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BAB > L12: Aurosal Coma And Unconsciousness > Flashcards

L12: Aurosal Coma And Unconsciousness Flashcards

1
Q

What is consciousness

A

Awareness of sleep and environment

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2
Q

What is arousal

A

Part of consciousness and it the level of consciousness i.e responding to predictable reflexes

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3
Q

Is arousal and awareness the same

A

No

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4
Q

What is awareness

A

The content of consciousness i.e to perceive to specific environmental stimuli to relate to yourself and the rest of the world

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5
Q

What can disorders of consciousness affect

A

Arousal

Awareness

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6
Q

What are the neural substrates of consciousness

A

The brainstem nuclei of reticular activating system

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7
Q

What does the reticular activating system switch on

A

The cortex

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8
Q

Where does the cortex send the information back to

A

Reticular activating system

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9
Q

Where does the frontal cortex send a signal to

A

Striatum

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10
Q

Where does the striatum send a signal to

A

Globus pallidus interna to inhibit it

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11
Q

When the stimulation of the striatum decreases what happens to the globus pallidus interna

A

Released which inhibits the reticular acitvating system

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12
Q

When the reticular acitvating system is inhibited what happens

A

Consciousness decreases and you fall into sleep

If pathological you go into coma

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13
Q

Therefore what is keeping is awake

A

The striatum inhibiting the globus pallidus interna

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14
Q

Therefore if there is an injury to the striatum what can we do to inhibit the globus pallidus interna and stimulate the cortex

A

Use inhibitor neurotransmitters that inhibit the globus pallidus interna

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15
Q

What is the cortex responsible for

A

Awareness

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16
Q

What is the brainstem responsible for

A

Arousal

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17
Q

What is brain stem death

A

Person has no brainstem function, permanent loss of consciousness and capacity to breathe but heart is beating

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18
Q

What is coma

A

Failure of arousal and awareness

19
Q

What can coma be assessed with

A

Glasgow coma scale

20
Q

What score indicates coma

A

Less than 8

21
Q

What is vegetative state

A

When the brainstem is maintained due to preserved arousal but complete absence of self and environment awareness

22
Q

What is minimally conscious state

A

Cognitive mediated behaviour occurs inconsistently but it reproducible that is different from a reflex and there is arousal

23
Q

What is the presentation of minimally conscious state

A

Person can follow a simple command
Gestural or verbal yes or no
Purposeful behaviour such as moving eyes with a mirror

24
Q

What are the 2 levels of minimal conscious state

A

With language

Without language

25
Q

What is moving on from minimally conscious state characterised by

A

Functional communication of yes or no

Functional object use e.g brining comb to head

26
Q

What is akinetic mutism

A

A subtype of minimally conscious state

27
Q

What is akinetic mutism

A

Everything is reduced but then you suddenly give high intensity sensory stimulus and things change

28
Q

Give an example of a high intensity stimulus in akinetic mutism

A

Giving a phone to their and they speak to someone meaningful

29
Q

What is locked in syndrome

A

Arousal and awareness are preserved but motor outflow is blocked

30
Q

What are the causes of locked in syndrome

A

Brain stem pathology

31
Q

What are the 3 subtypes of locked in syndrome

A

Classical
Incomplete
Complete

32
Q

How does classical locked in syndrome present

A

Upgaze
Blinking only with anarthria
Tetra paresis
Preserved consciousness

33
Q

How does incomplete locked in syndrome present

A

Minimal movements in other limb with upgaze and blinking

34
Q

What is complete locked in syndrome

A

No limb or eye movement but preserved consciousness

35
Q

What is cognitive motor dissociation

A

Unconscious awareness detected by MRI and EEG

36
Q

What can be seen on an MRI for someone who has cognitive motor dissociation

A

Reproducible brain repsonce as if a task is being carried out if you ask them to

37
Q

In an hyper acute situation what scale do we use to asses

A

Glasgow coma scale

38
Q

What does the Glasgow coma scale look for

A

Eye opening
Verbal response
Best motor response

39
Q

What are the physical finding that we also assess for

A

Pupils
Motor functions
Autonomic features

40
Q

If pupils are fixed and unresponsive what does this indicate

A

Brain stem damage

41
Q

As intracranial pressure increases and brainstem becomes under pressure what do we get

A

A Cushing’s triad

42
Q

What is the Cushing triad

A

Hypertension
Bradycardia
Respiratory irregularity

43
Q

In a post acute assessment what do we establish

A

Diagnosis
Trajectory: are things changing over time
Prognosis

44
Q

When does survival decrease

A

From traumatic injury to non traumatic

BAB (21 decks)

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