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16 Cards in this Set

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hallmarks of brainstem lesion
(Terry Schiavo)
a. loss of pupillary reflex occurs early (makes sense b/c brainstem contains CN 3)
b. absent/abnl oculomotor reflex (makes sense b/c brainstem contains CN 3)
c. sudden coma onset
MCC coma?
metabolic coma (supratentorial [cortex] AND infratentorial [brainstem], thus diffuse)
what do these suggest?

-pupillary rxns preserved til late
-motor signs are symmetrical
metabolic coma
focal cortical Sx (i.e. apashia, contralat hemiparesis/sensory) suggests?
supratentorial lesion (cortex)
apashia, contralat hemiparesis/sensory) suggests?
supratentorial lesion (cortex)
when do pts look away from lesion>?
-irritative lesions (seizures)
-pontine gaze center lesion
when do pts look toward lesion?
ablative lesion (infarct, hemorrhage)
what does unilateral, dilated, fixed pupil suggest?
third nerve palsy, consider early uncal herniation
if eyes move non-conjugately (during Dolls eyes), what does this suggest?
brainstem lesion
if there is no eye mvmt (during dolls eyes), what does this suggest?
either brainstem lesion or pt is in such deep coma that a stronger stimulus, such as calorics test, is req to drive the reflex
calorics: defective slow phase suggests?
brainstem pathology
calorics: absent fast phase suggests?
bilateral cortical dysfxn
calorics tests what ?
calorics test the oculovestibular reflex
dolls eyes tests what?
oculocephalic reflex
decerebrate:
-def?
-where is lesion?
extension of upper extremities
-indicatges lesion in upper brainstem
decorticate:
-def?
-where is lesion?
-flexion of upper extremities
-lesion in hemisphere/capsule