Task 1 L Flashcards
What are the two main components of consciousness ?
- Awareness (command following)
- Arousal (eyes opening)
What does consciousness mean in medical sense ?
- shows evidence of purposeful behavior in response to the environment
- not an all or nothing state
1. Consciousness content
2. Consciousness level
What is meant by consciousness content ?
- The subjective state
- It is on scale with 3 stages
- alll about recognition
- qualitative aspect of awareness
What are the 3 stages of consciousness content ?
- nothing noticed – normal perception – hallucinations
What are some impairments regarding qualitative consciousness (awareness/content) ?
- Clouded awareness”
- Narrowing of one’s awareness (very specific awareness) -> phobia
- Awareness shif
What is meant by consciousness level ?
- quantitative aspect of arousal
- objective state
- it is on a scale with 3 stages
What are the 3 stages of consciousness level ?
- awake
- unarousable
- dead
What are some impairments regarding quantittive consciousness (arousal/lvl) ?
- Drowsiness – normal sleepiness –
- Somnolence – abnormal sleepiness, but acoustically arousable
- Sopor – abnormal sleepiness but not acoustically arousable, but reaction to pain stimuli possible
- Coma – no reaction to visual, acoustic or pain stimuli
Explain the process on how we become unconscious:
- Head trauma
- Destroyed brain tissue
- Swellling of tissue (maybe bleeding)
- reduced space within skull
- high pressure on brain structures
- Dysfunctional arousal systems
Name the causes for a head trauma:
- High intracranial pressure or direct affection to brain structures
- Psychogenic/Psychiatric
- Neurological conditions
- Medical interventions
- Physiological
Which brain structures are involved in consciousness ?
- Reticular formation (RAS)
- Thalamus (gate)
- Cerebral cortex (Frontal and parietal lobe)
- Ascending and descending pathways
Which particular part of the cerebral cortex is important ?
- Corpus callosum for interacting
2. Fusiform face are (general specialized areas
Which particular pathways are of importants ?
- For arousal: cholinergic and (nor-)adrenergic pathways
- For awareness: dopaminergic and serotonergic pathways
How do we determine if someone is unconscious ?
- Needs several clinical signs (those are questions)
- Always two clinicans
- check medical history
- check reactions made from responses to external stimuli
- Also check neurological parts
- Also they make use of certain scales to evaluate
Which scales are usually used to meassure consciousness ?
- MMS
- GCS
What does the GCS in particular meassure ?
- Qualitive consciousness
1. Eye opening
2. verbal responses
3. best motor response - underneath or 6 points coma
What is meant by the locked syndrome ?
- consciousness / emotion is there but almost no controlled body movement
- Arousal andconsicouness is high
- no communication
- usually caused by stroke in ventral pons
What are the 3 lvls of the locked in syndrome ?
- incomplete LIS -> small extent of movement
- Classical LIS -> only eye movement possible
- Complete LIS -> nothing can be moved voluntairly
What is meant by the vegetative state ?
- No body movement and no conscious
- Also called Uresponsive wakefulness syndrome
- pain is still possible
- Abnormal sleep cyles
- 2 types of vegetative state
- Arousal is high but no awareness
What are the two types of the vegetative state ?
- Minimally conscious state
2. Permanent vegetative state (>3 months)
What is meant by minimally conscious state
- Generally unresponsive patients
- Sometimes cognitively mediated behavior
- Arousal high and awareness a bit active
What is the definiton of a coma ?
- Absence of arousal and awareness
- Unresponsiveness for at least 1 hour
What is meant by brain death ?
- Final breakdown of all brain functions
Which method can be used to determine brain death ?
- EEG - > shows a flat line
- Be aware that deep anesthesia or cardiac arrest also flat EGG
Which methods can be maybe used in the future to detect if someone is consicious or unconscious ?
- EEG
- FMRI
- PET
How does the fmri in particular determine consicousness ?
- Mental task will be performed
2. Focus on activity in SMA also on three P !!
How does the PET in particular determine consicousness ?
- High activation Trinagle on parietal lobe
2. Using a painful leaser
Can neuroimaging studies help to identify consciousness ?
- They can give certain insight on what kind of mechanism are involved in consciousness but we are not sure if the relationship between the mechanism and consciousness determines anything .
- neuroimaging will not exchange in near future the clinical perspective/judgemnt
How much money to we pay to keep people alive in a vegetative state ?
- 1 to 7 billion