Coma CC5

Question 1

Name an example of a normal alteration of consciousness?

Answer 1

sleep

Question 2

If someone has a coma, you know what locations are impaired?

Answer 2

bilateral cortex or reticular activating system

Question 3

What are the steps of COMA exam?

Answer 3

1. Neuro exam of altered consciousness
2. vital signs
3. respiratory pattern
4. Level of Consciousness
5. Pupils
6. Ocular movements
7. Motor responses

Question 4

What is cheyne-stokes respiration? Where is the lesion?

Answer 4

compressed time frame with waxing and waning character

-disrupted bilateral diencephalon or cortex

Question 5

What are apneustic respirations? where is the lesion?

Answer 5

deep and fairly regular

lesions of midbrain near RAS by colliculus
-cut off voluntary breathing centers

Question 6

What are ataxic respirations? Where is the lesion?

Answer 6

breathing is uncoordinated, but diaphragm is innervated
“breathing from their medulla”

-lesion in pontine tegmentum

Question 7

What are the four levels of consciousness?

Answer 7

1. normal - no external stim needed
2. somnolent - external stim–> normal waking
3. obtunded - external stim–>abnormal waking
4. COMA - no wakefulness

Question 8

What are metabolic pupils?

Answer 8

small and reactive

-downers

Question 9

What are pupils like after lesion to diencephalon?

Answer 9

small and reactive

-no sympathetic stimulation

Question 10

What are pupils like after a lesion to the tectum?

Answer 10

large and fixed - no pupillary light reaction

Question 11

What are the pupils like after a lesion to the right oculomotor nerve?

Answer 11

Right eye is Dilated and fixed

• shine light in either eye, right wont constrict
• shine light in right eye, left will constrict (consensual of right in tact)

Question 12

What are the pupils like after a lesion to the midbrain?

Answer 12

midposition, fixed and in a coma

Question 13

What are the pupils like after a lesion to the pons?

Answer 13

pinpoint pupils

Question 14

Where is the nuclei of the abducens nerves?

Answer 14

Pons

Question 15

Where is the nuclei of the III cranial nerve?

Answer 15

midbrain

Question 16

What is decorticate posturing?

Answer 16

abnormal flexor response of arms with extension of legs —- antigravity muscles

-lesion above the red nucleus

Question 17

What is spastic hemiparesis?

Answer 17

disconnection of cortex from motor centers
-lesion above the level of red nucleus
(same as decorticate posturing)

Question 18

What is decerebrate posturing?

Answer 18

abnormal extensor response of arm and legs
-antigravity mechanism for quads

-lesions caudal to red nucleus -release of vestibulospinal output

Question 19

If there is a progressive lesion bilaterally in the diencephalons, what is the:

1. respiratory pattern
2. pupil status
3. oculocephalic response
4. motor response

Answer 19

1. cheyne stokes
2. small pupils with small range of contraction
3. normal oculocephalic response, no nystagmus
4. motionless or decorticate rigidity

Question 20

If there is a progressive downward lesion that hits bilaterally in the midbrain, what is the:

1. respiratory pattern
2. pupil status
3. oculocephalic response
4. motor response

Answer 20

1. sustained regular hyperventilations
2. fixed pupils in midposition and irregular shape
3. dysconjugate oculocephalic response
   - medial rectus isnt functioning
4. motionless or decerebrate

Question 21

If there is a progressive downward lesion that hits bilaterally in the pons, what is the:

1. respiratory pattern
2. pupil status
3. oculocephalic response
4. motor response

Answer 21

1. more shallow and rapid, or slow and irregular
2. pupils at midposition and fixed
3. no oculocephalic response
4. no motor response to stimulus, bilateral babinski

Question 22

If there is a progressive downward lesion that hits unilaterally in the diencephalon, what is the:

1. respiratory pattern
2. pupil status
3. oculocephalic response
4. motor response

Answer 22

1. eupneic with deep sighs or cheyne stokes
2. small pupils, but react
3. oculocephalic response is normal
4. unilateral motor response to noxious orbital roof pressure, unilateral babinski

Question 23

If there is a progressive downward lesion that is in the late third nerve stage, what is the:

1. respiratory pattern
2. pupil status
3. oculocephalic response
4. motor response

Answer 23

1. regular sustained hyperventilation
2. no direct pupil response, consensual intact
3. ipsilateral eye doesnt move medially, contralateral eye retains full lateral movement
4. decorticate or decerebrate

Question 24

Central hyperventilation indicates a lesion where?

Answer 24

midbrain