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Neuro > Disorders of consciousness and PTA > Flashcards

Disorders of consciousness and PTA Flashcards

1
Q

What are the MOI for disorders of consciousness?

A

Traumatic brain injury
Non-traumatic/neuronal injury
–> acute hypoxic-ischemic neuronal injury (cardiac arrest, stroke, meningoencephalitis)

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2
Q

What is the annual incidence of vegetative state Dx in the US?

A

4200

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3
Q

What is the incidence rate of minimal conscious state?

A

Unknown due to there being no diagnostic code in the international classification of diseases

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4
Q

Post-traumatic cases resulting in vegetative state has a (better/worse) prognosis than non-traumatic cases resulting in vegetative state.

A

better prognosis

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5
Q

It is believed that ___% of cases have misdiagnosis when the patient was actually minimally conscious.

A

40%

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6
Q

What signals are lost with coma?

A

functioning of cortex and reticular systems

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7
Q

How long does a coma normally last?

A

2 weeks… rarely 2-4 weeks.

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8
Q

(true/false) There is evidence of sleep/wake cycles on EEG when a patient is in a coma

A

FALSE (there is not)

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9
Q

(true/false) Behavioral responses with a coma consist of reflex activity

A

true

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10
Q

(true/false) The autonomic system is preserved in vegetative state.

A

true

–> variable preservation of CN and spinal reflexes

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11
Q

“wakeful unawareness”

A

vegetative state

–> no evidence of sustained, reproducible, purposeful, or voluntary behavioral responses to visual, auditory, tactile, or noxious stimuli

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12
Q

(true/false) A patient in vegetative state has periodic episodes of eye opening

A

true

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13
Q

(true/false) A patient in vegetative state does not experience B/B incontinence

A

false

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14
Q

definition: “A condition of severely altered consciousness in which minimal, but definite behavioral evidence of self or environmental awareness is demonstrated”

A

minimally conscious state

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15
Q

How does MCS differ from a coma and vegetative state?

A

has a presence of specific behavioral manifestations of consciousness; behaviors occur inconsistently but can be differentiated between reflex and random behavior.

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16
Q

What marks a person of being out of a minimally conscious state?

A

Recovery of the capacity to communicate or interact consistently with the environment (functional object use of 2 common articles)

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17
Q

What are the neuropathologies of a coma?

A

Hemispheric: bilateral diffuse cortical or subcortical white matter lesions

Brainstem injury: focal lesions of the midbrain or rostral pons

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18
Q

What is the neuropathology of vegetative state?

A

moderate to severe ischemic damage involving the thalamus and arterial watershed areas

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19
Q

What diagnostic imaging can demonstrate preserved ability to process meaningful information where behavioral evidence is not present for a patient in a vegetative state?

A

PET

–> used to determine the presence and extent of residual cortical activity in patients diagnosed with VS
Radiation burden

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20
Q

___% of those in a vegetative state have a diffuse axonal injury

A

71%

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21
Q

What grades of diffuse axonal injuries tend to be present with those in a vegetative state?

A

Grades 2 and 3 in addition to thalamic damage

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22
Q

(true/false) Thalamic lesions are less prevalent in MCS than vegetative state

A

True (50% MCS… 80% VS)

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23
Q

What level of consciousness appears to be characterized by greater sparing of cortico-cortical and cortico-thalamic connections?

A

MCS

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24
Q

definition: widespread axonal damage with NO focal abnormalities

A

DAI grade I

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25
Q

definition: widespread axonal damage with presence of focal abnormalities in the corpus callosum

A

DAI grade II

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26
Q

definition: widespread axonal damage, focal abnormalities in corpus callosum, and injury to the rostral brain stem w/ tissue tears

A

DAI grade III

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27
Q

What is an Increasingly utilized noninvasive technique for localizing brain activity?

A

fMRI

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28
Q

Overall life expectancy is (shortened/lengthened) in those who are in a vegetative state

A

shortened

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29
Q

If a person has a higher DRS score, they have a (bad/good) prognosis

A

bad

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30
Q

(true/false) Children who experience traumatic vegetative state can have posttraumatic hyperthermia at any time.

A

true

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31
Q

(true/false) Any reproducible evidence of volitional responding, however slight, establishes diagnosis of MCS

A

true BUT responses are infrequent and unpredictable and require a large number of observations to establish if there is a pattern/response to stimuli

32
Q

What assessment tools should be used in the acute recovery period from DOC?

A

GCS
Glasgow-Liege Coma Scale
Swedish Reaction Level Scale

33
Q

What assessment tools are used in the rehabilitation period after a DOC?

A

rancho levels
DRS
CLOCS
CNC
CRS-R
SSAM
SMART
WHIM
WNSSP
DOCS

34
Q

What assessment is a useful adjunct or alternative to standardized measures?

A

individualized quantitative behavioral assessment (IQBA)

–> measurements are developed around specific behaviors or questions of interest in individual patients intended to complement comprehensive neurobehavioral assessment

–> useful when behavioral responses are infrequent

35
Q

(true/false) Consciousness can be directly observed.

A

FALSE

36
Q

What are the 5 most common complications of DOC? Other complications?

