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Medicine /Psychotherapy: 84b - Brain States and Coma

Psychotherapy: 84b - Brain States and Coma

Medicine10 CardsCreated 1 day ago

This flashcard set outlines different levels of impaired consciousness—obtundation, stupor, and coma—ranked from most to least responsive. It also defines brain death as a clinical diagnosis marked by the absence of all brainstem reflexes and purposeful responses, distinguishing it from states where minimal reflexive or autonomic functions may still occur.

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List the following brain states from most responsive to least responsive:

Coma, obtundation, stupor

  • Obtundation

    • Most responsive

  • Stupor

    • Vague term, between alert an in a coma

    • Patient can respond peruposefully, but requires constant stimulation

  • Coma

    • Unresponsive

      • Patient cannot be stimulated to responsd purposefully

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Key Terms

Term
Definition

List the following brain states from most responsive to least responsive:

Coma, obtundation, stupor

  • Obtundation

    • Most responsive

  • Stupor

    • Vague term, between alert an in a coma

      <...

What is the medical definition of brain death?

  • No purposeful response to any stimuli

    • Including noxious stimuli

  • No brainstem reflexes

How will a patient with abulia present/act?

  • Slowing of cognitive and behavioral function

  • Intact cognitive function

  • Apathy

<...

How can you tell if a patient is in a coma or “locked in”?

A person who is locked in may be able to move their eyes up in response to commands

  • Patients with locked in syndrome are conscious, b...

What is the difference between a vegetative state and a minimally conscious state?

  • Vegetative state

    • No purposeful response to stimuli

      • No environmental awareness

    • ...

Which part of the brain mediates arousal and sleep/wake changes?

Ascending reticular activating system (ARAS)

Damage to ARAS and/or pathway results in impaired arousal

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Psychotherapy: 84b - Brain States and Coma
TermDefinition

List the following brain states from most responsive to least responsive:

Coma, obtundation, stupor

  • Obtundation

    • Most responsive

  • Stupor

    • Vague term, between alert an in a coma

    • Patient can respond peruposefully, but requires constant stimulation

  • Coma

    • Unresponsive

      • Patient cannot be stimulated to responsd purposefully

What is the medical definition of brain death?

  • No purposeful response to any stimuli

    • Including noxious stimuli

  • No brainstem reflexes

  • No spontaneous respiratory movments

  • Clear underlying etiology

    • Not due to medications or sedatives

May be present:

Simple reflexes, circadian rhythm, autonomic function

How will a patient with abulia present/act?

  • Slowing of cognitive and behavioral function

  • Intact cognitive function

  • Apathy

Often caused by medial frontal lobe injuries

How can you tell if a patient is in a coma or “locked in”?

A person who is locked in may be able to move their eyes up in response to commands

  • Patients with locked in syndrome are conscious, but unable to effectuate muscles

What is the difference between a vegetative state and a minimally conscious state?

  • Vegetative state

    • No purposeful response to stimuli

      • No environmental awareness

    • No brainstem reflexes

    • No spontaneous repsiratory movements

    • Eyes may open and rove randomly

  • Minimally conscous state

    • May require respiratory support

    • Behavioral evidence of self or environmental awareness

    • Eyes may lock onto familiar faces, objects rather than just roving

Which part of the brain mediates arousal and sleep/wake changes?

Ascending reticular activating system (ARAS)

Damage to ARAS and/or pathway results in impaired arousal

What is the difference between a coma and a vegetative state?

Patinets who are brain-dead will progress from coma to vegetative state in 10-30 days

In both states, the patient cannot respond purposefully, has no respiratory drive, and no brainstem reflexes

  • Coma

    • No eye opening

    • No circadian rhythm

  • Vegetative state

    • Circadian rhythm restored

    • Periods of eye opening, roving eye movement

    • Autonomic changes observed

Injury at which 3 areas of the brain can result in decreased level of arousal?

  • Ascending Reticular Activating System in the midbrain

  • Bilateral thalami

    • Before ARAS branches off

  • Both cerebral hemispheres

Other focal deficits will not impair arousal

What is the difference between abulia and akinetic mutism?

Both involve slowing of cognitive and behavior functions

Akinetic mutism is extreme abulia

Injury to the ______ results in locked in syndrome

Describe the syndrome

Injury to the pons results in locked in syndrome

Patients are paralyzed except upward eye movments - no cognitive impairment