Babak Tamizi Far MD. Assistant professor of internal medicine Al-zahra hospital, Isfahan university of medical sciences
|
|
- Milton Hensley
- 6 years ago
- Views:
Transcription
1 Babak Tamizi Far MD. Assistant professor of internal medicine Al-zahra hospital, Isfahan university of medical sciences
2 ٢
3
4 Level of consciousness is depressed Stuporous patients respond only to repeated vigorous stimuli Comatose patients are unarousable and unresponsive
5 Coma is a major complication of serious CNS disorders Coma can result from seizures, hypothermia, metabolic disturbances, or structural lesions causing bilateral cerebral hemispheric dysfunction or a disturbance of the brainstem reticular activating system A mass lesion involving one cerebral hemisphere may cause coma by compressing the brainstem ۵
6 Abrupt onset of coma suggests Subarachnoid hemorrhage Brainstem stroke Intracerebral hemorrhage A slower onset and progression of coma occur with other structural or mass lesions A metabolic cause is likely with a preceding intoxicated state or agitated delirium ۶
7 In stupor, response to painful stimuli Purposive limb withdrawal from painful stimuli implies that sensory pathways from and motor pathways to the stimulated limb are functionally intact Unilateral absence of responses to stimuli to both sides of the body implies A corticospinal lesion Bilateral absence of responses suggests brainstem involvement Bilateral pyramidal tract lesions Psychogenic unresponsiveness ٧
8 Decorticate posturing occurs With lesions of the internal capsule and rostral cerebral peduncle With dysfunction or destruction of the midbrain and rostral pons In the arms accompanied by flaccidity or slight flexor responses in the legs in patients with extensive brainstem damage extending down to the pons at the trigeminal level ٨
9 Hypothalamic disease processes may lead to unilateral Horner syndrome Bilateral diencephalic involvement or destructive pontine lesions leads to small but reactive pupils Ipsilateral pupillary dilation with no response to light occurs with compression of the third cranial nerve, eg, with uncal herniation Pupils are slightly smaller than normal but responsive to light in many metabolic encephalopathies Pupils may be fixed and dilated following overdosage with atropine, scopolamine, or glutethimide Pupils may be pinpoint (but responsive) with opioids Pupillary dilation for several hours after cardiopulmonary arrest implies a poor prognosis ٩
10 Conjugate deviation to the side suggests the presence of an ipsilateral hemispheric lesion or a contralateral pontine lesion A mesencephalic lesion leads to downward conjugate deviation Dysconjugate ocular deviation in coma implies a structural brainstem lesion (or preexisting strabismus) ١٠
11 In response to brisk rotation, flexion, and extension of the head, conscious patients with open eyes do not exhibit contraversive conjugate eye deviation (doll's-head eye response) unless there is voluntary visual fixation or bilateral frontal pathology With cortical depression in lightly comatose patients, a brisk doll's-head eye response is seen With brainstem lesions, this oculocephalic reflex becomes impaired or lost, depending on the lesion site ١١
12 Tested by caloric stimulation using irrigation with ice water In normal persons, jerk nystagmus is elicited for about 2 or 3 minutes, with the slow component toward the irrigated ear In unconscious patients with an intact brainstem, the fast component of the nystagmus disappears, so that the eyes tonically deviate toward the irrigated side for 2 3 minutes before returning to their original position With impairment of brainstem function, the response is perverted and disappears In metabolic coma, oculocephalic and oculovestibular reflex responses are preserved, at least initially ١٢
13 Cheyne-Stokes respiration may occur with bihemispheric or diencephalic disease or in metabolic disorders Hyperventilation occurs with lesions of the brainstem tegmentum Apneustic breathing (prominent end-inspiratory pauses) suggests damage at the pontine level Atactic breathing (completely irregular pattern, with deep and shallow breaths occurring randomly): associated with lesions of the lower pons (pontine tegmentum) and medulla ١٣
14 Brain death Persistent vegetative state Locked-in syndrome ١۴
