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BB2 > Persistent Vegetative State > Flashcards

Persistent Vegetative State Flashcards

1
Q

consciousness

A

state of full awareness of self and environment

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2
Q

wakefeullness

A

ability to have basic reflexes

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3
Q

awareness

A

ability to carry out complex thought processes

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4
Q

psychological unconsciousness

A

state of unawareness or repressed ideas

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5
Q

neurological unconsciousness

A

paralytic coma due to brain disfunction

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6
Q

role of ascending reticular activating system ARAS

A

alerting and arousal

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7
Q

structures in the ascending reticular activating system

A

pontine tegmentum
thalamus
lateral prefrontal cortex

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8
Q

which parts of the hypothalamus promote arousal and sleep

A

arousal - tuberomammillary nucleus
sleep - venterolateral preoptic nucleus

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9
Q

which nucleus is involved in the circadian clock

A

suprachiasmatic nucleus

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10
Q

what can cause disorders of consciousness

A

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

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11
Q

scales for assessing consciousness alteration and duration

A

GCS glasgow coma scale
LOC loss of consciousness

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12
Q

4 outcomes of coma

A

brain death
vegetative state
locked in syndrome
recover wakefulness

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13
Q

3 main categories of unconsciousness

A

comatose
vegetative
minimally conscious

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14
Q

comatose state

A

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

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15
Q

stupor

A

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

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16
Q

difference between deep sleep and coma

A

no REM in coma

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17
Q

how long does coma usually last

A

a couple of weeks

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18
Q

locked in syndrome

A

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

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19
Q

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

A

ventral pons - interrupts corticospinal and corticobulbar tracts

20
Q

how can pts with locked in syndrome communicate

A

e-Tran frame
brain computer interface

21
Q

akinetic mutism

A

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

22
Q

brain areas most commonly affected in akinetic mutism

A

frontal lobe
basal ganglia
mesencephalothalamic regions

23
Q

which diseases are associated with akinetic mutism

A

alzheimers disease
picks disease
creutzfeldt jakobs disease

24
Q

vegetative state

A

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

25
Q

what posturing may be present in vegetative state

A

decorticate
decerebrate

26
Q

how long does persistent vegetative state last

A

at least 1 month

27
Q

how long does permanent vegetative state last

A

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

28
Q

minimally conscious state

A

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

29
Q

confusional state

A

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

30
Q

post confusional state

A

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

31
Q

what effect prognosis of vegetative state

A

cause
severity
site of damage
duration
depth of consciousness

32
Q

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

A

10%

33
Q

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

A

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

34
Q

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

A

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

35
Q

vegetative state management

A

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

36
Q

methods for assessing consciousness

A

auditory event related potential
PET scan
blood oxygen level dependent fMRI

37
Q

what do auditory event related potentials identify

A

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

38
Q

why there issues assessing consciousness based on P300 absence

A

P300 absent in 10-20% healthy individuals

39
Q

what do PETs measure to assess brain activity

A

glucose uptake

40
Q

what do BOLD fMRIs measure to assess brain activity

A

cerebral bloodflow via difference between oxyHb and deoxyHb

41
Q

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

A

no difference

42
Q

effects of sensory stimulation of vegetative pts

A

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

43
Q

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

A

amantadine

44
Q

amantadine mechanism

A

NMDA antagonist
blocks dopamine reuptake

45
Q

amantadine administration

A

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

46
Q

which drug can cause short term arousal in unconscious pts

A

Zolpidem

47
Q

how does zolpidem possibly work

A

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

BB2 (26 decks)

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