SM_84b: Brain States

Question 1

_____ is maintaining cognitive focus on a single task or behavior

Answer 1

Attention is maintaining cognitive focus on a single task or behavior

Question 2

____ is the level of conscious brain activity

Answer 2

Arousal is the level of conscious brain activity

Question 3

_____ is the process of receiving, interpreting, and acting on sensory input to the brain

Answer 3

Cognition is the process of receiving, interpreting, and acting on sensory input to the brain

Question 4

Clearest transition between normal states is between ____ and ____

Answer 4

Clearest transition between normal states is between awake and asleep

Question 5

Brain is a ____ system

Answer 5

Brain is a semiparallel system (distinct domains of function)

Question 6

____ deficits are abnormalities of brain function that typically result from injuries to specific parts of a pathway related to a domain of neurologic function

Answer 6

Focal deficits are abnormalities of brain function that typically result from injuries to specific parts of a pathway related to a domain of neurologic function

Question 7

Most focal deficits show patterns of injury that are _____, meaning they only occur from injury at a specific place in the nervous system

Answer 7

Most focal deficits show patterns of injury that are localizing, meaning they only occur from injury at a specific place in the nervous system

Question 8

Drunk rule of thumb for nonfocal deficits: ____, ____, ____, ____, ____, etc

Answer 8

Drunk rule of thumb for nonfocal deficits: ataxia, dysarthria, inattention, confusion, headache, etc

Question 9

System for modulating brain activity accomplishes basic neuron-to-neuron signaling with ____ and ____

Answer 9

System for modulating brain activity accomplishes basic neuron-to-neuron signaling with glutamate and GABA

Question 10

Pineal gland secreting ____ and hypothalamus-____ system are involved in inducing sleep

Answer 10

Pineal gland secreting melatonin and hypothalamus-orexin system are involved in inducing sleep

Question 11

_____ is a small collection of nuclei starting in the brainstem that induce arousal

Answer 11

Ascending reticular activating system is a small collection of nuclei starting in the brainstem that induce arousal

• Midbrain -> interlaminar nuclei of the thalami -> cortex
• Use ACh and NE

Question 12

Impairment of arousal results from

• ____
• ____
• ____

Answer 12

Impairment of arousal results from

• Injury to the ascending reticular activating system in the midbrain
• Injury to both thalami interrupting the transmission of the ascending reticular activating system to the cortex
• Widespread dysfunction of both cerebral hemispheres

Question 13

_____ is a state of unresponsiveness where the patient cannot be stimulated to respond purposefully

Answer 13

Coma is a state of unresponsiveness where the patient cannot be stimulated to respond purposefully

• No awareness of self or environment
• No eye opening or evidence of circadian rhythm

Question 14

_____ is a state between alert and coma in which the patient can respond purposefully but requires constant stimulation to engage

Answer 14

Stupor is a state between alert and coma in which the patient can respond purposefully but requires constant stimulation to engage

Question 15

____ is similar to stupor but involves a more mild reduction in level of arousla

Answer 15

Obtundation is similar to stupor but involves a more mild reduction in level of arousla

Question 16

_____ is a state of fluctuating attention and cognitive clarity often accompanied by sensory misperceptions / hallucinations

Answer 16

Delirium is a state of fluctuating attention and cognitive clarity often accompanied by sensory misperceptions / hallucinations

• Often due to generalized illness
• Often in people vulnerable due to age or other chronic mild brain injury, but not caused by direct brain injury
• Associated with poor outcomes after acute injury and greater risk of death

Question 17

_____ occurs when injury to the pons impairs facial movements, eye movements, and interrupts the corticospinal tract causing quadriplegia

Answer 17

Locked-in syndrome occurs when injury to the pons impairs facial movements, eye movements, and interrupts the corticospinal tract causing quadriplegia

• Conscious but unable to create muscle movements

Question 18

_____ is like a coma but with return of some circadian rhythm that causes periods of eye opening, roving eye movements, and autonomic changes typically seen with the sleep / wake cycle but without evidence of awareness of self or environment

Answer 18

Vegetative state is like a coma but with return of some circadian rhythm that causes periods of eye opening, roving eye movements, and autonomic changes typically seen with the sleep / wake cycle but without evidence of awareness of self or environment

• Coma -> vegetative state in 10-30 days

Question 19

_____ is a state of severely impaired consciousness with minimal but definite behavioral evidence of self or environmental awareness

Answer 19

Minimally conscious state is a state of severely impaired consciousness with minimal but definite behavioral evidence of self or environmental awareness

Question 20

_____ is an apathetic state with cognitive and behavioral slowing (psychomotor retardation) but with intact cognitive function caused by _____ injuries

Answer 20

Abulia is an apathetic state with cognitive and behavioral slowing (psychomotor retardation) but with intact cognitive function caused by medial frontal lobe injuries

Question 21

_____ is an extreme form of abulia, typically caused by _____ basal-medial frontal lobe injuries, also often involving the hypothalamus

Answer 21

Akinetic mutism is an extreme form of abulia, typically caused by bilateral basal-medial frontal lobe injuries, also often involving the hypothalamus

Question 22

_____ is a term usually applied to acute global brain dysfunction

Answer 22

Encephalopathy is a term usually applied to acute global brain dysfunction

Question 23

Altered mental status may result from ____, ____, ____, or ____

Answer 23

Altered mental status may result from bihemispheric brain dysfunction, bilateral thalamic dysfunction, midbrain injury, or mimics

Question 24

_____ is irreversible loss of all functions of the entire brain, including all functions of the cerebrum, brainstem, and respiratory function

Answer 24

Brain death is irreversible loss of all functions of the entire brain, including all functions of the cerebrum, brainstem, and respiratory function

Question 25

Brain death is based on ____

Answer 25

Brain death is based on function

Question 26

Basic brain death criteria include ____, ____, and ____

Answer 26

Basic brain death criteria include no purposeful responses to any stimuli including noxious stimuli, no brainstem reflexes, and no spontaneous respiratory movements

Question 27

Determination of brain death requires ____ and ____ while ____ may occur

Answer 27

Determination of brain death requires identification of a clear etiology that can cause massive brain injury and confirmation that there are no factors confounding exam findings while movements generated by the spinal cord may occur

Question 28

Ancillary tests to determine brain death are needed when

• _____
• _____

Answer 28

Ancillary tests to determine brain death are needed when

• Apnea test to confirm absence of spontaneous respiratory movements cannot be done safely
• Certain factors impede a complete neurologic exam (e.g. traumatic facial injuries obscure brainstem reflex tests)