Stupor and Coma -Rothrock

Question 1

If you are having decreased level of consciousness what does this imply?

Answer 1

diffuse bihemispheric disorder, disorder afflicting the ascending reticular activating system or both

Question 2

If you have a greater decreased level of consciousness and only a few focal signs, what should you be thinking?

Answer 2

extracerebral problem

Question 3

If you have a large amount of focal signs and a small amount of decreased level of consciousness, then what should you be thinking?

Answer 3

intracerebellarl problem

Question 4

What does intracerebral mean?

Answer 4

it means relating to the brain

Question 5

IF you have a patient with this type of hemmorhage, the initial exam may be normal unless you get the patient out of bed

Answer 5

intracerebellar hemorrhage

Question 6

An intracerebellar hemorrhage is a subtype of what kind of hemorrhage?

Answer 6

intracerebral hemorrhage

Question 7

As will all intracerebral hemorrhages, Intracerebellar hemorrhage may expand in size over the first few (blank) following presentation (w/ associated clinical deterioration).
What can this cause?

Answer 7

hours

cerebellar tonsils to (rapidly) herniate through the foramen magnum

Question 8

(blank) also known as focal neurological deficits or focal CNS signs are impairments of nerve, spinal cord, or brain function that affects a specific region of the body, e.g. weakness in the left arm, the right leg etc.

Answer 8

Focal neurologic signs

Question 9

When will you see focal signs with a SAH?

Answer 9

if it extends into brain parenchyma or the pnt subacutely suffers vasospasm and ischemic stroke

Question 10

If you have a seizure patient who is unconscious do to alcohol and hypoglycemia, fosphenytoin takes (blank) minutes before it works so you should give (blank) first. WHy cant you give lorazepam alone?

Answer 10

15 minutes

lorazepam has short half life

Question 11

What are some manifestations of subarachnoid hemorrhage?

Answer 11

subhyaloid hemorrhages
early papilledema
cushings sign

Question 12

What is a subhyaloid hemorrhage?

Answer 12

bleeding under the hyaloid membrane, which envelops the vitreous body of the eye

Question 13

What is papilledema?

Answer 13

swelling of the optic disc due to increase ICP

Question 14

What is Cushings sign/reflex?

Answer 14

Cushing reflex is a physiological nervous system response to increased intracranial pressure (ICP) that results in Cushing’s triad of increased blood pressure, irregular breathing, and a reduction of the heart rate.

Question 15

What is hepatic encephalopathy?

Answer 15

the loss of brain function that occurs when the liver is unable to remove toxins from the blood

Question 16

If you have a decorticate movement what is wrong?

Answer 16

brainstem

Question 17

What is oculocephalics?

Answer 17

VOR reflex

Question 18

In the absence of bilateral pupillary trauma or surgery, and if there is no hypothermia or barbituate on board (or other condition known to produce “reversible brain death”), the absence of a pupillary light response in a comatose patient typically suggests a (blank) percent chance of meaningful neurologic recovery

Answer 18

zero%

Question 19

T or F

A patient can remain comatose and yet exhibit neurologic improvement via a focused neurologic exam

Answer 19

T

Neurologic deterioration in a comtaose patient conveys a very poor prognosis

Question 20

How do you determine brain death?

Answer 20

no evidence of brain or brain stem function (in absence of sedative/hypnotic drugs, paralytic agents or hypothermia)
-diagnosis best made via history and bedside exam

Question 21

What is the “brain death” bedside exam?

Answer 21

LOC
Pupils, corneal responses, oculocephalics/oculocalorics, [fundi]
Apnea test