Persistent Vegetative State

Question 1

consciousness

Answer 1

state of full awareness of self and environment

Question 2

wakefeullness

Answer 2

ability to have basic reflexes

Question 3

awareness

Answer 3

ability to carry out complex thought processes

Question 4

psychological unconsciousness

Answer 4

state of unawareness or repressed ideas

Question 5

neurological unconsciousness

Answer 5

paralytic coma due to brain disfunction

Question 6

role of ascending reticular activating system ARAS

Answer 6

alerting and arousal

Question 7

structures in the ascending reticular activating system

Answer 7

pontine tegmentum
thalamus
lateral prefrontal cortex

Question 8

which parts of the hypothalamus promote arousal and sleep

Answer 8

arousal - tuberomammillary nucleus
sleep - venterolateral preoptic nucleus

Question 9

which nucleus is involved in the circadian clock

Answer 9

suprachiasmatic nucleus

Question 10

what can cause disorders of consciousness

Answer 10

structural brain lesions
metabolic and nutritional disorders
exogenous toxins
CNS infections and sepsis
seizures
hypo/hyperthermia
trauma

Question 11

scales for assessing consciousness alteration and duration

Answer 11

GCS glasgow coma scale
LOC loss of consciousness

Question 12

4 outcomes of coma

Answer 12

brain death
vegetative state
locked in syndrome
recover wakefulness

Question 13

3 main categories of unconsciousness

Answer 13

comatose
vegetative
minimally conscious

Question 14

comatose state

Answer 14

state of complete unresponsiveness in which pt lies with eyes closed and cannot be aroused to respond to any stimuli

Question 15

stupor

Answer 15

state of unresponsiveness similar to coma but pt will respond to strong stimuli

Question 16

difference between deep sleep and coma

Answer 16

no REM in coma

Question 17

how long does coma usually last

Answer 17

a couple of weeks

Question 18

locked in syndrome

Answer 18

state of unresponsiveness where pt lies with eyes closed and cannot be aroused to respond to any stimuli however retains eye movement and is fully conscious

Question 19

injury to which brain area is the primary cause of locked in syndrome

Answer 19

ventral pons - interrupts corticospinal and corticobulbar tracts

Question 20

how can pts with locked in syndrome communicate

Answer 20

e-Tran frame
brain computer interface

Question 21

akinetic mutism

Answer 21

condition of apparent alertness with a lack of almost all motor functions including speech, gestures, and facial expression

Question 22

brain areas most commonly affected in akinetic mutism

Answer 22

frontal lobe
basal ganglia
mesencephalothalamic regions

Question 23

which diseases are associated with akinetic mutism

Answer 23

alzheimers disease
picks disease
creutzfeldt jakobs disease

Question 24

vegetative state

Answer 24

spontaneous eye opening but no evidence of purposeful behaviour suggesting awareness of self or environment

Question 25

what posturing may be present in vegetative state

Answer 25

decorticate decerebrate

Question 26

how long does persistent vegetative state last

Answer 26

at least 1 month

Question 27

how long does permanent vegetative state last

Answer 27

at least 12 months after TBI at least 3 months after non traumatic causes

Question 28

minimally conscious state

Answer 28

condition of sevrely altered consciousness in which there is a definitive but often subtle and inconsistent behavioural evidence of self or environmental awareness

Question 29

confusional state

Answer 29

interactive communication with amnesia, confusion, and hypokinetic/agitated/labile behaviour

Question 30

post confusional state

Answer 30

resolution in amnesia and confusion and functional independence, but higher level cognitive impairments and deficits in self awareness, social awareness, behavioural and emotional regulation

Question 31

what effect prognosis of vegetative state

Answer 31

cause severity site of damage duration depth of consciousness

Question 32

what % of pts recover from a vegetative state lasting over 1 year

Answer 32

10%

Question 33

what care is needed for a pt in vegetative state to keep pt alive

Answer 33

clinically assisted nutrition and hydration moving to prevent bedsores and muscle atrophy

Question 34

when does the decision to withdraw feeding tubes from a comatose pt need to go to court or not

Answer 34

hospital staff+family agree - no court 1 party disagrees - court of protection

Question 35

vegetative state management

Answer 35

stabilise ABC ICU admission control ICP establish cause CANH bedsore and muscle atrophy prevention

Question 36

methods for assessing consciousness

Answer 36

auditory event related potential PET scan blood oxygen level dependent fMRI

Question 37

what do auditory event related potentials identify

Answer 37

response in primary auditory and prefrontal cortices to change in monotonous sequence of sounds - MMN(negative component), P300(positive component)

Question 38

why there issues assessing consciousness based on P300 absence

Answer 38

P300 absent in 10-20% healthy individuals

Question 39

what do PETs measure to assess brain activity

Answer 39

glucose uptake

Question 40

what do BOLD fMRIs measure to assess brain activity

Answer 40

cerebral bloodflow via difference between oxyHb and deoxyHb

Question 41

how do the PET and MRI scans of a person with locked in syndrome differ from that of a healthy person

Answer 41

no difference

Question 42

effects of sensory stimulation of vegetative pts

Answer 42

increase responsiveness avoid sensory deprivation enrich environment promote neural plasticity involve family - favourite smells, tastes, images, etc

Question 43

which drug can improve functional recovery rate in early stages of unconsciousness disorders

Answer 43

amantadine

Question 44

amantadine mechanism

Answer 44

NMDA antagonist blocks dopamine reuptake

Question 45

amantadine administration

Answer 45

100-200mg 2x/day for 4wks 4-16wks after injury

Question 46

which drug can cause short term arousal in unconscious pts

Answer 46

Zolpidem

Question 47

how does zolpidem possibly work

Answer 47

increase thalamic excitatory influence on prefrontal cortices by activating GABAa in GPi