Lecture 7+8+DLA Flashcards
area of the brain responsible for arousal
reticular activating system
part of the brain for conscious awareness
higher-order thalamic nuclei
part of the brain that controls the content of awareness
specific thalamic relay nuclei
content-specific sensory regions
levels of unconsciousness
lethargic - patient is fully aroused
obtunded - patient cannot be fully aroused
stuporous - sleep-like status
comatose - no purposeful response to stimuli
major inputs to the RAS come from???
association cortices limbic system sensory pathways thalamic reticular nucleus brain stem hypothalamus
cholinergic pathways (consciousness)
The brain stem and basal forebrain cholinergic
systems work together to abolish cortical slow
wave activity and promote an alert state.
cholinergic = acetylcholine
burst vs transmission mode (EEG)
burst = slow wave sleep
bursts seen on EEG
transmission = waking
single spikes seen on EEG
desynchronized
vegetative state
develops after coma
loss of ability to think, speak, and respond
no awareness of environment
brainstem is still intact:
still breathe and circulate
autonomic functions
locked-in syndrome
blockage of the basilar A. = pons infarction
Tetraplegia: paralysis of all voluntary muscles with
exception of vertical eye movements
are fully aware of environment
can think, remember, and see
cortical brain activity is normal usually
brain death
irreversible loss of all brain functions due to a number of reasons
Ex: anoxia, ischemia, trauma, tumors,
how to diagnose brain death
no response to speech, pain, or other stimuli
no spontaneous respiration
pupils are dilated, no reaction to light
no vestibulo-ocular reflex
no corneal reflex
isoelectric EEG
what are some reasons for coma?
small lesions in the mesencephalon
lesion of posterior lateral hypothalamus
lesion of thalamus
impairment of both cortical hemispheres (metabolic or trauma)
mass lesion (hemorrhage or tumor)
brain stem lesion, tumor, or hemorrhage
metabolic cerebral disorder (anoxia, infection, concussion, hypoglycemia etc.)
Glasgow coma scale
looks at eye opening, motor response, and verbal response.
score can be from 3 to 15
score below 8 = coma
what kind of breathing is seen in a comatose patient with a forebrain lesion??
Cheyne-Stokes respiration
lots of breathes.. then nothing… then lots of breaths again
what kind of lesion will lead to hyperventilation when in coma
midbrain lesion
lesion seen in the pons.. what kind of breathing?
apneusis (inspiratory cramps)
what kind of lesion will lead to ataxic breathing?
lower pons / upper medulla
bilateral medullary lesion
respiratory arrest
lesion in diencephalon would lead to what eye appearance?
both pupils are small
pretectal lesion does what to pupils?
both will be large
pons lesion does what to the pupils
both are very small or pinpoint
lesion in the midbrain at mid point does what to the pupils
no change; stuck in midway pupil size
CN III lesion does what to the pupils
one pupil is very dilated the other is normal
anorexia nervosa
restriction of food that leads to a person being underweight
or having a BMI that is under 18.5 (normal is 19-25)
intense fear of gaining weight
body image disturbance (thinking they are fat)
must occur for 3 months or longer
For anorexia nervosa you can be of two subtypes.. which are?
binge-eating/ purge type:
someone who recurrently will binge then purge
restricting type:
person does no recurrently binge and purge
weight loss is through dieting, fasting, and exercise
associated features of anorexia nervosa?
amenorrhea (if female)
decreased sex drive
constipation
hair loss
low BMI
hypothermia, bradycardia, hypotension
lanugo (soft, fine hair)
dry brittle nails
can also have low bone density, anemia, leukopenia, and hypocholesteremia
what associated features are seen those with the binge-purge subtype of anorexia??
Russell’s sign (calloused knuckles)
dental enamel erosion
salivary gland inflammation (chipmunk cheeks)
hypokalemia
treatment for those with anorexia
weight gain is the first step for in-patient care
will be combined with behavioral principles to encourage weight gain (CBT)
no FDA drug
short-term is usually good, long-term prognosis is usually poor
Bulimia nervosa
recurrent binge eating
recurrent inappropriate compensatory behaviors (purging/ non-purging)
these episodes must occur at least once a week for 3 months
BMI is usually normal or slightly high (unlike AN were the BMI is low)
associated features seen in BN
electrolyte imbalance
enamel erosion
parotid gland enlargement (seen alot in BN)
russell’s sign
treatment for BN
treatment is usually out-patient
CBT is a must
can use an antidepressant for impulse control
prognosis tend to be better compared to AN
Binge- eating disorder
binge-eating is done, BUT there is not compensatory behavior
must be done 1 time per week for 3 months
associated features with binge-eating disorder
usually have a higher BMI, not always
treatment for BED
CBT
lisdexamfetamine
unspecified eating disorder
do not meet the criteria for the other eating disorders but do have subclinical eating issues
