Neuropalliative Care

Question 1

Brain death: definition

Answer 1

• Whole brain death
• brainstem and cortical function

Question 2

Locked in State: Definition

Answer 2

• Disorder of motor output
• consciousness and cognition are preserved

Question 3

Coma

Answer 3

• eyes closed state of unresponsiveness
• no wakefulness or response to stimuli
• dysfunction of brainstem and higher cortical areas
• may remain in coma for weeks after severe brain injury
• can progress to brain death, full recovery or inbetween

Question 4

Persistent vegetative state

Answer 4

• recovery of brainstem but not consciousness
• higher cortical functions impaired
• Eyes OPEN state of unresponsiveness
• may open eyes to stimuli, exhibit reflexive movements, autonomic functions (sleeping, respiraroy drive, etc)

Question 5

Minimally conscious state (MIS)

Answer 5

• evidence of consciousness
• intention, attention, memory, awareness of self / others
• may track objects in visual field
• say a word or phrase
• prognostic uncertainty for recovery

Question 6

How do a diagnostic assessment for patient with disorder of consciousness?

Answer 6

• careful neuro exam
• Coma REcovery Scale - revised
• neuro imaging (fMRI, PET)

Question 7

Pain relief in patients with disorders of consciousness

Answer 7

• in MCS, look for localized response to pain
• frowns, shouts may not be reliable if not localized
• no standardized guidelines or approach
• Minimally Conscious State (can perceive pain)
• Vegetative State (cannot perceive pain)
• Assume MCS can understand what is said at bedside

Question 8

Palliative Care in Acute Devastating Brain Injury

Answer 8

• ICH
• expected course - immently dying
• Palliative care: GCD, symptom management, family support, place of death, bereavement care

Question 9

Palliative Care in Acute/relapsing brain injury with recovery

Answer 9

• Ischemic stroke
• MS
• expected course:
  
  • acute functional deterioration with potential for partial recovery
  • possible recurrence and future progression
• Palliative care:
  
  • sx mx, ACP, location of care, location of death, family support

Question 10

Neuro palliative care : Common Problems

Answer 10

• Airway
  
  • secretions, aspiration
  • feeding tubes, etc
• Breathing
  
  • resp failure (ALS)
  • PNA
• Comfort
  
  • pain control
• Cognition
  
  • Capacity
• Communication
  
  • may be motor dysarthria or aphasia
  • develop communication strategies
• Decision making
  
  • goals of care
• Expectations
  
  • recognize limits of medical interventions
• Feeding
  
  • tube feeds?