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BB CC > Persistent Vegetative State > Flashcards

Persistent Vegetative State Flashcards

1
Q

Wakefulness

A

Ability to have basic reflexes such as open eyes, cough, swallow, suck

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2
Q

Awareness

A

Ability to carry out complex though processes

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3
Q

Seat of consciousness

A

Lateral Prefrontal cortex

Posterior Parietal cortex

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4
Q

Pontine tegmentum

A

Controls sleep states + levels of arousal and vigilance

Disconnection causes disorders of consciousness

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5
Q

Global workshop theory

A

Integrate all senses into a single picture and filter out conflicting information

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6
Q

15 GCS

A

Alert

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7
Q

12 GCS

A

Verbal stimuli

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8
Q

8 GCS

A

Painful stimuli

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9
Q

3 GCS

A

Unresponsive

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10
Q

Levels of consciousness

A

AVPU

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11
Q

Ascending reticular activating system (ARAS)

A

Important for alerting or arousal (wakefulness/awareness)

Involve number of structures in rostral brain stem tegmentum, the diencephalon, and projections to cerebral cortex

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12
Q

Centres for sleep

A

Mainly in preoptic region of hypothalamus

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13
Q

Disorders of consciousness

A

Comatose- asleep + unconscious
Vegetative- awake and unconscious
Minimally conscious state- awake and some consciousness

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14
Q

Comatose state

A

State of complete unresponsiveness
Patient lies with eyes closed + can’t be aroused to respond appropriately to any stimuli
Lasts few weeks, rarely longer than month

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15
Q

Stupor

A

Similar to coma but will respond to strong stimuli

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16
Q

Locked in syndrome

A

Unresponsiveness
Patient lies with eyes closed + can’t be aroused to respond to stimuli
BUT patient retains eye movement + are fully conscious

17
Q

Locked in syndrome cause

A

Injury (trauma, ischaemia) to ventral pons
–> interruption to corticospinal + corticobulbar tracts –> quadriplegia + anarthrua
Guillain-Barre syndrome or MND

18
Q

Locked in syndrome communication

A

E-tran frame

Brain computer interface

19
Q

Akinetic mutism

A

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

20
Q

Vegetative state/ Unresponsive Wakefulness syndrome

A

Spontaneous eye-opening signalling wakefulness, but no evidence of purposeful behaviour suggesting awareness of self or environment
No purposeful behaviours when exposed to stimuli- visual, auditory, tactile, noxious, no language comprehension ore expression

21
Q

Persistent vegetative state

A

Vegetative state persisting for at least 1 month after TBI or non-TBI

22
Q

Permanent vegetative state

A

Persisting at least 12 months after TBI

Persisting for at least 3 months after non-traumatic causes

23
Q

Minimally conscious state

A 
Condition of severely altered consciousness where definite, but often subtle and inconsistent, behavioural evidence of self or environmental awareness
Yes or no simple
Follow simple commands
Smile etc
Often after coma or VGS
24
Q

Confusional state

A

Interactive communication
Amnesia/condfusion
Hypokinetic or agitated
Labile behaviour

25
Q

Post-confusional state

A

Resolution in amnesia/confusion
Cognitive impairments in higher levels- attention, memory retrieval, executive functioning
Deficits in self awareness
Functional independence in daily self care

26
Q

Poor prognosis

A

Absent brain stem reflexes

27
Q

More favourable prognosis

A

Return of speech
Spontaneous eye movements that can track objects
Normal resting tone
Ability to follow commands

28
Q

Auditory event-related potential

A

Assessing consciousness
Aim to identify a mismatch negativity (100-250ms after auditory change)
Aim to identify a P300- BUT absent in 10-20% of healthy individuals

29
Q

PET

A

Use radioactive FDG to see increase glucose uptake–> brain activity

30
Q

Blood oxygenation level dependent

A

fMRI imaging

Difference between oxyHb and deoxyHb

31
Q

Amantidine

A

Weak NMDA receptor agonist + blocks dopaminergic reuptake

100-200mg twice daily over 4 weeks

32
Q

Zolpidem

A

Indirect GABAa receptor agonist
Half life 2.4 hours
Is an insomnia drug
Mimics inhibition of striatum on GPi (had been lost)–> increase in thalamic excitatory influence on prefrontal cortices

33
Q

Vagal nerve stimulation

A

Future treatment

BB CC (29 decks)

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