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Neurology > Disturbances of Consciousness > Flashcards

Disturbances of Consciousness Flashcards

1
Q

Define consciousness

A

is the state of being aware of self and the environment

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2
Q

Describe an “alert” patient

A

full wakefulness and immediate and appropriate responsiveness

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3
Q

Describe a “confused” patient

A

inability to think with the usual speed and clarity

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4
Q

What is obtundation?

A

the patient is drowsy and indifferent to the environment, but responsive to verbal stimuli

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5
Q

What is stupor?

A

the patient is unconscious but rousable when stimulated

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6
Q

When would a patient be described as being in a coma?

A

the patient is unaware of self and the environment and is not rousable

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7
Q

What is important for forming a Dx relating to impaired consciousness?

A

the duration of impaired consciousness

- can be transient or ongoing

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8
Q

What does the normal conscious state depend on?

A

the integrity of the brainstem reticular activating system and the cerebral hemispheres

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9
Q

What are the most common causes of transient loss of consciousness (LOC) ?

A
  • Syncope
  • Seizures
  • Psychogenic/’non-epileptic’ attacks
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10
Q

What are uncommon causes of transient LOC?

A
  • Hypoglycaemia
  • Narcolepsy/cataplexy
  • Hyperventilation
  • Vertebrobasilar ischaemia
  • Vertebrobasilar migraine
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11
Q

What is syncope?

A

transient LOC and posture that results from a global reduction in blood flow to the brain

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12
Q

What are the main symptoms of syncope?

A
  • usually when standing
  • hypotensive symptoms: light-headed, faint, blurred/dim vision, sounds seem distant, nausea, hot/cold, sweating
  • pale skin colour
  • shallow respiration
  • floppy tone
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13
Q

What are the features of recovery from syncope?

A
  • Recovery is usually rapid with no confusion
  • Pallor may persist
  • No focal neurological signs
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14
Q

What are the 5 main causes of syncope?

A
  • Vasovagal syncope
  • Situational syncope; micturition/cough
  • Postural hypotension
  • Primary cardiac dysfunction
  • Carotid Sinus disease
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15
Q

What causes vasovagal syncope?

A

caused by a sudden drop in BP due to peripheral vasodilation (systolic drops to <60mmHg)

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16
Q

Describe micturition syncope

A

Men who get up to urinate in the middle of the night. it is a combination of vasodilation (from emptying of the bladder), postural hypotension (from standing) and bradycardia

17
Q

Describe cough syncope?

A

sustained coughing can increase intrathroacic pressure, which impairs venous return to the heart (valsalva). Increase in CSF pressure, reduction in pCO2 and resultant vasoconstriction may be contributory

18
Q

What is postural hypotension

A

upright posture is accompanied by an uncompensated fall in BP

19
Q

Who is postural hypotension likely to occur in?

A
  • Normal individuals
  • Drugs (antihypertensives)
  • Autonomic neuropathy (diabetes, Guillian-Barre)
  • Hypovolemia (blood loss, sepsis, hypoadrenalism)
  • Neurodegenerative disease (Parkinsons, mutlisystem atrophy)
20
Q

What conditions are likely to cause primary cardiac dysfunction syncope?

A
  • arrhythmias
  • LV outflow obstruction (aortic stenosis, hypertrophic obstructive cardiomyopathy)
  • RV outflow obstruction (pulmonary stenosis, pulmonary hypertension, PE)
  • Ventricular failure (acute anterior MI, dilated cardiomyopathy)
21
Q

How does carotid sinus disease cause syncope?

A

Hypertensive - less stretch needed for reflex bradycardia/decreased BP

22
Q

What are the prodromal symptoms for syncope caused by hypoglycaemia?

A
  • feeling tremulous and sweaty
  • palpitations
  • confusion
23
Q

What are the main causes of syncope caused by hypoglycaemia?

A
  • over treatment of diabetes
  • liver failure
  • hypopituitarism
  • Addison’s disease
  • insulinsomas
24
Q

What is narcolepsy?

A

excessive sleepiness and sleep attacks at inappropriate times

25
Q

what is catoplexy?

A

attacks of sudden relaxation of muscle tone; usually precipitated by emotion/laughing

26
Q

What is hyperventilation?

A

over breathing

This results In decreased pCO2, cerebral vasoconstriction, metabolic alkalosis and decreased ionised Ca2+

27
Q

What are the main features of hyperventilation?

A
  • breathlessness and air hunger with rapid respiration
  • light-headed
  • perineal and digital parasethesia
  • carpopedal spasm
  • anxiety and fatigue
28
Q

What is vertebrobasilar ischaemia and what are the main symptoms?

A
  • brainstem = supplied by the vertebrobasilar system
  • vertigo, nausea and diplopia
    VERY RARE
29
Q

When are non-epileptic attacks diagnosed as a reason for LOC?

A

diagnosis of exclusion

A specialist should be consulted before giving this diagnosis

30
Q

How does syncope differ from seizures?

A

unrelated to posture

31
Q

What are the symptoms the precede a focal seizure/aura?

A
  • deja vu
  • epigastric rising sensation
  • anxiety and fear
  • focal sensory symptoms
  • focal twitching
32
Q

What are the clinical signs of a seizure?

A
  • Skin = blue/normal
  • respiration = stertorous (noisy)
  • tone = tonic-clonic
  • convulsions and urinary incontinence
  • tongue biting
  • occasional focal neurological symptoms
33
Q

What is a coma?

A

state of impaired consciousness in which the patient is not rousable despite external stimuli

34
Q

Define a minimally conscious state

A

reduced cerebral metabolism on fMRI

Increased medial parietal lobe and posterior cingulate activity compared with more severe comas

35
Q

Define persistent vegetative state

A

have lost neurological cognitive function and awareness of the environment but retain non cognitive function and preserved sleep-wake cycle

36
Q

Define a permanent vegetative state

A

remain in a vegetative state for more than 6 months if caused by a non-TBI or more than 12 months if caused by a TBI

Neurology (3 decks)

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