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Brain and Behavior > Lecture 53: Disorders of consciousness > Flashcards

Lecture 53: Disorders of consciousness Flashcards

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The Brain flashcards
1
Q

What is the location of the source nuclei for the ascending reticular activating system (ARAS)? NT?

A

Ponto-mesencephalic junction; ACh

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2
Q

Pathway (three regions) responsible for “arousal”

A

ARAS –> thalamus –> thalamo-cortical relays

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3
Q

Brain region responsible for “awareness.” Is it easy to “knock the lights out” here?

A

Cortex; NO – would have to damage cortex BILATERALLY to cause loss consciousness

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4
Q

What type of stroke can cause mass effect? What brain region can this effect?

A

Epidural hematoma; brainstem

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5
Q

What scary transmitted disease can cause loss of consciousness at the level of the cortex?

A

Creutzfeld-Jacob Disease (CJD)

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6
Q

Levels of consciousness/arousal (6)

A

Awake, somnolent (full arousal by auditory/tactile), lethargic (sub-arousal by non-noxious), obtunded (depressed LOC, still responds to non-noxious), stupor (req noxious stimuli), coma (unresponsive)

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7
Q

Content of consciousness: levels of awareness (3)

A

Alert –> inattentive –> vegetative

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8
Q

Neurologic examination of coma features (3, if you don’t know the wheres or the whys…)

A

Respiratory pattern, eye function, motor responsitivity (listen to breath and look at the eyes)

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9
Q

Respiratory pattern w/ forebrain dysfunction

A

Cheyne-Stokes respiration (hyperventilation with pauses)

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10
Q

Respiratory pattern w/ midbrain dysfunction

A

Hyperventilation

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11
Q

Respiratory pattern w/ rostral pons dysfunction

A

Apneusis

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12
Q

Respiratory pattern w/ caudal pons dysfunction

A

Ataxic breathing (disorganized)

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13
Q

Respiratory pattern w/ medulla dysfunction

A

Respiratory arrest

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14
Q

Pupil patterns w/ thalamic dysfunction

A

Small reactive

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15
Q

Pupil patterns w/ herniation

A

One fixed dilated (impacting para on CN III)

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16
Q

Pupil patterns w/ pretectal dysfunction

A

Fixed dilated

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17
Q

Pupil patterns w/ midbrain dysfunction

A

Fixed mid-size

18
Q

Pupil patterns w/ pontine dysfunction

A

Pinpoint

19
Q

Corneal reflex (afferent/efferent). Lesions localize where?

A

Afferent: CN V; Efferent: CN VII; pons

20
Q

Two clinical provocative maneuvers for VOR

A

Oculo-cephalic/Doll’s eyes reflex; calorics

21
Q

Oculo-cephalic reflex

A

Tests VOR: eye tilt to provoked head movements

22
Q

Oculo-cephalic reflex w/ right lateral pontine lesion

A

Cannot look to the right (no pontine lateral gaze function)

23
Q

Cold water calorics w/ right lateral pontine lesion

A

No slow gaze drift to the right side

24
Q

Oculo-cephalic reflex w/ bilateral midbrain lesion

A

Turn right: cannot adduct right eye; Turn left: cannot adduct left eye; Turn up/down: eyes stay still

25
Q

Cold water calorics w/ bilateral midbrain lesion

A

Cannot adduct proper eye during application to either ear (no medial rectal activity in III)

26
Q

In full consciousness, what happens to Doll’s eye reflex?

A

+ or - due to ability to inhibit it

27
Q

With knocked out cortex but OK brain stem, what happens to Doll’s eye reflex?

A

+

28
Q

With knocked out cortex AND brain stem, what happens to Doll’s eye reflex?

A

-

29
Q

Descriptive characteristics of motor responsivity (6)

A

Purposeful, localize, withrdaw, decorticate, decerebrate, none

30
Q

Knocked out motor cortex/thalamus…

A

No contralateral purposeful movement

31
Q

Knocked out upper midbrain…

A

Flexion response/ decorticate posture (high lesion, body goes up)

32
Q

Knocked out upper pons…

A

Extension response/ decerebrate posture (low lesion, body goes down)

33
Q

What eye movements are spared in locked-in syndrome

A

Voluntary opening, vertical movements, covergence

34
Q

Categories of consciousness impairment (3 w/ subtypes for 1)

A

Coma, vegetative (persistent, permanent), minimally conscious

35
Q

Arousal/awareness in vegetative state

A

Full arousal, no awareness

36
Q

Arousal/awareness in minimally conscious state. Describe.

A

Full arousal, fluctuating partial awareness (eye movements, simple commands, purposeful behavior)

37
Q

Arousal/awareness in coma

A

No arousal, no awareness

38
Q

T/F: Sleep wake cycles in vegetative state

A

True

39
Q

Main point of coma prognosis

A

Longer the absence of key brainstem function signs (breathing, motor responsivity, eyes) = worse prognosis

40
Q

Brain death

A

Absent midbrain reflxes (pupillary reactivity); absent pontine reflexes (VORs, corneal); absent medullary reflexes (apnea)

41
Q

To determine brain death, must do…(2)

A

Brain stem function testing; apnea testing

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