Quiz 1 - definitions, substrates, evaluation of consciousness Flashcards
coma definition
- pathological
- unconscious
- cannot be aroused
- deep vs light - in light reflex motor response can be aroused by noxious stimulus
stupor definition
- pathological
- reduced consciousness
- can be aroused with intense or purposeful stimulation
range of stupor
drowsiness to deep stupor
sleep definition
- non-pathological
- active and reversible state of consciousness
hysterical coma definition, how differentiated?
- feigned or subconsciously assumed depression of consciousness
- will have normal EEG, nystagmus on irrigation of auditory canal, no abnormal neurologic signs
explain the base of the pons exception
- most of the time when someone is conscious yet unresponsive it is obvious what (GB syndrome, MG, porphyria)
- damage to base of pons - patient becomes acutely unresponsive but will keep vertical and convergent eye movement, sight, and hearing
- LOCKED IN syndrome
reticular vs hemispheric involvement in depression of consciousness
- reticular involves mass lesions above or below the tentorium affecting reticular function (less common)
- hemispheric involvement is almost always metabolic and depresses the reticular formation indirectly
importance of cortical hemispheres in consciousness
- anything causing diffuse dysfunction of the cortex, whether destruction or encephalopathy, will cause stupor and/or coma
relationship between cortex and rostral reticular formation
- rostral reticular formation is termed the reticular activating system and the cortex can’t function without it
- reticular activating system can work without cortex and maintain a crude sleep-wake vegetative state
- cortex is much more sensitive to toxic stimuli
common causes of direct damage to reticular formation
- hemorrhage
- neoplasm
- abscess
- trauma
- inschemia/infarction
what part of the temporal lobe usually herniates the tentorial notch?
uncus
what pattern of deterioration is caused by tentorial notch herniation
rostrocaudal deterioration
order of brain deterioration in rostrocaudal process
- diencephalon
- mesencephalon
- pons/medulla
evaluation of coma is primarily to differentiate between which two things?
- coma caused by diffuse cortical damage vs that caused by damage for reticular activating system
components of neuro eval of coma patient
- LOC
- resp pattern
- pupil size
- oculomotor vestibular function
- motor function
what does drowsy look like?
opens eyes to stimulation but goes back to eyes closed when not stimulated
what does deep stupor look like?
needs vigorous stimulation to get response
what does deep coma look like?
no reaction even to noxious stimuli
if best motor response is withdrawal or posturing…
patient is not conscious
respiration in diffuse cerebral cortical dysfunction
- drowsiness, sighing respirations, yawning
when is a Cheyne Stokes resp pattern seen?
- damage to diencephalon or mesencephalon
- sometimes in diffuse cerebral cortical dysfunction
what is Cheyne Stokes respiration?
- crescendo-decrescendo pattern
- periods of apnea of variable length
when is Cheyne Stokes respiration most apparent?
during sleep
respiration in damage to lower mesencephalon/upper pons
- central neurogenic hyperventilation, 20-40 rpm
- danger of respiratory alkalosis
- deep breathing
