Dx of Stupor and Coma

Question 0

Excessively sleepy but normal cognition

Answer 0

hypersomnia

Question 1

Sleepy but easily aroused

Answer 1

Lethargy

Question 2

mental blunting, decreased alertness

Answer 2

Obtundation

Question 3

Eyes open briefly only after vigorous stimulation before returning to sleep; cognition impared

Answer 3

Stupor

Question 4

Eyes remain closed after vigorous stimulation

Answer 4

Coma

Question 5

Disoriented, misperception of sensory stimuli, hallucinations. Vacillates b/n quiet, sleepy periods and hypervigilance/ agitation

Answer 5

Delirium

Question 6

What must always be done when documenting the suspected coma patient?

Answer 6

Essential to describe a patients response to stimulation–> docs use many of these terms in different ways, so be clear

Question 7

With regard to describing a patient in the aftermath of a coma, what does the term “abulia” mean?

Answer 7

Pt is awake, but apathetic. With vigorous stimulation, cognition may be normal (can answer questions, etc.)

Question 8

What does the term akinetic mutism mean? (coma aftermath)

Answer 8

silent, alert-appearing immobility. No mental activity even with vigorous stimulation

Question 9

What is MCS, or minimally conscious state? (coma aftermath)

Answer 9

Pts have fragments of awareness; can reach for objecys, may grunt in response to commands, may visually fixate and track but are unable to do much more–> fragments of awareness

Question 10

What is a vegetative state?

Answer 10

They have the functions of brainstem intact–> maintain sleep-wake cycles, RR, BP, HR, and visceral autonomic function, but have no meaningful interaction with the environment

Question 11

What usually happens to coma patients within 2 weeks regardless of cause of coma?

Answer 11

Will usually develop eye-opening and sleep/wake cycles

Question 12

What two components to consciousness are there?

Answer 12

1. Arousal or wakefulness

2. Content of consciousness

Question 13

What system is responsible for wakefulness?

Answer 13

Ascending arousal system–> neural circuits that mediate sleep-wake cycles. (Sometimes called the reticular activating system)

Question 14

What does disruption of the ascending arousal system lead to clinically? (2 things)

Answer 14

Stupor and coma

Question 15

What is meant by the content of consciousness?

Answer 15

Cerebral activity responsible for self awareness, cognition and purposeful interactions with the environment–> neural network in the cortex are responsible

Question 16

What does disease affecting the content of consciousness cause clinically?

Answer 16

Dementia

Question 17

What do awareness and cognition require to work?

Answer 17

Arousal

Question 18

Where on the brainstem do lesions begin to affect wakefulness?

Answer 18

Upper pontine and midbrain level

Around the area of the tectum or quadrigeminal plate

Question 19

In what two areas of the brain were lesions seen resulting from encephalitis lethargica, a sleeping sickness?

Answer 19

1. Rostral periaqueductal gray matter

2. Posterior 3rd ventricule

Question 20

Lesions at what level of the brain can cause quadriplegia and respiratory depression?

Answer 20

At the level of the cervical medulla