L7: Coma - Pt 3

Question 1

Clinical manifestations of ↑↑ ICP

Answer 1

Question 2

Clinical manifestations of ↑↑ ICP

• Non-Specific

Answer 2

Question 3

Clinical manifestations of ↑↑ ICP

• Neurological

Answer 3

Question 4

Clinical manifestations of ↑↑ ICP

• Comlications

Answer 4

Question 5

Cushing Response

• Indicates

Answer 5

Impending brain herniation

Question 6

Cushing Response

• Components

Answer 6

◈ Hypertension
◈ Bradycardia
◈ Decreased sensorium
◈ Sometimes + pupillary changes

Question 7

Cushing Response

• Mechanism

Answer 7

Question 8

Assessment of Coma

• Neurological Ex

Answer 8

1. Level of consciousness
2. Posture
3. Cranial nerve examination
4. Random blood sugar

Question 9

Neuro Ex in Coma

• LVL of Consciousness

Answer 9

A. AVPU score
B. Murray score for incubated child
C. Modified Glasgow Coma Scale

Question 10

Consciousness Assessment in Coma

• AVPU

Answer 10

Question 11

Consciousness Assessment in Coma

• Murray score for incubated child

Answer 11

Question 12

Consciousness Assessment in Coma

• Modified GCS

Answer 12

Question 13

Significance of Modified Glasgow Coma scale

Answer 13

• Provides easily reproducible basic neurologic exam
• Allows physicians to track neurologic changes over time and multiple examiners

Question 14

Posture in Assesment of Coma

Answer 14

Question 15

Decorticate Posture

• Site of Lesion

Answer 15

◈ Cerebral hemisphere
◈ Internal capsule
◈ Thalamus

Question 16

Decorticate Posture

• Mechanism

Answer 16

Damage to the corticospinal tract

Question 17

Decorticate Posture

• Signs

Answer 17

◈ Abnormal rigidity
◈ Flexion of arms
◈ Extension of legs
◈ Clenched fists

Question 18

Decorticate Posture

• Illustration

Answer 18

Question 19

Decerebrate Posture

• Site of Lesion

Answer 19

Midbrain

Question 20

Decerebrate Posture

• Mechanism

Answer 20

Damage below the red nucleus in the midbrain

Question 21

Decerebrate Posture

• Signs

Answer 21

◈ Arched back head
◈ Extension of arms
◈ Extension of legs
◈ Extension of elbows

Question 22

Decerebrate Posture

• Illustration

Answer 22

Question 23

Pupil Examination in Assessment of Coma

• Causes of small Bilateral Fixed Pupils

Answer 23

Pontine lesion

Question 24

CN Ex in Coma

Answer 24

Question 25

CN Ex in Coma

• Pupillary Light Reflex

Answer 25

Question 26

CN Ex in Coma

• Corneal Reflex

Answer 26

Question 27

CN Ex in Coma

• Oculo-cephalic / Oculo-caloric reflex

Answer 27

Question 28

CN Ex in Coma

• gag Reflex

Answer 28

Question 29

Pupil Examination in Assessment of Coma

Answer 29

Question 30

Pupil Examination in Assessment of Coma

• Causes of small Bilateral Reactive Pupils

Answer 30

◈ Barbiturate
◈ Narcotic
◈ Organophosphate

Question 31

Pupil Examination in Assessment of Coma

• Causes of small Unilateral Reactive Pupils

Answer 31

◈ Midbrain dysfunction
◈ Sympathetic dysfunction

Question 32

Pupil Examination in Assessment of Coma

• Causes of Normal Bilateral Fixed Pupils

Answer 32

Midbrain dysfunction

Question 33

Pupil Examination in Assessment of Coma

• Causes of Large Bilateral Reactive Pupils

Answer 33

◈ Post-ictal
◈ Anticholinergics
◈ Metabolic

Question 34

Pupil Examination in Assessment of Coma

• Causes of Large Bilateral Fixed Pupils

Answer 34

◈ Toxic
◈ Anoxic
◈ Metabolic

Question 35

Pupil Examination in Assessment of Coma

• Causes of Large Unilateral Fixed Pupils

Answer 35

◈ Third nerve lesion
◈ Tentorial herniation