Coma-2 - Evaluation of Patients in Coma Liam Durcan MD...

Info iconThis preview shows pages 1–10. Sign up to view the full content.

View Full Document Right Arrow Icon
Evaluation of Patients in Coma Liam Durcan MD FRCPC Department of Neurology and Neurosurgery
Background image of page 1

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
What We’ll Cover Basic definitions Key  exam points Epidemiology of Coma Coma mimics
Background image of page 2
What we won’t talk about Brain death/ chronic vegetative state toxidromes really complex neuroanatomy Exhaustive lists of causes Basic Resuscitative Care
Background image of page 3

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
Definitions Coma: “Unarousable unresponsiveness in  which the subjects lie with eyes closed” Plum and Posner- Diagnosis of Stupor and  Coma Other terms: obtundation, stupor fallen out of favour because of imprecision descriptive methods favoured
Background image of page 4
Consciousness Two components of conscious behavior content- the sum of cognitive and affective  function arousal- appearance of wakefulness Content depends on arousal but normal  arousal does not guarantee normal  content
Background image of page 5

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
Really Simple Neuroanatomy Arousal: where is it localized? Ascending Reticular Activating System  (ARAS) ‘core of the brainstem’ receives input from numerous somatic  afferents projects to midline thalamic nuclei (which are  in a circuit with cortical structures) and the   limbic system
Background image of page 6
ARAS ARAS acts as a gating system, increasing  or decreasing thalamic inhibitory influence  on the cortex alters effect of sensory stimuli ascending alters descending cortical stimulation 
Background image of page 7

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
Demands of Arousal Function of ARAS-Thalamic-Cortical  system depends on: anatomic integrity of structures metabolic integrity (circulatory integrity) communicative integrity (neurotransmitter  function)
Background image of page 8
Coma Fact Number One Coma implies dysfunction of: ARAS  or Both  hemi-cortices Anatomically, this means central brainstem structures (bilaterally) from  caudal medulla to rostral midbrain both hemispheres
Background image of page 9

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
Image of page 10
This is the end of the preview. Sign up to access the rest of the document.

Page1 / 35

Coma-2 - Evaluation of Patients in Coma Liam Durcan MD...

This preview shows document pages 1 - 10. Sign up to view the full document.

View Full Document Right Arrow Icon
Ask a homework question - tutors are online