SM_84b: Brain States Flashcards
_____ is maintaining cognitive focus on a single task or behavior
Attention is maintaining cognitive focus on a single task or behavior
____ is the level of conscious brain activity
Arousal is the level of conscious brain activity
_____ is the process of receiving, interpreting, and acting on sensory input to the brain
Cognition is the process of receiving, interpreting, and acting on sensory input to the brain
Clearest transition between normal states is between ____ and ____
Clearest transition between normal states is between awake and asleep
Brain is a ____ system
Brain is a semiparallel system (distinct domains of function)
____ deficits are abnormalities of brain function that typically result from injuries to specific parts of a pathway related to a domain of neurologic function
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
Most focal deficits show patterns of injury that are _____, meaning they only occur from injury at a specific place in the nervous system
Most focal deficits show patterns of injury that are localizing, meaning they only occur from injury at a specific place in the nervous system
Drunk rule of thumb for nonfocal deficits: ____, ____, ____, ____, ____, etc
Drunk rule of thumb for nonfocal deficits: ataxia, dysarthria, inattention, confusion, headache, etc
System for modulating brain activity accomplishes basic neuron-to-neuron signaling with ____ and ____
System for modulating brain activity accomplishes basic neuron-to-neuron signaling with glutamate and GABA
Pineal gland secreting ____ and hypothalamus-____ system are involved in inducing sleep
Pineal gland secreting melatonin and hypothalamus-orexin system are involved in inducing sleep
_____ is a small collection of nuclei starting in the brainstem that induce arousal
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
Impairment of arousal results from
- ____
- ____
- ____
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
_____ is a state of unresponsiveness where the patient cannot be stimulated to respond purposefully
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
_____ is a state between alert and coma in which the patient can respond purposefully but requires constant stimulation to engage
Stupor is a state between alert and coma in which the patient can respond purposefully but requires constant stimulation to engage
____ is similar to stupor but involves a more mild reduction in level of arousla
Obtundation is similar to stupor but involves a more mild reduction in level of arousla
_____ is a state of fluctuating attention and cognitive clarity often accompanied by sensory misperceptions / hallucinations
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
_____ occurs when injury to the pons impairs facial movements, eye movements, and interrupts the corticospinal tract causing quadriplegia
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
_____ 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
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
_____ is a state of severely impaired consciousness with minimal but definite behavioral evidence of self or environmental awareness
Minimally conscious state is a state of severely impaired consciousness with minimal but definite behavioral evidence of self or environmental awareness
_____ is an apathetic state with cognitive and behavioral slowing (psychomotor retardation) but with intact cognitive function caused by _____ injuries
Abulia is an apathetic state with cognitive and behavioral slowing (psychomotor retardation) but with intact cognitive function caused by medial frontal lobe injuries
_____ is an extreme form of abulia, typically caused by _____ basal-medial frontal lobe injuries, also often involving the hypothalamus
Akinetic mutism is an extreme form of abulia, typically caused by bilateral basal-medial frontal lobe injuries, also often involving the hypothalamus
_____ is a term usually applied to acute global brain dysfunction
Encephalopathy is a term usually applied to acute global brain dysfunction
Altered mental status may result from ____, ____, ____, or ____
Altered mental status may result from bihemispheric brain dysfunction, bilateral thalamic dysfunction, midbrain injury, or mimics
_____ is irreversible loss of all functions of the entire brain, including all functions of the cerebrum, brainstem, and respiratory function
Brain death is irreversible loss of all functions of the entire brain, including all functions of the cerebrum, brainstem, and respiratory function
Brain death is based on ____
Brain death is based on function
Basic brain death criteria include ____, ____, and ____
Basic brain death criteria include no purposeful responses to any stimuli including noxious stimuli, no brainstem reflexes, and no spontaneous respiratory movements
Determination of brain death requires ____ and ____ while ____ may occur
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
Ancillary tests to determine brain death are needed when
- _____
- _____
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)