15 Serum glucose, electrolyte, and calcium levels Arterial blood gases Liver and kidney function tests Toxicologic studies ١۵
16 CT scan to identify a structural lesion ١۶
17 The diagnostic workup of the comatose patient must proceed concomitantly with management Lumbar puncture (if CT scan reveals no structural lesion) to exclude subarachnoid hemorrhage or meningitis ١٧
18 Dextrose 50% (25 g), naloxone ( mg), thiamine (50 mg) are given intravenously ١٨
19 Treatment of coma depends on underlying cause Emergency measures Supportive therapy for respiration or blood pressure is initiated In hypothermia, all vital signs may be absent; all such patients should be rewarmed before the prognosis is assessed The patient is positioned on one side with the neck partly extended, dentures removed, and secretions cleared by suction If necessary, the patency of the airways is maintained with an oropharyngeal airway ١٩
20 WHEN TO REFER All patients WHEN TO ADMIT All patients to an ICU ٢٠
21 In coma because of cerebral ischemia and hypoxia, the absence of pupillary light reflexes at the time of initial examination implies little chance of regaining independence By contrast, preserved pupillary light responses, the development of spontaneous eye movements (roving, conjugate, or better), and extensor, flexor, or withdrawal responses to pain at this early stage imply a relatively good prognosis ٢١
22 ٢٢
23 ٢٣
24 MENINGEAL CAUSES Subarachnoid hemorrhage (uncommon) Bacterial meningitis Encephalitis Subdural empyema ٢۴
25 ٢۵
26 ٢۶
27 ٢٧
INCREASED INTRACRANIAL PRESSURE
INCREASED INTRACRANIAL PRESSURE Sheba Medical Center, Acute Medicine Department Irene Frantzis P-Year student SGUL 2013 Normal Values Normal intracranial volume: 1700 ml Volume of brain: 1200-1400 ml CSF:
More informationCOMA. DIAH MUSTIKA HW,SpS,KIC INTENSIVE CARE UNIT of EMERGENCY DEPARTMENT
COMA DIAH MUSTIKA HW,SpS,KIC INTENSIVE CARE UNIT of EMERGENCY DEPARTMENT NAVAL HOSPITAL dr RAMELAN, SURABAYA DEFINITIONS Coma State of unresponsiveness to external or internal stimuli in which a patient
More informationNeurologic Examination
John W. Engstrom, MD October 16, 2015 Neurologic Examination Overview The Neurologic Examination Neurologic Examination John W. Engstrom, M.D. Dept. of Neurology University of California, San Francisco
More informationThe Neurologic Examination. John W. Engstrom, M.D. University of California San Francisco School of Medicine
The Neurologic Examination John W. Engstrom, M.D. University of California San Francisco School of Medicine Overview The Neurologic Examination Mental status demonstration/questions Cranial nerves demonstration/questions
More informationArboviral infections of the CNS: Japanese Encephalitis, West Nile, Dengue, Zika and co
3 rd Congress of the European Academy of Neurology Amsterdam, The Netherlands, June 24 27, 2017 Teaching Course 15 Neurological infections in travellers and immigrants - Level 3 Arboviral infections of
More informationBRAIN HERNIATION S54 (1) Brain Herniation
BRAIN HERNIATION S54 (1) Brain Herniation Last updated: September 5, 2017 PATHOPHYSIOLOGY... 1 TYPES OF HERNIATION... 2 SUPRATENTORIAL MASSES... 2 Central (s. downward transtentorial) herniation... 2 Uncal
More informationCOMA & INTENSIVE CARE
COMA & INTENSIVE CARE Jozef Firment, MD. PhD., Judita Capkova, MD. PhD. Department of Anaesthesiology & Intensive Care Medicine Šafárik University Faculty of Medicine, Košice Coma Is a state of unarousable
More informationNeurological Assessment of the Unresponsive Patient
Neurological Assessment of the Unresponsive Patient Disclosures The author has no financial disclosures related to any of the topics covered Receives grant support from the American Heart Association for
More informationcoma problems of consciousness
coma problems of consciousness in children Kees Braun UMC Utrecht definitions consciousness state of full awareness of the self and one s relationship to the environment consiousness responsiveness level
More informationOrganic Mental Disorders. Organic Mental Disorders. Axes. Damrongsak Bulyalert Department of Internal Medicine
Organic Mental Disorders Damrongsak Bulyalert Department of Internal Medicine www.metadon.net 1 Organic Mental Disorders In DSM (Diagnostic and Statistical Manual of Mental Disorders), OMD includes Delirium,
More informationcoma in children Kees Braun UMC Utrecht
