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Neurology 2 > Stupor and Coma - Sachen > Flashcards

Stupor and Coma - Sachen Flashcards

1
Q

Impaired consciousness means what?

A 
1. Diffuse or bilateral hemisphere involvement
OR
2. Brainstem ARAS involvement
OR
3. BOTH
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2
Q

Stupor

A

Arouses only to noxious stimuli (purposeful motor responses only)

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3
Q

Locked-In state

A

Aroused and aware, complete paralysis except vertical gaze

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4
Q

Akinetic mutism

A

Appears aroused but not aware, no spontaneous motor activity

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5
Q

Neck stiffness causes

A

Meningitis, sub-arachnoid hemorrhage

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6
Q

Acne cause?

A

Long-term anti-epilepsy drugs

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7
Q

Dark pigmentation in creases of hands/skin

A

Addison’s disease

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8
Q

Edema

A

Hepatic or renal failure

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9
Q

Purpura

A

Meningococcal meningitis

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10
Q

Needle marks

A

Drug OD

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11
Q

Rash

A

Meningitis, viral encephalitis, rickettsia

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12
Q

Musty breath

A

Hepatic failure

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13
Q

Fruity odor

A

Ketoacidosis

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14
Q

3 categories of causes of coma

A

Supratentorial mass (pressure-producing)
Infratentorial lesions involving brainstem
Diffuse or multifocal disease

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15
Q

Unilateral hemisphere coma causes (5)

A 
Intraparenchymal emorrhage
MCA infarct
Hematoma
Abscess
Neoplasm
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16
Q

Bilateral hemisphere coma causes (6)

A 
Subarachnoid hemorrhage
Multiple infarcts
Venous thrombosis
Cerebral edema
Hydrocephalus
Metastases
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17
Q

Intratentorial coma causes

A

Pontine hemorrhage (–> hyperthermia)
Basilar artery occlusion
Central pontine myelinolysis (hyponatremia cure)
Cerebellar hemorrhage/infarct/neoplasm/abscess
Brainstem neoplasm/infarct

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18
Q

Diffuse causes of coma

A

Hypoxia, hypoglycemia, hyperglycemia (NON-KETOTIC), hyponatremia, hepatic failure (EtOH, hepatitis), malignant hypertension, toxins, drugs, seizures

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19
Q

ESSENTIAL elements to neural exam (5)

A 
Pupillary responses
EOM movements
Motor response
Corneal reflex
Respiratory pattern
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20
Q

ALMOST essential elements to neural exam (4)

A

Neck stiffness
Cough/gag reflex
Fundoscopic exam (papilledema)
Carotid auscultation

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21
Q

Sympathetic path from brain to pupil

SO, what test result could mean a lesion along this path?

A

Hypothalamus, IMLCC, superior cervical ganglion, up carotid artery, CN V1, long ciliary nerve (dilator)

Constricted pupil

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22
Q

Parasympathetic path from brain to pupil

A

E-W nucleus (midbrain), CN 3, ciliary ganglion, short ciliary nerve (constrictor)

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23
Q

Pupillary reflexes and coma

A

Nuclei/tracts for pupils and ARAS are adjacent in brainstem, thus lesion could affect both

24
Q

Key to brainstem localization of lesion

A

Absent or unequal pupillary responses

25
Q

Pinpoint pupils

A

Pontine lesion or opiates (heroin, morphine)

26
Q

Pupils midline and unreactive

A

Midbrain lesion

27
Q

The 4 P’s of Pinpoint Pupils

A

Pontine, oPiates, Pilocarpine, Phenoparbitol

28
Q

Frontal gaze center lesion

A

Eyes deviate towards lesion

29
Q

Pontine gaze center lesion

A

Eyes deviate away from lesion

30
Q

Dysconjugate roving eye movements

A

Brainstem lesion

31
Q

Ping-pong nystagmus

A

Bi-hemispheric or midbrain

32
Q

Converge/rapid jerk back nystagmus

A

Mesencephalon

33
Q

Bobbing nystagmus (rapid down, slow up)

34
Q

Dipping nystagmus (slow down, rapid up)

A

Bihemispheric

35
Q

Caloric test - eyes deviate towards stimulus

A

Unilateral PONS

36
Q

Caloric test - eyes deviate down

A

Bilateral PONS

37
Q

Decorticate posture

Meaning?

A

Arm(s) flexed, leg(s) extended

Hemispheric lesion

38
Q

Decerebrate posture

Meaning?

A

All extremities extended

Brainstem lesion

39
Q

Flaccid paralysis

A

Pontomedullary or metabolic

40
Q

Hyper breathing alternating with no breathing

Meaning?

A

Cheynes-Stokes

Bilateral hemispheres or diencephalon

41
Q

Sustained hyperventilation

42
Q

Long inspiration followed by 2-3 second pause, then expiration

A

Apneustic - many causes

43
Q

Ataxic/irregular breathing

A

Medullary respiratory centers

44
Q

Blown pupil –> ipsilateral hemiparesis –> respiratory and postural abnormalities

A

Uncal (transtentorial) herniation progression

45
Q

Brainstem dysfunction signs (dysequilibrium, dysarthria, diplopia, vertigo), CN palsies, weird respirations

A

Subtentorial mass lesion

46
Q 
Confusion and stupor
LATER, symmetrical motor signs
Normal pupils
Asterixis, tremor, seizures
Fluctuating consciousness
A

Diffuse or metabolic cause

47
Q

Asterixis

A

Raise straight arm with wrist extended –> wrist starts to do flapping motion
- Indicates METABOLIC disorder

48
Q 
Unpredictable oculocephalic (Dolls' eye) tests
Dizzy and vomiting w/ oculovestibular (Caloric) tests
A

Psychiatric unresponsiveness

49
Q

Causes of global cerebral ischemia

A

Cardiac arrest or pulmonary arrest

50
Q

Cause of persistent vegitative state

A

Prolonged global cerebral ischemia

51
Q

Brain death

A

No brain function, including respirations
Heartbeat still active
Unresponsive
Absent brainstem reflexes

52
Q

Things that can mimic brain death

A

Shock, sedative intoxication, neuromuscular blockade, hypothermia (

53
Q

Initial steps for comatose treatment

A

ABCs, Hx, exam, EKG, glucose and thiamine, antidote, adjust body temp, control agitation and seizures

54
Q

How to reduced increased ICP?

A 
Elevate head of bed
Intubate and hyperventilate to PCO2 of 20mm
Mannitol for ischemic lesions
Decadron for masses or hemorrhage
Maybe Lasix (diuretic)
55
Q

How to treat seizures?

A

Lorazepam or Phenytoin

Neurology 2 (22 decks)

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