disorders of consciousness and death Flashcards
exam 1
arousal (wakefulness) requires the
ascending reticular activating system
awareness (content) requires
cerebral cortex and its connections to the subcortical structures
An active process often defined as the state of awareness of the self and the environment
consciouseness
loss consciousness is always pathological
nope; it can be normal as part of the sleep-wake cycle
state of drowsiness or near-sleep
somnolence
extreme fatigue or drowsiness
lethargy
syndrome of global brain dysfunction
encephalopathy
encephalopathy Caused by damage or suppression of the
brainstem ARAS or of both cerebral hemispheres
is the sleep-wake cycle absent in people on a coma?
yep
unarouseable unresponsiveness
coma
apallic syndrome
persistent vegetative state
State of complete unawareness in which the patient may open eyes spontaneously or to verbal stimuli, but without recognition of the environment
PVS
lights on but no one is home
PVS
PVS unlike coma is associated with sleep-wake cycles
yep
when to dx. PVS?
not before one month for non-traumatic and before 1 yr after traumatic
prognosis for PVS poor?
yea; generally adults have a 50% of recovery while children have a 60% from PVS w/in 6 months
Minimally conscious state is between
PVS and normal
MCS have a better prognosis than PVS
yea
Locked in syndrome typically caused by a
pontine infarction
can also be caused by:
- ALS
- Guillain Barre
- MS
- snake bites
intact occulomot system but otherwise complete paralysis
locked in syndrome
central pontine myelinolysis is caused
by a dymyealination in the pons
- can cause Locked in syndrome
what chemoreceptors are spared in locked in syndrome leading to intact respiratory function
ventral medulla
what other features are left intact with locked in syndrome
RAS and Hearing
Directly compressing the ascending arousal system or distorting brain tissue (shift) so it secondarily compresses components of the ascending arousal system.
compressive lesions
Directly cause damage to the ascending arousal system through tumor, hemorrhage, stroke, trauma and infection
destructive lesions
multifocal, diffuse disease causing coma (just name a few)
- ischemia, hypoxia
- glucose disorders
Doll’s eyes afferent and efferent
afferent: CN 8
Efferent: CN 6 and 3
Caloric reflex afferent and effect
what relfex is this?
afferent: CN 8
efferent: CN 3, 6, 4
cold water in ear and to see if head/eyes turns to the ipsilateral
nystagmus in contralateral in caloric reflex?
normal
hypertension and Bradycardia should be setting off warning bells for
intracranial hypertension
FOUR
dull outline of unresponsivenss
score of 16
Poor prognostic signs in post-anoxic coma
Absent pupillary responses = _____
Absent corneal respons= ____
Absent motor responses= ____
Absent Somatosensory Evoked Potentia= ____
Absent pupillary responses, Day 1
Absent corneal responses, Day 1
Absent motor responses, Day 3
Absent Somatosensory Evoked Potentials within the first week
sepsite sophisticated techniques is TIME still the most uselful tool to prognosticate?
yes
determination of Death by
neurologic criteria
Brain death determined by what criteria?
- total cessation of hemispheric and brainstem neuronal functioning
- irreversible brain injury
cardinal features of brain death
- unresponsive
- no brainstem reflexes
- apnea test; absence of respiratory reflex
brain death ancillary testing
- cerebral blood flow
- EEG
- ultrasound
- nuclear flow study SPECT- no uptake of isotope in the brain
