Glossary of INTRACRANIAL PROBLEMS
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- WHAT IS THE SINGLE MOST IMPORTANT SYMPTOM OF NEUROLOGICAL PROBLEMS?
- CHANGE IN LEVEL OF CONSCIOUSNESS.
- WHAT ARE THE 2 COMPONENTS OF THE CONSCIOUS STATE?
- IS PATIENT AWAKE? ALERT
AWARENESS - ABLE TO REACT IN A PURPOSEFUL MANNER WITH THEIR ENVIRONMENT. (EVEN IF IT'S JUST PULLING BACK FROM A PAINFUL STIMULI)
- WHAT DOES AWARENESS INDICATE?
- INDICATES THE CEREBRAL CORTEX IS INTACT.
- A CONSCIOUS PERSON IS BOTH -
- AWAKE - OPENS EYES AND
AWARE - RESPONDS WITH PURPOSE (OPENS EYES OR WITHDRAWS FROM PAIN)
- UNCONSCIOUS STATE
- COMATOSE - PERSON NEITHER AWAKE NOR AWARE. RAS NOT INTACT AND PERSON DOESN'T RESPOND WITH PURPOSE.
- WHEN SOMEONE IS COMATOSE IS USUALLY INDICATES A PROBLEM WITH ...
- UPPER BRAIN STEM - COULD BE CEREBRAL
- PERSISTANT VEGETATIVE STATE
- OPERATES ON SOME INNER CYCLE THAT APPEARS LIKE SLEEP/WAKE CYCLES. LOOKS LIKE RAS IS FUNCTIONING, BUT DON'T REACT WITH PURPOSE TO ENVIRONMENT; NO RESPONSE TO PAINFUL STIMULI.
- A PERSISTANT VEGETATIVE STATE IN INDICATIVE OF WHAT KIND OF PROBLEM?
- PROBLEM BETWEEN RAS AND CEREBRAL CORTEX. MAY BE GLOBAL - ANOXIA AT CHILDBIRTH, COULD BE A STROKE.
- LOCKED IN SYNDROME
- PT. IS BOTH AWAKE AND AWARE BUT CANNOT RESPOND TO STIMULI.
- WHAT IS THE CAUSE OF LOCKED IN SYNDROME?
- MOTOR DEFICITS. DAMAGE TO BRAIN IS IN MOTOR PATHWAYS THAT COME DOWN FROM BRAIN. COULD BE STROKE, GUILLIAN BARRE SYNDROME. INTELLECTUALLY KNOW WHAT'S GOING ON BUT CAN'T RESPOND.
- WHAT IS THE BEST WAY TO ASSESS UNCONSCIOUS STATE?
- DESCRIBE BEHAVIOR BECAUSE MOTOR RESPONSE IS THE MOST INCONSISTENT WITH DIFFERENT ASSESSORS.
- GLSASGOW COMA SCALE
- PROVIDES A QUANTITATIVE MEASURE OF LOC
- WHAT DOES THE GLASCOW MEASURE?
- ALERTNESS - OPENS EYES
AWARENESS - VERBAL AND MOTOR RESPONSES TO STIMULI - OBEYS COMMANDS.
- WHAT IS THE SCALE OF THE GLASCOW?
- 3 TO 15
- WHAT SCORE IS CONSIDERED A COMA?
- 7 OR LESS
- what Glascow score is considered dead?
- decorticate posturing
- problem in cerebral cortex
legs internally rotate, extend toes, point down, flexion of arms, wrist, fingers
- decerebrate posturing
- abnormal extension of arms, wrists hyperextend. Worse damage on R side of brain. Brain stem problem.
- which posturing is worse?
- decerebrate posturing
- irreversible coma
- cerebral death w/ intact brain stem; RES doesn't function; pt. appears to be sleeping, don't respond to stimuli.
- Does pt. in irreversible coma have sleep/wake cycle?
- Does pt. in irreversible coma require a vent. or life support.
- No, because brain stem intact - BP, RR works.
- Brain death
- Cerebral and brain stem death
- who can declare a person brain dead?
- 2 doctors, if concur
- What criteria do doctors look at when deciding if pt. is brain dead?
- No motor or reflex movements to pain.
No spontaneous respirations.
No cephalic reflexes.
- What do doctors usually do to assess motor or reflex movements to pain?
- pinch, pressure on periorbits; pressure under nails.
- What do doctors usually do to assess spontaneous resp?
- take off vent for a while; after CO2 good, well-oxygenated, take off; watch and wait until CO2 is above 60- about 6 minutes.
- What do doctors usually look at when assessing cephalic responses?
- Pupillary constriction - Cr. Nerve III
Has to be fully dilated and nonreactive. If see any movement or pinpoint pupils - not brain dead.
- What is necessary for pt. to be off of to test for brain death?
- pt. should be off all sedatives.
- Doll's eyes
- Cr nerves III, IV, VI, VIII
- What is positive doll's eyes?
- Normal when move head to L, eyes deviate to R and vice versa
- What is negative doll's eyes?
- When move head L to R eyes don't deviate. Eyes are fixed - brain death.
- Corneal Reflex
- Cr. nerves V (tearing up), VII (blink)
- What is positive corneal reflex?
- normal if touch cornea, eye tears up and person blinks.
- What is negative corneal reflex?
- No tearing, no blinking - brain death
- Caloric Stimulation
- Cr.nerves III, IV, VI, VIII
- What is normal or positive caloric stimulation?
- Inject ice water in ear, eyes will deviate in direction of stimuli. Warm water injected in R eye - get nastagmas on L side.
- What is negative caloric stimulation?
- no response, brain dead
- what is nystagmas?
- involuntary rapid movement of eyeballs.
- Flat EEG
- no electrical currents in brain
- persistance of negative response to assessment criteria for how long can define brain death?
- persistance of the signs for 30 minutes after 6 hours of comatose state.
- What does Alabama law require for a pt. to be declared brain dead?
- Independant evals by 2 doctors licensed to practice in state.
- Is EEG required by law to declare pt. brain dead?
- No, but it may be required by institutional policy or physician practice.
- Can a physician take a pt. off a vent without family's consent?
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