Neurologic Examination of Patients with Altered Sensorium

Question 1

Awareness of self and environment

Answer 1

Intuitive

Question 2

Steps in determining level of consciousness

Answer 2

Inspection - ask whether the pt adapts appropriately to visual, auditory and tactile stimuli
Verbal stimulation - whether pt responds to inquiries
Painful stimulation

Question 3

Neuroanatomic connection that receives and delivers stimuli

Answer 3

1. Receptor and sensory pathway

Question 4

Neuroanatomic connection for interpretation

Answer 4

2. Cerebrum

Question 5

Neuroanatomic connection to send across 4th

Answer 5

3. Pathway through the CNS to the PNS

Question 6

Neuroanatomic connection which is the space between the muscles and the nerves

Answer 6

4. Neuromuscular junction

Question 7

Neuroanatomic connection that produces volitional, behavior, verbal or nonverbal, depending on consciousness

Answer 7

Effector organ

Question 8

Disorientation, amnesia, misperceptions, agitations, hallucinations, irrational behaviors, increased psychomotor behaviors

Answer 8

Hyperactive Delirium

Question 9

Decreased sensorium, or sometimes with global impairment of sensorium

Answer 9

Hypoactive Delirium

• often called encephalopathy

Question 10

Level of consciousness with the appearance of wakefulness

Answer 10

Alert

Question 11

Level of consciousness with the inability to sustain wakeful state

Ability to sustain alertness for at least some brief period without the need to further necessitate additional stimuli

Answer 11

Drowsiness

Question 12

Roused only by vigorous and repeated stimuli
- Arousal cannot be sustained without repeated stimulation
- When left unstimulated, drifts back into a deep sleep-like state

Answer 12

Stupor

Question 13

They do not respond to verbal or painful stimulation even of it has been repeated, or
the stimulation is already a vigorous one

Answer 13

Coma

Question 14

GCS Scale Eye Responses

Answer 14

1 - No eye opening
2 - Eye opening in response to pain
3 - Eyes opening to speech
4 - Eyes opening spontaneously

Question 15

GCS Verbal Responses

Answer 15

T - Intubated
1 - none
2 - incomprehensible sounds
3 - inappropriate words
4 - confused
5 - oriented

Question 16

GCS Sale Motor Responses

Answer 16

1 - No response
2 - Decerebrate
3 - Decorticate
4 - Withdraws from pain
5 - Localized to pain
6 - Obeys commands

Question 17

It is an emergency situation and should be reported immediately necessitating rapid interventions

Answer 17

Decrease in GCS >2

Question 18

Four glance survey anatomic involvement when there is normal breathing and oropharyngeal reflexes

Answer 18

CN IX, X, XI
Ponto,edullary reticular formation
Cervical and thoracic SC

Question 19

Four glance survey anatomic involvement when there is blinking or tonic closure of the eyelids

Answer 19

CN V and VII

Question 20

Four glance survey anatomic involvement when there is random slow conjugate drifts of the eyelids to the sides

Answer 20

CN III, IV, VI
Front Pontine Pathway

Question 21

Four glance survey anatomic involvement when there is random spontaneous, particularly purposive symmetrical movement of all extremities

Answer 21

Pyramidal tracts

Question 22

Characterized by progressive and sometimes deeper and sometimes faster breathing —> gradual decrease that sometimes result in apnea

Answer 22

Cheyne-Stokes

• can also be seen in lateral thalamic injury

Question 23

• Sustained regular rapid and deep breathing
• Pontomesencephalic lesions

Answer 23

Central Neurogenic Hyperventilation

Question 24

Prolonged inspiratory phases or pauses
Alternating with expiratory pauses

Answer 24

Apneustic breathing

Question 25

Cluster of breathes that follow each other with irregular pauses in between

Answer 25

Cluster breathing

Question 26

Characterized by completely irregular breathes, with some deep shallow patterns

Answer 26

Ataxic breathing