5 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
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.
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.
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.
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.
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.
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.
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.
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.
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 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.
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.
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.
Three stages of coma DOC includes coma, the vegetative state (VS) and the minimally conscious state (MCS).
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.
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.
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.
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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 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
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 ...
Open before stimulus After spoken or shouted request After finger tip stimulus Closed by local factor Abnormal Flexion Slow Sterotyped Arm across chest
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.
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.
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.
Coma without focal signs with meningism. This results from subarachnoid haemorrhage, meningitis, and meningoencephalitis.
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.
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.
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.
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.
“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.
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.
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.
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.
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.
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.
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.
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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.
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.
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.
Coma without focal signs with meningism. This results from subarachnoid haemorrhage, meningitis, and meningoencephalitis.
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.
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.
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.