medical report sample patient with neurological disorders who slips into coma

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The Neurological Exam of a Comatose Patient: An …

10 hours ago  · A coma, sometimes also called persistent vegetative state, is a profound or deep state of unconsciousness. Persistent vegetative state is not brain-death. An individual in a state of coma is alive but unable to move or respond to his or her environment. Coma may occur as a complication of an underlying illness, or as a result of injuries, such ... >> Go To The Portal


What is the role of the neurologist in the evaluation of coma?

T he neurologist is often required to evaluate the unconscious patient from both the diagnostic and prognostic perspective. Knowledge of the anatomical basis of coma is essential for competent evaluation but must be combined with an understanding of the many, often multi-factorial, medical conditions that result in impaired consciousness.

What is included in the neurological exam of a comatose patient?

In the neurological exam of a comatose patient, the outline includes: i) general examination; ii) level of consciousness; iii) cranial nerves; and iv) motor assessment. General Examination The examiner must have a systematic and thorough examination.

How do doctors assess coma severity?

Doctors will consider a variety of factors when assessing a coma’s severity. One of the most common tools a doctor might use is the Glasgow Coma Scale (GCS). The Glasgow Coma Scale is a simple test that gauges the degree of impaired consciousness in acute medical and trauma patients.

Which movement disorders are associated with coma?

Movement disorders such as myoclonus, epilepsia partialis continua, and tonic-clonic seizures may all occur in coma. They are important to identify since seizures require urgent treatment.

What does it mean when a doll's eye movements are absent?

What is the Oculocephalic response?

What is the diagnosis of a 63 year old man with colon cancer?

What is a coma without focal signs?

What causes coma in the brain?

How long after knee replacement can you go into a coma?

Why is Dr. Xavier in a coma?

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What diseases can put you in a coma?

Overview. Coma is a state of prolonged unconsciousness that can be caused by a variety of problems — traumatic head injury, stroke, brain tumor, drug or alcohol intoxication, or even an underlying illness, such as diabetes or an infection. Coma is a medical emergency.

How can you tell if someone slips into a coma?

Signs of vegetative state comaThe person looks like they're asleep.They can't wake up, talk or respond to commands.The eyes may open in response to stimuli.The person is able to move their body.Heart rate, blood pressure and respiration continue.The person can randomly laugh, cry or pull faces.

What brain damage causes coma?

Comas are caused by damage to the brain, especially if there's bilateral damage to the cerebral cortex (which means damage on both sides), or damage to the reticular activating system. The reticular activating system controls arousal and awareness of the cerebral cortex.

What is a medical professional looking for when they perform a neurological assessment?

There are many aspects of this exam, including an assessment of motor and sensory skills, balance and coordination, mental status (the patient's level of awareness and interaction with the environment), reflexes, and functioning of the nerves.

What part of the brain wakes you up from a coma?

We now know that there are collections of nerve cells in the lower part of the brain, called the brainstem, which are responsible for maintaining a waking state.

How long can you be in a coma without brain damage?

How long will a coma last? There is no reliable way to accurately tell how long a coma will last and there are currently no medications which will reliably shorten the duration of a coma. A coma is usually said to last no longer than four weeks, but post-coma unresponsiveness may last from months to years.

Which condition of the victim is referred as coma stage?

Explanation: A coma is a prolonged state of unconsciousness. During a coma, a person is unresponsive to their environment. The person is alive and looks like they are sleeping. However, unlike in a deep sleep, the person cannot be awakened by any stimulation, including pain.

What is the most common cause of coma?

More than 50% of comas are related to head trauma or disturbances in the brain's circulatory system. Problems that can lead to coma include: Anoxic brain injury. This is a brain condition caused by total lack of oxygen to the brain.

What are the stages of a coma?

Three stages of coma DOC includes coma, the vegetative state (VS) and the minimally conscious state (MCS).

How do I document a neurological assessment?

Documentation of a basic, normal neuro exam should look something along the lines of the following: The patient is alert and oriented to person, place, and time with normal speech. No motor deficits are noted, with muscle strength 5/5 bilaterally. Sensation is intact bilaterally.

What is the most reliable indicator of a patient's neurologic function?

A patient's mental status is the most reliable indicator of brain function, so when there is altered mental status, obtaining a history and assessing for cerebellar function, weakness and paresthesia becomes far more difficult.

