Higher cerebral functions Flashcards
consciousness
reception processing cognition reactoin language memory foresight
Mental status exam
memory orientation concentration language performance of learned skilled movements - apraxia recognition of stimuli - agnosia
delirium
acute confusional state
ex: alcohol intoxication
dementia
failing memory and impairment of intellectual or cognitive function
Alzheimer’s disease
degeneration and loss of nerve cells in the cortical association areas and medial temporal lobes
Aphonia/dysphonia
less to do with brain and more to do with voice disturbance due to larynx or innervation issues
person will whisper with ______ paralysis
vocal chord paralysis
anarthria/dysartharia
more issue with using tongue, jaw, breathing to say words
words slurred
dyspraxia of speech involving cerebellum
Aphasia/dysphasia
problem with speaking
dysphagia
swallowing problem
Mini mental status exam
orientation registration attention and calculation recall language
testing - memory, orientation, concentration, language
MMSE scale
30 total possible 28-30 normal 21-27 Mild cognitive 10-20 Moderate cognitive 0-9 severe impairment
standardized min mental state examination (SMMSE)
if memory, orientation, concentration and language are intact, the performance of learned skilled movements and recognition of stimuli will also be intact
clouding of consciousness
patient has inattention and reduced wakefulness
confusional state
includes disorientation, bewilderment, and difficulty following commands
lethargy
severe drowsiness
patient can be aroused by moderate stimuli and then drifts back to sleep
obtundation
similar to lethargy
patient has little interest in the environment, slowed responses to stimulation and tends to sleep more than normal with drowsiness in between sleep states
stupor
pt aroused only by vigorous and repeated stimuli
when left undisturbed, the pt will immediately lapse back o the unresponsive state
coma
state of unarousable unresponsiveness
deep - no reflex activity
light - reflex activity
no voluntary movement
dysfunctions of ascending reticular activating system ARAS
clouding of consciousness confusional state delirium lethargy obtundation stupor dementia hypersomnia vegetative state akinetic mutism - frontal cortex problem, semi conscious , cant talk, move -> no motor planning locked in syndrome coma
vegetative state
loss of cognition
intact wake/sleep cycle
intact autonomic functions
Cause of altered state? evidence to look for
infection, HTN, shock, increased intracranial pressure with bradycardia, trauma (check for periorbital or retroauricular ecchymosis or blood behind tympanic membrane to suggest basilar skull fracture
is there papilledema or intraocular hemorrhage?
Icteric conjunctiva
stiff neck
intoxication
Hepatic Encephalopathy
Portal systemic encephalopathy due to chronic hepatic insuff/cirrhosis, intolerance of dietary protein, raised ammonia levels confusion, drowsiness, coma icteric conjuntiva develops over days to weeks
Small reactive pupils
suggest diencephalic localization, freq metabolic basis
large pupils that dilate and contract automatically but do not react to direct light stimulus
suggest tectal lesion
Midposition fixed pupils
lesion of midbrain
bilateral pinpoint pupils
indicative of opioid toxicity, pontine lesion, organophosphate toxicity (excess Ach)
Most common cause of decreased state of consciousness
metabolic/toxic disturbance - acid-base disequilibrium, oxygen or glucose metabolism disorder, uremic and hepatic encephalopathy, drug overdose, poisoning
epilepsy
cerebrovascular issue - ischemia, hemorrhage
Hypertensive encephalopathy
malignant HTN, hypertensive emergency
severe headache, nausea with vomiting, visual disturbance,confusion, coma
findings: Retinal hemorrhage, papilledema
Midbrain RF lesion
EEG appearance of large amplitude
slow waves
Pontine RF lesion
EEG alpha rhythm (vertical gaze palsy)
normal autonomic and somatomotor reflexes are present
almost like a normal drowsy
Frontal lobe lesion
somnolent or apathetic
akinetic mutism
lower brainstem lesion
produces coma but are usually fatal b/c stops breathing
confusion, faitgue, lethargy, sleepiness, SOB, tachypnea, may be caused by
respiratory acidosis, hypercapnia: Low O2
respiratory alkalosis: cerebrovascular constriction
metabolic acidosis: ketoacidosis, dehydration, loss of bicarb (diarrhea, vomitting) renal disease
aspirin, methanol, ehtylene glycol poisoning
lactic acid
occiptal ischemia
due to compression of ipsilateral posterior cerebral artery at the tentorial edge
Boxer takes punch to face, twists head on neck
twists the brainstem and contorted in tentorial hiatus, small areas of hemorrhage or ischemia may develop within it, resulting in alterations in level of consciousness
cerebellar lesions compress
brainstem and can cause coma
subconscious mind
composite of everything one sees, hears and any info the mind collects that it cannot otherwise consciously process to make meaningful sense
stores info for the conscious mind to retrieve
superconscious
collective unconscious
Jungian psychology
spirituality/religion
Pt doesnt eat, drinks excessive liquids, drops potassium dangerously low,
CT shows black area that is liquid, indicating hydrocephalus ex vacuo.
Thalamus was ok but cortex was damaged leaving pt in vegetative state which is a loss of cognition with intact sleep/wake cycle and intact autonomic functions
Pt unconscious after consuming diazepam, detropropoxyphene, and alcohol. After collapsed and stopped breathing twice for 15 mins was brought to hospital
pt lapsed into persistent vegetative state
Pt is in COMA - unconsciousness, unresponsive to stimuli
Cerebral cortex has moderate scarring
Thalamus was extensively damaged bilaterallly
brain stem undamaged - leaving cardiac and respiratory function intact
suggests thalamus plays role in consciousness
Pt has has locked in syndrome for long time, what is he at risk for?
developing pneumonia because he cannot breath deeply
had a basal pontine stroke
COMA
state of unconsciousness in which person cannot be awakened
fails to respond normally to painful stimuli, light or sound
lacks a normal wake-sleep cycle and doesnt intiate voluntary movement
no eye opening, speech/communication
VEGETATIVE STATE
return of sleep/wake cycle with periods of eye opening and eye closing
may moan or make sounds esp when tight muscles are stretched
may cry or smile or make other facial expressions
-may briefly move eyes towards persons or objects
-may react to a loud sound w/ a startle
-unable to follow intstructions
-no speech or communication
-no purposeful movement
