Neuro Flashcards
Define conciousness
Consciousness: Wakefulness and awareness
Assessment relies on physical responses at the bedside
Define minimally conscious state
Legal aspects?
-May move finger
-Continual (>4weeks) versus permanent (years)
-Could get better
Official solicitor protects people with minimal consciousness
Define persistent vegetative state
Some weeks/months after initial injury Unawareness of self Awake but not aware May open eyes, can breathe and heart will pump Will not respond to commands, loved ones Permanent>6 months
Define coma
Not awake and not aware
Eyes are closed
No response to environment, voices or pain
Brainstem involvement in consciousness?
- Survival functions
- Contains ascending reticular activating system (RAS)
- Determines how awake people are, necessary for consciousness
Define locked in syndrome
Patient fully awake and alert but cannot move or speak
Can mimic loss of consciousness
Ocular muscle usually spared (communicate by blinking)
After basilar artery occlusion/pontine injury/ALS/MS
Name 2 confounders of the Glasgow Coma Scale
Spinal cord injury
Deafness
When are pupils small and reactive?
Opioid use
When are pupils small and unreactive?
Pontine haemorrhage
When are pupils unreactive
Atropine
When are pupils unreactive and dilated?
Brainstem herniation
Seizures
Definition of a stroke
Sudden onset loss of CNS functioning lasting >24 hrs due to a vascular cause
Cause of 1/10 deaths in UK
Causes of stroke
- 85% ischaemic
* 15% haemorrhagic
Causes of ischaemic stroke (12)
- Atherothrombosis: 50%, large vessel atheroma causing local narrowing and distal thromboembolism, usually aortic arch, carotid bifurcation, vertebral artery
- Small vessel disease: 20-25%, lipohyalinosis and fibrinoid degeneration of small intracranial vessels, hypertension. Causes small lacunar infarcts of internal capsule
- Cardioembolic: 20-25%, emboli secondary to arrhythmia (AF), valvular disease (replacements, vegetations), poor LV function, post MI. Usually left side of heart-> intracranial vessels unless septal defect, then from DVTs
- Arterial dissection (may present with neck pain and Horner’s syndrome)
- Hypotension-> watershed infarct after cardiac arrest
- Vasculitis
- Hypercoagulability: Antiphospholipid syndrome, malignancy
- Genetic disorders: mitochondrial, homocysteinuria, CT disorders, sickle cell
- Illicit drugs (cocaine)
- Secondary to CNS infection (syphilis, HIV)
- Trauma to neck vessels
- Secondary to venous sinus thrombosis
4 types of intracranial haemorrhage
- Intracerebral
- Subarachnoid
- Subdural
- Extradural