Alterations Of Conscoiusness

Front 1

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

Back 1

1. RAS

2. Mid-pons to the hypothalamus

Front 2

What parts of the brain does content depend on?

Back 2

The person must have some level of arousal accompanied by fuctional cortex, cortical-cortical and cortical-thalamic interconnections.

Front 3

What are three basic pathologic divisions of comas?

Back 3

1. Supratentorial (secondary impinged on RAS)

2. Infratentorial (directly damaged RAS)

3. Metabolic disorders (diffusely interferes w/ brain fxn)

Front 4

What condition is described as having a rapid onset and fluctuations in level of awareness?

Back 4

Delirium

Front 5

What condition is described as reduction in alertness/lethargic?

Back 5

Obtundation

Front 6

What condition is described as a setting where the patient has to be constantly stimulated to maintain them/behavioral unresponsiveness?

Back 6

Stupor

Front 7

What condition is described as unarousable unresponsiveness?

Back 7

Coma

Front 8

What type of breathing is described as a repetitive cresendo-decresendo pattern? Where is the damage to the brain?

Back 8

1. Cheyne-Stokes

2. Bilateral hemispheric

Front 9

What type of breathing is describes as big, fast, deep breaths that are continuous? Where is the damage to the brain?

Back 9

1. Tachypnea

2. Midbrain or upper pons

Front 10

What type of breathing has end-inspiratory pauses followed by end-expiratory pauses? Where is the damage to the brain?

Back 10

1. Apneusis

2. Mid-pons

Front 11

What type of breathing is described as irregular clusters of breathing separated by irregular time periods? Where is the damage to the brain?

Back 11

1. Cluster breathing

2. Lower pons to upper medulla

Front 12

What type of breathing is described as having a chaotic rate and amplitude that is indicative of impending apnea?

Back 12

Ataxic breathing

Front 13

What is the best way to distinguish between a diffuse metabolic problem or a focal structural damage?

Back 13

Examine the pupils

Front 14

Metabolic problems show what type of pupils?

Back 14

Small reactive pupils

Front 15

Diencephalon/thalamic damage show what type of pupils?

Back 15

Small reactive pupils

Front 16

Tectal damage show what type of pupils?

Back 16

Large, fixed pupils with hippus

Front 17

CNIII damage shows what type of pupils?

Back 17

Fixed and dilated

Front 18

Pons damage shows what type of pupils?

Back 18

Pinpoint

"Pons = Pinpoint"

Front 19

Midbrain damage show what type of damage?

Back 19

Midposition and fixed pupils

"Midbrain = Midposition"

Front 20

Eyes should move conjugately in the direction opposite to head rotation

Back 20

Oculocephalic reflex (Doll's eyes)

Front 21

Cold calorics is which reflex?

Back 21

Oculovestibular reflex

Front 22

A full range of horizontal and vertical eye movements rules out what type of damage?

Back 22

Brainstem damage

Front 23

squirt cold water in both ears = ?

sprirt hot water in both ears = ?

Back 23

Look down

Look up

"Hot water good...so look UP and take your shower zilla!"

Front 24

What two CNs does the corneal reflex test?

Back 24

CN V - feeling
CN VII - blinking

Front 25

Gag reflex involves which CN(s)?

Back 25

CN's IX & X

Front 26

Decorticate posturing is flexion/extension?

Back 26

Flexion

Front 27

Decerebrate posturing is flexion/extension?

Back 27

Extension

Front 28

What is an uncal herniation a result of? What CN does this affect? What then happens?

Back 28

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)

Front 29

What happens with progressive bilateral motor dysfunction

Back 29

Central transtentorial herniation

Front 30

What is a deterioration in cognitive abilities without a decline in arousal?

Back 30

Dementia

Front 31

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?

Back 31

1. Locked in syndrome

2. Selective destruction of the base of the pons

3. Basilar artery thrombosis

Front 32

What is STRICTLY defined as IRREVERSIBLE cessation of ALL functions of the brain INCLUDING brainstem

Back 32

Brain death

Front 33

How long must one be in a vegetative state to be considered in PVS?

Back 33

at least 1 month

Front 34

Pathology of PSV (persistent veg state)?

Back 34

widespread cortical destruction with INTACT brainstem (eyes roll, sleep-wake cycles but no meaningful movements)

sometimes called "cortical brain death"