a diagnostic approach to coma in children Kees Braun UMC Utrecht free pdf: Google search Plum and Posner s diagnosis of stupor and coma pdf first hit definitions consciousness state of full awareness
More informationBrain Death Determination: Outline. Definition. Brain Death Determination. Brain Death Determination. No conflict of interest
No conflict of interest : Outline Definition Definition Confounding factors Clinical examination Apnea test Confirmatory testing Communicating the diagnosis Ethical issues Brain death remains the preferred
More informationEVALUATION OF COMATOSE PATIENT. Prof. G. Zuliani
EVALUATION OF COMATOSE PATIENT Prof. G. Zuliani Consciousness Two components of conscious behavior: Vigilance (arousal): appearance of wakefulness Awareness (content): the sum of cognitive and affective
More informationelectrophysiological, and pathological correlations1
Journal of Neurology, Neurosurgery, and Psychiatry, 1972, 35, 582-588 Orbicularis oculi reflex in coma: clinical, electrophysiological, and pathological correlations1 LYNN W. LYON, JUN KIMURA,2 AND WILLIAM
More informationPHYSIOLOHY OF BRAIN STEM
PHYSIOLOHY OF BRAIN STEM Learning Objectives The brain stem is the lower part of the brain. It is adjoining and structurally continuous with the spinal cord. 1 Mid Brain 2 Pons 3 Medulla Oblongata The
More informationStroke School for Internists Part 1
Stroke School for Internists Part 1 November 4, 2017 Dr. Albert Jin Dr. Gurpreet Jaswal Disclosures I receive a stipend for my role as Medical Director of the Stroke Network of SEO I have no commercial
More informationNeurocritical Care Basics. Tapan Kavi, MD Christina Fox, RN
Neurocritical Care Basics Tapan Kavi, MD Christina Fox, RN GOAL 1: DON T LET THE PATIENT DIE Not unique ACLS, ATLS, ENLS, other strategies common to all emergency medical care ABCs MORE not less important
More informationBrain Injuries. Presented By Dr. Said Said Elshama
Brain Injuries Presented By Dr. Said Said Elshama Types of head injuries 1- Scalp injuries 2- Skull injuries 3- Intra Cranial injuries ( Brain ) Anatomical structure of meninges Intra- Cranial Injuries
More informationChapter 16 - Depressed consciousness and coma
Chapter 16 - Depressed consciousness and coma Episode overview: 1) List a broad differential diagnosis for coma 2) List GCS / Pediatric GCS 3) Describe the oculocephalic and oculovestibular reflex Wise
More informationAPPROACH TO THE COMATOSE CHILD
APPROACH TO THE COMATOSE CHILD Jimmy S. Lee 1. Background... 1 a) Definitions... 1 b) Background Physiology... 1 2. Questions to ask... 2 a) Timing... 2 b) Associated symptoms... 2 3. Differential diagnosis...
More information8th Annual NKY TBI Conference 3/28/2014
Closed Head Injury: Headache to Herniation A N T H O N Y T. K R A M E R U N I V E R S I T Y O F C I N C I N N A T I B L U E A S H E M S T E C H N O L O G Y P R O G R A M Objectives Describe the pathological
More informationNeurological Determination of Death Adult
Approved by: Vice President and Chief Medical Officer Neurological Determination of Death Adult Corporate Policy & Procedures Manual Number: VII-B-400 Date Approved June 9, 2015 Next Review (3 years from
More informationUNIVERSITY OF JORDAN FACULTY OF MEDICINE DEPARTMENT OF PHYSIOLOGY & BIOCHEMISTRY NEUROPHYSIOLOGY (MEDICAL) Spring, 2014
UNIVERSITY OF JORDAN FACULTY OF MEDICINE DEPARTMENT OF PHYSIOLOGY & BIOCHEMISTRY NEUROPHYSIOLOGY (MEDICAL) Spring, 2014 Textbook of Medical Physiology by: Guyton & Hall, 12 th edition 2011 Eman Al-Khateeb,
More informationUnit VIII Problem 4 Physiology lab: Brain Stem Lesions
Unit VIII Problem 4 Physiology lab: Brain Stem Lesions - Motor and sensory somatotopy: Pre-central gyrus: is the motor area. Post-central gyrus: is the sensory area. Somatotopy: there is a map of thee
More informationVestibular System. Dian Yu, class of 2016
Vestibular System Dian Yu, class of 2016 Objectives 1. Describe the functions of the vestibular system: What is it? How do you stimulate it? What are the consequences of stimulation? 2. Describe the vestibular
More informationPEDIATRIC BRAIN CARE
PEDIATRIC BRAIN CARE The brain matters most! OVERVIEW OF NEURO ASSESSMENT 1. Overall responsiveness/activity 2. The eyes 3.? Increased ICP 4. Movements 5.? Seizures 6. Other OVERALL RESPONSIVENESS/ ACTIVITY
More informationVISUAL REFLEXES. B. The oculomotor nucleus, Edinger-Westphal nucleus, and oculomotor nerve at level of the superior colliculus.