A

spasticity (8.3%)
UTI (6.4%)
aggression (6.4%)
sleep disturbance (6.2%)
hyperkinesia (4.7%)

pneumonia
post-traumatic epilepsy
post-traumatic hydrocephalus
heterotopic ossification
dysautonomia

37
Q

What complication of DOC is the most common reason for acute-care transfers?

A

pneumonia

38
Q

What are s/s to look for when suspecting heterotopic ossification?

A

pain/grimacing
warmness
swelling

39
Q

(true/false) it is common for DOC patient to form polyneuropathy

A

true

40
Q

What test should you use when testing sensation?

A

flexor withdrawal

41
Q

What is the purpose of the JFK coma recovery scale?

A

assist with:
- differential Dx
- prognostic assessment
- treatment planning

42
Q

What is the scoring range meanings for the CRS-R? How is the scoring determined?

A

Lowest item on each subscale represents reflexive activity while the highest items represent cognitively-mediated behaviors

–> Scoring is standardized and is based on the presence or absence of operationally-defined behavioral responses to specific sensory stimuli

43
Q

What is a pro for CRS-R?

A

Captures emergence from a coma and the progression through disorders of consciousness

44
Q

When was the DOC scale (DOCS) developed?

A

2011

45
Q

GCS has a (low/moderate/high) correlation with mortality.

A

moderate (not reliable at predicting functional capabilities of survivors)

46
Q

What type of potentials tell if pathways are intact?

A

Evoked potentials

–> earliest response/cranial and brainstem neurons

47
Q

What type of potentials are higher level and include the subcortical-cortical circuits?

A

event-related potentials (ERPs)

48
Q

What type of evoked potential reveals structural integrity of pathways?

A

short latency evoked potentials

49
Q

What event-related potentials are indicative of higher cortical function?

A

long latency ERPs

oddball design: detect an infrequent stimulus within a string of frequent stimuli

50
Q

Studies suggest ___-___% errors in classifying patients as Vegetative vs. Minimally Conscious

A

15-43%

51
Q

What medication accelerates the pace of recovery and is given in the acute phase of recovery?

A

amantadine

52
Q

(true/false) a patient can stay agitated for weeks to months after a TBI

A

true

–> episodes can have a spontaneous and rapid onset

53
Q

(true/false) Majority of expert psychiatrists do not utilize formal assessment of agitation within the clinical setting they practice in.

A

true

54
Q

What is the Rancho level for a patient being confused and agitated?

A

IV

55
Q

What are descriptors of agitation?

A
  • delirium
  • akathisia
  • post-traumatic amnesia
  • aggression
56
Q

definition: Syndrome characterized by unpleasant sensations of “inner” restlessness that manifests itself with an inability to sit still or remain motionless

A

akathisia

57
Q

What medications can potentially contribute to akathisia?

A

SSRIs

58
Q

definition: A subtype of delirium unique to survivors of a TBI in which the survivor is in the state of post-traumatic amnesia and there are excesses of behaviors that include some combination of aggression, akathisia, disinhibition, and/or emotional lability

A

interdisciplinary

59
Q

Arousal, attention, memory, and limbic behavioral functions are commonly affected when there is injury to what regions of the CNS?

A

fronto-temporal systems
Subcortical region
brainstem

60
Q

What systems cause cognitive effects with post-traumatic agitation?

A

dopaminergic system (arousal and attention)
noradrenergic system (arousal and attention)
cholinergic system (memory)

61
Q

What systems cause behavioral effects with post-traumatic agitation?

A

serotonergic (aggression)
dopaminergic (akathisia)

62
Q

What are risk factors for post traumatic agitation?

A

Fronto-temporal lesions
Disorientation
co-morbidity complications
anticonvulsants

63
Q

(true/false) Despite the prevalence of aggressive behaviors during the initial recovery phase of TBI, it is rarely measured.

A

true

64
Q

What is the ABS scale used to measure?

A

used to measure agitation in the brain injury population

65
Q

Why was the ABS scale developed?

A

Developed to allow objective, sequential assessment of aggressive behaviors to determine if interventions to reduce these behaviors are effective.

66
Q

What is the grading scale of the ABS?

A

1 = absent
2= present to slight degree
3= present to moderate degree
4= present to an extreme degree

67
Q

What does it mean if a person has an ABS score < 21?

A

WNL

68
Q

What does it mean if a person has an ABS score of 22-28?

A

mild agitation

69
Q

What does it mean if a person has an ABS score 29-35?

A

moderate agitation

70
Q

What does it mean if a person has an ABS score > 35?

A

severe agitation

71
Q

definition: Learning to associate a response with a consequence- the individual has associated that a specific consequence will follow if they do the appropriate response

i.e. “if you finish therapy, you can go have a smoke”

A

response-consequence learning

72
Q

definition: Consequence follows response

A

operant conditioning

73
Q

definition: Consistent schedule and activities

A

structured milieu

74
Q

What is ABC of behavior management short for? What is it used for?

A

Antecedent : what is causing the behavior

Behavior

Consequence

–> used for behavior modification

75
Q

What medications can be used to treat PTA?

A

Carbamazepine
Antidepressants
B-adrenergic receptor antagonists
Antipsychotics
benzodiazepines
sympathomimetics
buspirone
amantadine
lithium
valproic acid

76
Q

Traditionally _________, such as Ritalin, are found to increase agitation.

A

psychostimulants

Neuro (45 decks)

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