfunction
hypoglycemia and hepatic encephalopathy

23
Q

causes of abrupt onset unconsciousness

A

SA hemorrhage, brainstem stroke, intercerebral hemorrhage

24
Q

what does papilledema on fundoscopic exam point towards

A

subhyaloid hemorrhage

25
Q

corneal sensitivity bilateral loss

A

large pontine lesion or deep coma

26
Q

corneal sensitivity unilateral loss

A

ipsilateral pons or trigeminal defect

27
Q

positive oculocephalic reflex

A

eyes move opposite the rotation of the head

28
Q

negative oculocephalic reflex

A

eyes stay midline

29
Q

negative oculocephalic reflex points toward

A

severe brainstem dysfunction

30
Q

Cheyne stokes respiration

A

deep breathing alternate with periods of apnea

31
Q

Cheyne stokes respiration meaning

A

bihemispheric or diencephalic disease or metabolic disorders

32
Q

Central neurogenic
hyperventilation meaning

A

lesions of brainstem tegmentum

33
Q

apneustic breathing

A

prominent end-inspiratory pauses

34
Q

apneustic breathing meaning

A

damage at pontine level, basilar artery occlusion

35
Q

ataxic breathing

A

irregular/deep and shallow breathing randomly occurring

36
Q

ataxic breathing means

A

lesions of lower pontine tegmenjtum and medulla

37
Q

Kussmaul breathing

A

deep labored breathing

38
Q

Kussmaul breathing means what

A

severe DKA

39
Q

CT of the head

A

urgent, non-contrast

40
Q

immediate neurosurgical intervention is needed for ____

A

intracranial hemorrhage, brain herniation, structural lesions

41
Q

CT angiogram is used to

A

rule of basilar artery occlusion

42
Q

when is EEG performed

A

suspected non-convulsive status epilepticus