What are the 7 areas of documentation of the neurological exam?

The neurological exam can be organized into 7 categories: (1) mental status, (2) cranial nerves, (3) motor system, (4) reflexes, (5) sensory system, (6) coordination, and (7) station and gait. You should approach the exam systematically and establish a routine so as not to leave anything out.

Glasgow Coma Scale – Traumatic Brain Injury

TraumaticBrainInjury.COM. The #1 online Resource for TBI Information & Help. Powered by Tools for Meeting Life’s Challenges, Inc.

Glasgow Coma Scale (GCS) • LITFL • CCC Trauma

Hi David. As with any tool, the validity of the result depends on who is using it, for what reason, and in which patients. I have revised the sentence to say “similar or greater” in different settings, as the evidence base for the examples given -FOUR score and AVPU ( not to mention other simpler scales) – are not equivalent.

Glasgow Coma Scale

Glasgow Coma Scale Eye Opening Response • Spontaneous--open with blinking at baseline 4 points • To verbal stimuli, command, speech 3 points • To pain only (not applied to face) 2 points • No response 1 point Verbal Response

Glasgow Coma Scale - StatPearls - NCBI Bookshelf

The Glasgow Coma Scale was first published in 1974 at the University of Glasgow by neurosurgery professors Graham Teasdale and Bryan Jennett.[1] The Glasgow Coma Scale (GCS) is used to objectively describe the extent of impaired consciousness in all types of acute medical and trauma patients. The scale assesses patients according to three aspects of responsiveness: eye-opening, motor, and ...

GLASGOW COMA SCALE : Do it this way

Open before stimulus After spoken or shouted request After finger tip stimulus Closed by local factor Abnormal Flexion Slow Sterotyped Arm across chest

What does it mean when a doll's eye movements are absent?

Caloric response: if doll's eye movements are absent proceed to calorics. Ice cold water applied to the tympanic membrane normally elicits a slow conjugate deviation to the irrigated side. Absence indicates brain stem disease. Caloric testing is more sensitive than the oculocephalic response.

What is the Oculocephalic response?

Oculocephalic (doll's eyes) response: move head passively and observe motion of the eyes. The eyes should move conjugately in the direction opposite to the movement. An abnormal response (absent or asymmetric) implies brain stem disease. Do not perform when neck instability is suspected.

What is the diagnosis of a 63 year old man with colon cancer?

A 63 year old man is admitted for carcinoma of the colon. He has a history of high alcohol intake. The day after admission he has a tonic-clonic seizure and is treated with thiamine and chlordiazepoxide. Surgery is performed the next day. Because of poor conditions post surgery, he is admitted to the intensive therapy unit and put on a ventilator for two days. As he is weaned and sedation reduced, he is thought to be in a coma and there is no limb response to pain. However, when you assess him there is a brief eye opening to verbal response. The eye movements are difficult to assess because of blepharospasm. He appears to have lateral but not vertical doll's eyes and normal pupils. The facial grimace is symmetrical. There is no voluntary jaw opening and a poor gag. Limb tone is normal with minimal response to painful stimuli, normal reflexes and flexor plantars.

What is a coma without focal signs?

Coma without focal signs with meningism. This results from subarachnoid haemorrhage, meningitis, and meningoencephalitis.

What causes coma in the brain?

Coma is caused by disordered arousal rather than impairment of the content of consciousness, this being the sum of cognitive and affective mental function, dependent on an intact cerebral cortex. The absence of all content of consciousness is the basis for the vegetative state.

How long after knee replacement can you go into a coma?

You are called to the HDU to see a 78 year old patient in a coma 24 hours after undergoing knee replacement surgery. There is a history of progressive memory failure and deterioration in other cognitive function over the past few years. Preoperatively the patient was taking digoxin and a diuretic.

Why is Dr. Xavier in a coma?

Because of poor conditions post surgery, he is admitted to the intensive therapy unit and put on a ventilator for two days. As he is weaned and sedation reduced, he is thought to be in a coma and there is no limb response to pain. However, when you assess him there is a brief eye opening to verbal response.

What are the symptoms of a coma?

