Levels of Consciousness
Q: This term describes a state of vigorous stimulation needed to produce a response, with the patient appearing very drowsy but able to be aroused briefly.
A: What is stupor?
Q: This abnormal breathing pattern is characterized by gradual increases and decreases in respirations with periods of apnea, often seen with bilateral cerebral or diencephalic dysfunction.
A: What is Cheyne–Stokes respiration?
Q: This abnormal posture shows flexion of the arms, wrists, and fingers with adduction of upper extremities and extension of lower extremities, usually indicating damage above the midbrain.
A: What is decorticate posturing?
Q: This term describes an acute, fluctuating disturbance in attention, awareness, and cognition, often caused by medical illness, drugs, or surgery.
A: What is delirium (or an acute confusional state)?
Q: This term describes elevated pressure within the skull resulting from increased brain volume, blood volume, or CSF.
A: What is increased intracranial pressure (ICP)?
Q: This term describes a state in which the patient opens eyes to voice, is drowsy and disoriented, and may have decreased attention and awareness.
A: What is obtundation (or obtunded)?
Q: This term describes deep, rapid, regular respirations that may occur with increased intracranial pressure or metabolic acidosis, such as in severe brain injury.
A: What are central neurogenic hyperventilation (or hyperventilation)?
Q: This abnormal posture shows rigid extension and internal rotation of the arms, pronated forearms, and plantar flexion of the feet, usually indicating more severe damage to the brainstem.
A: What is decerebrate posturing?
Q: This term describes a chronic, progressive decline in memory and at least one other cognitive domain, severe enough to interfere with daily function.
A: What is dementia?
Early (compensated) intracranial hypertension may present with subtle changes such as headache, confusion, and this change in pupil response.
A: What is slower or sluggish pupillary reaction (or mild pupillary changes)?
Q: In Table 15.2, structural causes of altered arousal typically produce asymmetric motor responses, abnormal brainstem reflexes, and this type of pupillary change.
A: What are unequal or fixed/dilated pupils?
Pinpoint pupils that are reactive are most often associated with this type of cause of altered consciousness.
A: What is an opioid or narcotic overdose?
this term describes increased muscle tone with resistance to passive movement, often seen with upper motor neuron lesions.
A: What is spasticity?
This type of dysphasia is characterized by difficulty producing language, non‑fluent speech, but relatively preserved understanding.
A: What is Broca’s (expressive) dysphasia?
Q: Table 15.15 describes obstructive (non‑communicating) hydrocephalus as a blockage of CSF flow within the ventricular system. Name one possible cause.
A: Any one of: tumor, cyst, congenital aqueductal stenosis, scarring/obstruction of ventricular pathways.
Q: A patient with altered arousal has intact eye‑opening and sleep–wake cycles but no awareness of self or environment, and only reflex motor responses. This outcome of severe brain damage is called:
A: What is a persistent vegetative state?
Q: The oculocephalic reflex (“doll’s eyes”) is tested by turning the head rapidly from side to side. In a patient with an intact brainstem, the eyes will move in which direction relative to the head turn?
A: What is opposite to the direction of head movement
this term describes involuntary rhythmic oscillatory movements, often seen at rest in Parkinson’s disease.
A: What is a resting tremor?
Name one key difference between delirium and dementia in terms of onset and course.
A: Delirium has acute onset and fluctuating course; dementia has insidious onset and progressive, stable course.
Q: Table 15.13 lists structural and metabolic causes of recurrent seizures. Name one structural and one metabolic cause.
A:
Q: This outcome of severe brain injury is characterized by minimal but definite behavioral evidence of self or environmental awareness, such as following simple commands or purposeful behavior not due to reflex.
A: What is a minimally conscious state?
Q: In the oculovestibular (caloric ice water) test, cold water is instilled into one ear. In a patient with an intact brainstem, the eyes deviate in which direction?
A: What is toward the irrigated ear?
Upper motor neuron lesions typically cause this pattern of reflexes and muscle tone, while lower motor neuron lesions cause the opposite.
A: What are increased (hyperreflexia) and increased tone (spasticity) in UMN lesions, and decreased or absent reflexes and reduced tone (flaccidity) in LMN lesions?
Q: Health promotion strategies that may help reduce risk for Alzheimer’s disease (p. 365) include controlling vascular risk factors. Name two such modifiable factors.
A: Any two of: hypertension, diabetes, hyperlipidemia, smoking, physical inactivity, obesity.
Q: This term describes a sudden, abnormal, excessive discharge of neurons in the brain, which can cause changes in behavior, sensation, or level of consciousness.
A: What is a seizure?