What is brain death?
Where is it one the Arousal/Awareness scale?
complete, irreversible loss of all brain functions, including brain stem
demonstration of continuing apnoea (breathing stops for a short period) in a persistently comatose patient
What is coma?
deep unconsciousness —> unresponsive to external stimuli
cannot be woken up
coma recovery may not go further than VS or MCS (can also be states to more recovery)
What is the vegetative state?
person is awake but not aware of themselves or their surroundings
—> often follows a coma
What is the difference between
Persistent vegetative state
Permanent vegetative state?
Persistent VS:
one month after traumatic/non-traumatic brain damage
—> not imply irreversibility
Permanent VS
3 months after non-traumatic / 12 month after traumatic
—> imply irreversibility
What is the minimally conscious state?
severely altered consciousness with minimal but definite evidence of self / environmental awareness (not bc of reflexes)
following simple commands
gestural or verbal yes/no response (regardless of accuracy)
intelligence verbalization
purposeful behavior
What is the Locked-In syndrome?
rare neurilogical disorder: complete paralysis of voluntary muscles in all parts of body except those that control eye movements
completely aware of self and environment
What can trigger coma?
brain injuries
stroke (reduced/interrupted blood supply in brain)
tumors
diabetes (too high/low blood pressure levels)
lack of oxygen
infections (of brain)
seizures
toxins
drugs/alkcohol
Place the states:
brain dead
vegetative state
coma
minimally conscious state
Locked-in Syndrome
in the coordinates of Cognitive and Motor function
What are some tests to check if a patient is brain death?
no motor response / eyes do not open (when painful stimulus)
brain-stem reflexes:
absent corneal reflex
absent light reflex
absent oculovestibular response (ice water)
absent cough reflex
Apnea reflex —> spontaneous breathing
On neurobiologically level, what can cause a coma?
diffuse bihemispheric cortical / white matter damage
neuronal / axonal injury
focal brainstem lesions
—> lower metabolism in thalamus, brainstem and cerebellar cortex
What is the Glasgow coma scale?
Eye opening: Spontaneous to None
Verbal response: Orientated to None
Motor response: obey commands to None
On neurobiologically level, what can cause the vegetative state?
brainstem relatively spared
grey / white matter of both cerebral hemispheres widely and severly damaged
mostly reduced metabolism
relative sparing of metabolism in brainstem
systematic impairment of metabolism in polymodal associative cortices important for consciousness (attention, language, memory)
Place the states
Light sleep
Deep sleep
REM sleep
Coma
anaesthesia
Drowsiness
Conscious wakeness
Sleepwalking
Locked-In Syndrome
in the coordinates of awareness / wakefulness.
Is a global depression of cerebral metabolism unique to coma?
no, when different anaesthetics titrated to point of unconsciousness —> resulting reduction is similar as in comatose patients
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