Some neurological reflexes that a doctor may look for in coma patients include: 1 Pupillary reactivity. The pupils should shrink in response to a light being shone in the eyes. 2 Oculocephalic response. The eyes should turn to the right when the individual’s head is turned to the left, and vice versa. 3 Gag reflex. The individual should gag or cough if a cotton swab or endotracheal tube is placed down their throat.

What happened to Sharat's son?

“My son Sharat suffered a severe traumatic brain injury 23 years ago leaving him with Aphasia and right sided weakness from his vision,hearing to his limbs. The lockdown in June was a great challenge for him as his caregivers stopped coming, no gym workouts and no outings for a coffee.

What is the Glasgow Coma Scale?

The Glasgow Coma Scale is a simple test that gauges the degree of impaired consciousness in acute medical and trauma patients. It can indicate the severity of a TBI and is used to predict the outcome of an injury.

How long does a coma last?

Lack of speech or other forms of communication. No purposeful movement. An actual coma rarely lasts over four weeks. Instead, most patients who remain unconscious for long periods have progressed to the next stage of consciousness.

How long does it take to recover from a coma?

In fact, patients who transition from a coma to minimal consciousness within eight weeks are the most likely to reach this state and regain higher functions.

What to do after a coma?

After a person emerges from a coma and regains consciousness, occupational and physical therapy exercises and other cognitive rehabilitation exercises will be crucial in their recovery. These activities are great ways to engage neuroplasticity and help their brain heal.

What happens when you are in a coma?

While in a coma, a person is unresponsive and cannot wake up, even when stimulated. In nearly every coma, no matter what triggered it, the same event occurs: the brain swells, pushes up against the skull, and damages the Reticular Activating System, (RAS) the part of the brain stem that controls arousal from sleep.

Abstract

This resource is a collection of over 50 case histories of patients with acute neurological illness. Each case is outlined in brief and followed by several questions on diagnosis and management. It illustrates the clinical issues surrounding patients with neurological diseases, summarising what information is available in the medical literature.

Bibliographic Information

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What does it mean when a doll's eye movements are absent?

Caloric response: if doll's eye movements are absent proceed to calorics. Ice cold water applied to the tympanic membrane normally elicits a slow conjugate deviation to the irrigated side. Absence indicates brain stem disease. Caloric testing is more sensitive than the oculocephalic response.

What is the Oculocephalic response?

Oculocephalic (doll's eyes) response: move head passively and observe motion of the eyes. The eyes should move conjugately in the direction opposite to the movement. An abnormal response (absent or asymmetric) implies brain stem disease. Do not perform when neck instability is suspected.

What is the diagnosis of a 63 year old man with colon cancer?

A 63 year old man is admitted for carcinoma of the colon. He has a history of high alcohol intake. The day after admission he has a tonic-clonic seizure and is treated with thiamine and chlordiazepoxide. Surgery is performed the next day. Because of poor conditions post surgery, he is admitted to the intensive therapy unit and put on a ventilator for two days. As he is weaned and sedation reduced, he is thought to be in a coma and there is no limb response to pain. However, when you assess him there is a brief eye opening to verbal response. The eye movements are difficult to assess because of blepharospasm. He appears to have lateral but not vertical doll's eyes and normal pupils. The facial grimace is symmetrical. There is no voluntary jaw opening and a poor gag. Limb tone is normal with minimal response to painful stimuli, normal reflexes and flexor plantars.

What is a coma without focal signs?

Coma without focal signs with meningism. This results from subarachnoid haemorrhage, meningitis, and meningoencephalitis.

What causes coma in the brain?

Coma is caused by disordered arousal rather than impairment of the content of consciousness, this being the sum of cognitive and affective mental function, dependent on an intact cerebral cortex. The absence of all content of consciousness is the basis for the vegetative state.

How long after knee replacement can you go into a coma?

You are called to the HDU to see a 78 year old patient in a coma 24 hours after undergoing knee replacement surgery. There is a history of progressive memory failure and deterioration in other cognitive function over the past few years. Preoperatively the patient was taking digoxin and a diuretic.

Why is Dr. Xavier in a coma?

Because of poor conditions post surgery, he is admitted to the intensive therapy unit and put on a ventilator for two days. As he is weaned and sedation reduced, he is thought to be in a coma and there is no limb response to pain. However, when you assess him there is a brief eye opening to verbal response.