Neuroanatomy Suzanne Stensaas February 24, 2011, 10:00-12:00 p.m. Reading: Waxman Ch. 15 HyperBrain: Ch 7 with quizzes and or Lab 7 videotape http://www-medlib.med.utah.edu/kw/hyperbrain/anim/reflex.html
More informationRole of brainstem in somatomotor (postural) functions
Role of brainstem in somatomotor (postural) functions (vestibular apparatus) The muscle tone and its regulation VESTIBULAR SYSTEM (Equilibrium) Receptors: Otolith organs Semicircular canals Sensation (information):
More informationYALE-NEW HAVEN HOSPITAL CLINICAL ADMINISTRATIVE POLICY & PROCEDURE MANUAL
YALE-NEW HAVEN HOSPITAL CLINICAL ADMINISTRATIVE POLICY & PROCEDURE MANUAL Administrative Policy Title: Brain Death, Guidelines Determination of Death by Neurological Criteria in the Pediatric Patient Manual
More informationPediatric emergencies (SHOCK & COMA) Dr Mubarak Abdelrahman Assistant Professor Jazan University
Pediatric emergencies (SHOCK & COMA) Dr Mubarak Abdelrahman Assistant Professor Jazan University SHOCK Definition: Shock is a syndrome = inability to provide sufficient oxygenated blood to tissues. Oxygen
More informationRAPID BEDSIDE NEUROLOGIC ASSESSMENT. Stephan A. Mayer, MD, FCCM Director, Neurocritical Care Mount Sinai Health System
RAPID BEDSIDE NEUROLOGIC ASSESSMENT Stephan A. Mayer, MD, FCCM Director, Neurocritical Care Mount Sinai Health System Classic Neurological Examination 1. Mental Status 2. Cranial Nerves 3. Motor Exam
More informationStroke - Intracranial hemorrhage. Dr. Amitesh Aggarwal Associate Professor Department of Medicine
Stroke - Intracranial hemorrhage Dr. Amitesh Aggarwal Associate Professor Department of Medicine Etiology and pathogenesis ICH accounts for ~10% of all strokes 30 day mortality - 35 45% Incidence rates
More informationEpilepsy CASE 1 Localization Differential Diagnosis
2 Epilepsy CASE 1 A 32-year-old man was observed to suddenly become unresponsive followed by four episodes of generalized tonic-clonic convulsions of the upper and lower extremities while at work. Each
More informationChronic Brain-Dead Patients Who Exhibit Lazarus Sign
CASE REPORT Korean J Neurotrauma 2017;13(2):153-157 pissn 2234-8999 / eissn 2288-2243 https://doi.org/10.13004/kjnt.2017.13.2.153 Chronic Brain-Dead Patients Who Exhibit Lazarus Sign Department of Neurosurgery,
More informationNeurologic Determination of Death. Ian Ball FRCPC Regional Medical Lead for Organ Donation October 26, 2015
Neurologic Determination of Death Ian Ball FRCPC Regional Medical Lead for Organ Donation October 26, 2015 Format Definition of Brain Death Historical Perspectives International consistency / inconsistency
More informationI: To describe the pyramidal and extrapyramidal tracts. II: To discuss the functions of the descending tracts.
