persistent vegetative states

Question 1

which two nuclei in the hypothalamus promote arousal vs sleep

Answer 1

Tuberomammillary nucleus (TMN) – promote arousal.
Ventrolateral preoptic nucleus (VLPO) – promotes sleep.

Question 2

describe the levels of consciousness in terms of arousal/awareness

normal
coma
vegetative state
minimally conscious
locked-in

Answer 2

Question 3

severe traumatic brain injury - how long minimum duration loss of consciousness

Answer 3

> 24h

Question 4

cause of locked-in system - which tracts, what symptoms

Answer 4

Primarily due to injury (e.g. trauma, ischemic) to ventral pons causing interruption to corticospinal and corticobulbar tracts causing quadriplegia and anarthria (mute).

also Guillain Barre or MND

Question 5

decorticate injury is … the red nucleus - what posture

Answer 5

above

flexed arms

Question 6

decerebrate injury is …..the red nucleus

Answer 6

below

extended everything

Question 7

what is persistent vegetative state

Answer 7

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

Question 8

what is permanent vegetative state

Answer 8

Vegetative state persisting for at least 12 months after traumatic injury.

OR
Vegetative state persisting for at least 3 months after non-traumatic causes (e.g. anoxic/hypoxia or others).

Question 9

what is the rate of recovery after 3 years persistent vegetative state

Answer 9

5%

Question 10

if someone is vegetative state, what assessment tool can you use to try to determine their level of consiousness. What are you looking for?

Answer 10

Auditory event-related potential (AERP)
P300 after after an auditory change in a monotonous sequence of sounds (oddball paradigm)

Question 11

what will you use in PET scanner to see brain activity

Answer 11

use radioactive Fluorodeoxyglucose (FDG) to see increase glucose uptake, a proxy to brain activity.