Stupor & Coma

Question 1

vasogenic edema

Answer 1

edema due to breakdown of BBB and fluid infiltration from vessel leakage

Question 2

cytotoxic edema

Answer 2

edema due to cell damage

Question 3

Hydrocephalus

Answer 3

excess accumulation of the CSF in the ventricular system (usually due to impaired flow or resorption of CSF

Question 4

wallerian degeneration

Answer 4

degeneration of an axon distal to the site of injury

Question 5

stupor

Answer 5

pathological reduced LOC from which person can be aroused w/ intense or persistant stimulation

Question 6

hysterical coma

Answer 6

coma-like state w/ normal EGG, nystagmus and neuro signs

Question 7

what maintains consciousness?

Answer 7

the reticular formation of the rostral brainstem

Question 8

what depresses consciousness?

Answer 8

bilateral diffuse suppression of cerebral cortical activity or damage to the reticular formation

Question 9

decorticate position

Answer 9

upper ext. flexion and low ext. extension (damage to diencephalon)

Question 10

decerebrate position

Answer 10

upper and lower ext. extension (damage to mesencephalon or upper pons)

Question 11

what are the milestones of decreasing respiratory function?

Answer 11

sighing and yawning –> Cheyne-Stokes resp. pattern –> central neurogenic hyperventialtion –> ataxic respirations, apnea

Question 12

what is the last brainstem reflex to be affected with midbrain damage?

Answer 12

pupillary light reflex

Question 13

general effects of damage/pressure on the upper diencephalon (thalamus)?

Answer 13

drowsy, yawning, sighs
small, reactive pupils (SNS affected)
depression of nystagmus
left hemiparesis, bilateral paratonia

Question 14

general effects of damage/pressure on the lower diencephalon (hypothalamus)?

Answer 14

coma
cheyne-stokes respirations
small reactive pupils
no nystagmus
hemiparesis, decorticate posturing

Question 15

general effects of damage/pressure on the mesencephalon (midbrain)?

Answer 15

coma
Cheyne Stokes of Central neuro hyperventilation
pupils fixed in mid-position
dysconjugate ocular response
decerebrate posturing

Question 16

general effects of damage/pressure on the upper pons?

Answer 16

coma
hyperventialtion or ataxic respirations
midposition, fixed pupils
decr. ocular responses
decerebrate

Question 17

general effects of damage/pressure on the lower pons or medulla?

Answer 17

coma
ataxic or apneic respirations
midposition fixed pupils
no ocular-vestibular reflexes
flaccid body

Question 18

What is the most common cause of stupor or coma?

Answer 18

metabolic encephalopathy

Question 19

What is the vegetative state?

Answer 19

pt. is wakeful but is not aware of self and environment (brainstem and hypothalamus are spared)

Question 20

What commonly causes the vegetative state?

Answer 20

1. diffuse hypoxic-ischemic neuronal damage (MI)

2. diffuse axonal injury (trauma)

Question 21

What is the minimally conscious state?

Answer 21

profound lack of consciousness, but partial or intermittent evidence of awareness of self and environment

Question 22

Locked-in syndrome

Answer 22

state of profound paralysis in which the patient is alert and awake - can still perform vertical eye movements and eyelid movements

Question 23

general criteria for brain death

Answer 23

no drugs on board, normal temp, normal BP, coma, apnea, no reflexes, can be confirmed with neuroimaging, CT or MR angiography, or EEG testing (isoelectric)