Stupor And Coma

Front 1

What is conciousness?

Back 1

appreciation of self and environment

Front 2

What are the 5 overarching causes of delirium?

Back 2

1. endogenous
2. metabolic
3. exogenous intoxication
4. structural CNS
5. cardiovasc

Front 3

What term is used to describe one who has:
-decreased alertness
-diminished involvement in environment
-increased drowsiness and sleep

Back 3

Obtundation

Front 4

What characterizes a stupor?

Back 4

unresponsive state that requires forceful or repetetive stimuli to obtain arousal

arousal ends when stimulation stops

Front 5

What term decribes:
-unresponsiveness to internal/external stimuli
-lack of appreciation for self and environment, even with noxious stimuli

Back 5

COMA

Front 6

Brain Death

Back 6

When all brain functions are pemanently lost

Front 7

Dementia

Back 7

loss of cognitive processes w/o diminished LOC

Front 8

What neurological system is described below:

-neuronal core extending almost entire length of dorsal-central brainstem
-recieves input from all somatic and special sensory pathways
-forms ascending control system that regulates conciousness

Back 8

Reticular system

Front 9

What are some areas influenced by the ascending control function of the reticular system?

Back 9

Projects onto:

-thalamic reticular nuclei (-->cortex)
-hypothalamus (-->basal forebrain and limbic systems)
-diffuse serotinergic (dorsal raphe-->neocortex)
-diffuse noradrenergic (locus coeruleus-->neocortex)

Front 10

What are the most common causes of LOC.

Back 10

metabolic abnormalities

Front 11

What are 5 important categories to include in descriptin of loss of Conciousness?

Back 11

1) Describe LOC (easily rousable but falls asleep when unstimulated)
2) Describing language function (if present)-fluency/response
3) Attention (spelling reversal)
4) Respiratory function, pupillary light reflex, Ocular Motility, Mortor Function
5) Corneal reflex, DTRs, plantar responses

Front 12

What types of verbal responses are most likley to be preserve in a patient with impaired LOC?

Back 12

-response to simple commands (over-learned language function)

(spontaneous/interactive speech is most easily lost as it is unique to person and situation)

Front 13

How test recent memory?

Back 13

Verbal and visual item recall

Front 14

Example of frontal lobe function that is easily lost.

Back 14

Executive function-->ability to organize and sequence tasks

Front 15

Where does reflex regulation of oxygenation and acid-base balance occur?

Back 15

PONTO-Medullary Reticular system

Front 16

What type of breathing is described below and what lesion is suggested:

-periodic breathing with phases of hyperpnea alternating with apnea

Back 16

Cheyne-Stokes respirations (CSR)

-suggests bilateral diencephalic or deep hemispheric dysfunction
(delayed feedback loop betw. alveolar ventilation and brainstem chemoreceptor response regulating CO2 build-up/removal:

-decreased CO2 triggers brain to slow resp-->incr CO2 producing hyperpnea)

Front 17

What type of breathing is described below and what is suspected lesion:

Sustained, rapid deep hyperventilation w/ no pattern

Back 17

Central Neurogenic Hyperventilation (CNH)

-Dorsal midbrain and upper pontine lesion or
-Pulmonary Congestion

Front 18

What type of breathing is described below and where is the lesion:

-Prolonged end-inspiratory pause w/without end-expiratory pauses

Back 18

-Apneustic

-major dysfunction of respiratory control mechanisms in mid-lower DL pons

Front 19

What is the type of breathing and where is lesion:

-slow irregularly deep and shallow breathing with random apneic periods

Back 19

Ataxic Breathing:

-disruption of medullary neuronal control of respiratory pattern

-Imminent respiratory failure-->need ventilary support

Front 20

Cushing Response

Back 20

increased BP and Decr HR

-occurs due to dysfunction of pressor control regions in floor of 4th ventricle

Front 21

Pupillar response in bilateral diencephalic dysfunction

Back 21

small but reactive pupils

Front 22

Oculomotor Nerve Palsy

Back 22

Ipsilateral fixed dilated pupil with normal consensual PLR (uncal herniation)

Front 23

midposition fixed PLR

Back 23

midbrain lesions involving 3rd nerve nucleus comprising sympathetic and parasympathetic innervation of eye

Front 24

Lesions of midbrain tectal/pretectal region

Back 24

large, spontaneously fluctuating (hippus) pupils that retain ability to accomodate

Front 25

affect on eye of Pontine or medullary lesions

Back 25

small or pinpoint pupils with retained PLR

Front 26

What type of abnormality is most likely in a patient with severe depression of respirations, EOM, and motor function, with a nl PLR

Back 26

metabolic abnormalities

Front 27

Non-reactive pupils indicate which type of brain disease

Back 27

Structural

Front 28

Occulocephalic reflex

Back 28

turn head, eyes go with head

Front 29

Occulovestibular reflex

Back 29

head @ 30 degrees-->cold water in ear-->eyes away from that ear
if lesion, eyes will turn toward that ear b/c saccadic system is suppressed

warm water is opposite

Front 30

which ways do eyes deviate if lesion in pontine horizontal eye movement centers

Back 30

away from lesion

Front 31

Flexion at elbow and wrist

Back 31

Decorticate posturing-->deep hemispheric dysfunction

Front 32

Upper extremities extended, adducted and hyperpronated

Lower extremities extended w/ feet plantar-flexed

Back 32

Decerebrate posturing: dysfunction @ midbrain/pons