Neuro - 16B 17A ( Unconsciusness And Coma)

Front 1

causes of short unconsciousness

Back 1

- vasovagal syncope
- postural hypotension
-cardiac arrhytmias
- hypervent

- hypoxia
- hypoglycemia
- vertebro-basilar transient ischemic attacks
- epileptic seizures

Front 2

vasovagal syncope

Back 2

increased vagal pressure leading to decreased sympathetic activity -> slows heart and blood pools peripherally, CO decreases --> inadequate brain perfusion-> LOC

Front 3

postural hypotension

Back 3

abcsence of cardoio- acceleration and perioheral vasoconstriction when changing to erect position .

Front 4

main cause of postural hypotension

Back 4

drugs that decreases the sympathetic tone

Front 5

hyperventilation mechanism forLOC

Back 5

hypervent -> decreased CO2 -> cerebral vasoconstriction -> LOC

Front 6

vertebro-basilar transient ischemic attacks mechanism

Back 6

thromboembolic material from heart or carotid lodges in small A supplying the brain stem -> ischemia ->

Front 7

vertebro-basilar transient ischemic attacks and LOC

Back 7

rarely without other symptoms of breinstem dysfunc

Front 8

what are the main parts of consciousness

Back 8

- arousal
- awareness

Front 9

arousal

Back 9

wakefullness due to ascending reticular activating system

Front 10

awarenes

Back 10

due to cortical functions

Front 11

vigilence

Back 11

the quality or state of staying alert especially to possible danger

Front 12

disorders of vigilance

Back 12

torpidi/daze
- somnolence
- sopor
- coma
- brein death

Front 13

torpidity/daze

Back 13

mildes disorder of vigilence
- completly alert
- slowed down
- problems focusing

Front 14

somnolence3

Back 14

- superficial sleeping
- awakened easily by verbal or other sensory stimuly

Front 15

sopor

Back 15

- only awakened by stronger stimuli
- falls back asleep during conversation

Front 16

coma

Back 16

pt can NOT be awakened by any stimuli

Front 17

superficial coma

Back 17

superficial reflexes (ex cornral reflex) can be elicted

Front 18

deep coma

Back 18

- superficial reflexes can not be elicited
- inadequate breathing

Front 19

awareness disorders

Back 19

- confusion
- delirium
- tenebrosity
- peraistant vegitative state
- minimal conscious state

Front 20

confusion

Back 20

impaired orientation in respect to place, time and person

Front 21

delirium

Back 21

an acutely disturbed state of mind characterized by restlessness, illusions, and incoherence and hallucinations

Front 22

T/F

delirium ids the most serious form for confusion

Back 22

true

Front 23

causes of delirium

Back 23

alcohol
- tranqulizers
- intox
- withdrawal
- infections

Front 24

tenebrosity

Back 24

pt reacts slowly and do not behave adequatly
- aphasia may be present

Front 25

tenebrosity may occur

Back 25

following an epileptic seizure
- in transient global amnesia

Front 26

persitant vegitative state

Back 26

the pts sleep wake cycle is intact, reflexes are normal but the pt is unable to preform conscious activities. no for for communication is possible.

Front 27

minimally conscious state

Back 27

similar to tenebrosity but the pt is able to communicate a little for short periods of time

Front 28

most common cases of impaired consciousness and coma

Back 28

- brain abscess
- brain tumor
- head trauma
- subarachnoid hemorrhage
- seizured
- resp failure
- heart failure
- DKA
- hypoglycemia
- hypothyroidism
- wernickes encephalopathy
- encephalitis
- meningitis
- sepsis
- hyer/hypothermia
- alcohol
- sedatives
- CO posoning

Front 29

GCS definition of coma

Back 29

- failure to open eyes in response to verbal stimuli (E2)
- only weak flexion as motor response (M4)
- incomprehensive sounds in response to pain (v2)

Front 30

coma results from

Back 30

damage to RAS in the brainste, or extensive bilat cortical damage

Front 31

classification of coma

Back 31

coma without focal signs or meningism
- coma with meningism
- coma with focal signs

Front 32

causes of coma without focal signs or meningism

Back 32

hypoxic - ischemic injury
- metabolic
- toxic
- post ictal

Front 33

causes of coma with meningism

Back 33

- meningoencephalitis
- SAH

Front 34

causes of coma with focal signs

Back 34

hemorrhage
- infarction
- abscess
- tumor
- hypoglycemia

Front 35

examination of comatose pt

Back 35

- quick amnamnestic data and inspection
- general examination
- neurologic exam

Front 36

general exam to be done in comatose pt

Back 36

- pulse - circ and frequency maintained?
- breathing
- temperature
- skin colour
- breath smell
- abdominal defence?

Front 37

what can periodic breathig in a comatose pt indicate

Back 37

hcaynes stokes
- brainstem lesio
- heart failure

Front 38

what can slow superficial breathing indicate in a comatose pt

Back 38

drugs/narcotics

Front 39

what can quick superficial breathing indicate in a comatose pt

Back 39

brain stem problem

Front 40

parts of neurologic examination in comatose pt

Back 40

menigeal signs ( only if cervical trauma can be excluded)
- fudus of eye examination
- pupil size and pupillary reflex
- position of eyes

- spontaneous eye movement
- cornea reflex
- pharyngeal and soft palate reflex
- Muscle tone
- muscle movement
- Deep reflexes
- pyramidal signs

Front 41

unilateral maximal dilated pupil that do not react to light can indicate

Back 41

tentorial herniation (oculomotor N)

Front 42

bilateral maximal dilated pupils that do not react to light can indicate

Back 42

- brainstem lesion
- herniation
- atropine-like subs

Front 43

tiny-pinpoint pupils may indicate

Back 43

- damage of pons
- opiods

Front 44

small but reactive pupils may indicate

Back 44

thalamic lesion

Front 45

skew deviation of eyes may indicate

Back 45

brainstem lesion

Front 46

conjugate lesion of eyes may indicate

Back 46

ipsilat frontal gaze center
- brainstem

Front 47

decorticate M tone

Back 47

hemisferic lesion

Front 48

ecerebrate M tone

Back 48

brainstem lesion

Front 49

investigations to be done in comatose pt

Back 49

- metabolic screen
- CT/MRI
- EEG
- consider lumbar puncture

Front 50

T/F
a normal CT can exclude elevated ICP

Back 50

FALSE

Front 51

T/F
the chance of making a good recovery from coma decreases with time in coma

Back 51

true