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34 Cards in this Set

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What part of the brain does arousal depend on? Where is this located?
1. RAS

2. Mid-pons to the hypothalamus
What parts of the brain does content depend on?
The person must have some level of arousal accompanied by fuctional cortex, cortical-cortical and cortical-thalamic interconnections.
What are three basic pathologic divisions of comas?
1. Supratentorial (secondary impinged on RAS)

2. Infratentorial (directly damaged RAS)

3. Metabolic disorders (diffusely interferes w/ brain fxn)
What condition is described as having a rapid onset and fluctuations in level of awareness?
Delirium
What condition is described as reduction in alertness/lethargic?
Obtundation
What condition is described as a setting where the patient has to be constantly stimulated to maintain them/behavioral unresponsiveness?
Stupor
What condition is described as unarousable unresponsiveness?
Coma
What type of breathing is described as a repetitive cresendo-decresendo pattern? Where is the damage to the brain?
1. Cheyne-Stokes

2. Bilateral hemispheric
What type of breathing is describes as big, fast, deep breaths that are continuous? Where is the damage to the brain?
1. Tachypnea

2. Midbrain or upper pons
What type of breathing has end-inspiratory pauses followed by end-expiratory pauses? Where is the damage to the brain?
1. Apneusis

2. Mid-pons
What type of breathing is described as irregular clusters of breathing separated by irregular time periods? Where is the damage to the brain?
1. Cluster breathing

2. Lower pons to upper medulla
What type of breathing is described as having a chaotic rate and amplitude that is indicative of impending apnea?
Ataxic breathing
What is the best way to distinguish between a diffuse metabolic problem or a focal structural damage?
Examine the pupils
Metabolic problems show what type of pupils?
Small reactive pupils
Diencephalon/thalamic damage show what type of pupils?
Small reactive pupils
Tectal damage show what type of pupils?
Large, fixed pupils with hippus
CNIII damage shows what type of pupils?
Fixed and dilated
Pons damage shows what type of pupils?
Pinpoint

"Pons = Pinpoint"
Midbrain damage show what type of damage?
Midposition and fixed pupils

"Midbrain = Midposition"
Eyes should move conjugately in the direction opposite to head rotation
Oculocephalic reflex (Doll's eyes)
Cold calorics is which reflex?
Oculovestibular reflex
A full range of horizontal and vertical eye movements rules out what type of damage?
Brainstem damage
squirt cold water in both ears = ?

sprirt hot water in both ears = ?
Look down

Look up

"Hot water good...so look UP and take your shower zilla!"
What two CNs does the corneal reflex test?
CN V - feeling
CN VII - blinking
Gag reflex involves which CN(s)?
CN's IX & X
Decorticate posturing is flexion/extension?
Flexion
Decerebrate posturing is flexion/extension?
Extension
What is an uncal herniation a result of? What CN does this affect? What then happens?
1. Unilateral supratentorial mass
2. CNIII - first unilateral pupillary diation, ptosis then full palsy.
3. It then can cause compression of the contralateral cerebral peduncle (KERNOHAN'S NOTCH) and bilateral hemplegia (false localizing sign)
What happens with progressive bilateral motor dysfunction
Central transtentorial herniation
What is a deterioration in cognitive abilities without a decline in arousal?
Dementia
What condition can be described as total loss of movement except for vertical eye movements and blinking. What part of the brain is damaged? What usually causes this?
1. Locked in syndrome

2. Selective destruction of the base of the pons

3. Basilar artery thrombosis
What is STRICTLY defined as IRREVERSIBLE cessation of ALL functions of the brain INCLUDING brainstem
Brain death
How long must one be in a vegetative state to be considered in PVS?
at least 1 month
Pathology of PSV (persistent veg state)?
widespread cortical destruction with INTACT brainstem (eyes roll, sleep-wake cycles but no meaningful movements)

sometimes called "cortical brain death"