Stupor & Coma Flashcards
vasogenic edema
edema due to breakdown of BBB and fluid infiltration from vessel leakage
cytotoxic edema
edema due to cell damage
Hydrocephalus
excess accumulation of the CSF in the ventricular system (usually due to impaired flow or resorption of CSF
wallerian degeneration
degeneration of an axon distal to the site of injury
stupor
pathological reduced LOC from which person can be aroused w/ intense or persistant stimulation
hysterical coma
coma-like state w/ normal EGG, nystagmus and neuro signs
what maintains consciousness?
the reticular formation of the rostral brainstem
what depresses consciousness?
bilateral diffuse suppression of cerebral cortical activity or damage to the reticular formation
decorticate position
upper ext. flexion and low ext. extension (damage to diencephalon)
decerebrate position
upper and lower ext. extension (damage to mesencephalon or upper pons)
what are the milestones of decreasing respiratory function?
sighing and yawning –> Cheyne-Stokes resp. pattern –> central neurogenic hyperventialtion –> ataxic respirations, apnea
what is the last brainstem reflex to be affected with midbrain damage?
pupillary light reflex
general effects of damage/pressure on the upper diencephalon (thalamus)?
drowsy, yawning, sighs
small, reactive pupils (SNS affected)
depression of nystagmus
left hemiparesis, bilateral paratonia
general effects of damage/pressure on the lower diencephalon (hypothalamus)?
coma cheyne-stokes respirations small reactive pupils no nystagmus hemiparesis, decorticate posturing
general effects of damage/pressure on the mesencephalon (midbrain)?
coma Cheyne Stokes of Central neuro hyperventilation pupils fixed in mid-position dysconjugate ocular response decerebrate posturing
general effects of damage/pressure on the upper pons?
coma hyperventialtion or ataxic respirations midposition, fixed pupils decr. ocular responses decerebrate
general effects of damage/pressure on the lower pons or medulla?
coma ataxic or apneic respirations midposition fixed pupils no ocular-vestibular reflexes flaccid body
What is the most common cause of stupor or coma?
metabolic encephalopathy
What is the vegetative state?
pt. is wakeful but is not aware of self and environment (brainstem and hypothalamus are spared)
What commonly causes the vegetative state?
- diffuse hypoxic-ischemic neuronal damage (MI)
2. diffuse axonal injury (trauma)
What is the minimally conscious state?
profound lack of consciousness, but partial or intermittent evidence of awareness of self and environment
Locked-in syndrome
state of profound paralysis in which the patient is alert and awake - can still perform vertical eye movements and eyelid movements
general criteria for brain death
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)