Descending Tracts I: To describe the pyramidal and extrapyramidal tracts. II: To discuss the functions of the descending tracts. III: To define the upper and the lower motor neurons. 1. The corticonuclear
More informationA GLANCE ON NEUROLOGICAL EMERGENCIES. Baystate Medical Center
A GLANCE ON NEUROLOGICAL EMERGENCIES Baystate Medical Center Anthony Shamoun, MSN, RN, ACNP-BC, CCNS Clinical Nurse Specialist/Nurse Educator anthony.shamoun@bhs.org Outline I. Neurological Examination
More informationHospital of the University of Pennsylvania POLICY MANUAL
Page 1 of 8 KEY WORDS: Brain Death Coma # 1-6-11 Procedures Following Patient Death # 1-6-13 Organ Donation and Anatomical Donation and Pennsylvania s Anatomical Gift Act #1-6-17 Withholding and Withdrawing
More informationV1-ophthalmic. V2-maxillary. V3-mandibular. motor
4. Trigeminal Nerve I. Objectives:. Understand the types of sensory information transmitted by the trigeminal system.. Describe the major peripheral divisions of the trigeminal nerve and how they innervate
More informationReflexes. Dr. Baizer
Reflexes Dr. Baizer 1 Learning objectives: reflexes Students will be able to describe: 1. The clinical importance of testing reflexes. 2. The essential components of spinal reflexes. 3.The stretch reflex.
More informationThe Determination of Brain Death. James Zisfein, M.D. Chief, Division of Neurology Lincoln Medical Center, Bronx, NY
The Determination of Brain Death James Zisfein, M.D. Chief, Division of Neurology Lincoln Medical Center, Bronx, NY James.Zisfein@nychhc.org The early history of brain death Until recently, death was determined
More informationCOMA BIOLOGY. Assist. Prof. Mehmet Akif KARAMERCAN Gazi University Faculty of Medicine Department of Emergency Medicine
COMA BIOLOGY Assist. Prof. Mehmet Akif KARAMERCAN Gazi University Faculty of Medicine Department of Emergency Medicine Outlines Definitions Classification and Major Causes Arousal Systems (Reticular Activating
More informationMotor tracts Both pyramidal tracts and extrapyramidal both starts from cortex: Area 4 Area 6 Area 312 Pyramidal: mainly from area 4 Extrapyramidal:
Motor tracts Both pyramidal tracts and extrapyramidal both starts from cortex: Area 4 Area 6 Area 312 Pyramidal: mainly from area 4 Extrapyramidal: mainly from area 6 area 6 Premotorarea: uses external
More informationSpinal Cord Tracts DESCENDING SPINAL TRACTS: Are concerned with somatic motor function, modification of ms. tone, visceral innervation, segmental reflexes. Main tracts arise form cerebral cortex and others
More informationElsevier's Encyclopedia of euroscience
REPRINTED FROM Elsevier's Encyclopedia of euroscience e Edited by George Adelman Barry H. Smith Editorial Manager Jennifer De Pasquale 1999 Elsevier Science B.V. All rights reserved. Visit the Encyclopedia's
More informationThe Nervous System: Sensory and Motor Tracts of the Spinal Cord
15 The Nervous System: Sensory and Motor Tracts of the Spinal Cord PowerPoint Lecture Presentations prepared by Steven Bassett Southeast Community College Lincoln, Nebraska Introduction Millions of sensory
More informationComa and Brain Death. Robert E. Hoesch and Romergryko G. Geocadin
Coma and Brain Death Robert E. Hoesch and Romergryko G. Geocadin 17 Abstract Arousal impairment, as manifested by coma, encephalopathy, and brain death, is a common final pathway for a broad range of diseases,
More informationLOSS OF CONSCIOUSNESS & ASSESSMENT. Sheba Medical Center Acute Medicine Department MATTHEW WRIGHT
LOSS OF CONSCIOUSNESS & ASSESSMENT Sheba Medical Center Acute Medicine Department MATTHEW WRIGHT OUTLINE Causes Head Injury Clinical Features Complications Rapid Assessment Glasgow Coma Scale Classification
More informationAnesthetic Management of a Patient with Traumatic Brain Injury
Anesthetic Management of a Patient with Traumatic Brain Injury Arne O. Budde, MD, DEAA Associate Professor of Anesthesiology Director, Division of Neuroanesthesia Department of Anesthesiology Milton S
More informationAnatomically and functionally the brain is the most complex
CHAPTER 37 Alterations in Brain Function Brain Injury Mechanisms of Brain Injury Hypoxia and Ischemia Excitatory Amino Acid Injury Cerebral Edema Increased Intracranial Volume and Pressure Brain Herniation
More informationExamination Approach. Examination Approach. Case 1: Mental Status. The Neurological Exam In the ICU: High Yield Techniques 5/8/2015
The Neurological Exam In the ICU: High Yield Techniques Examination Approach Two types of neurologic examinations 1. Screening Examination 2. Testing Hypotheses Select high-yield tests and techniques S.
More informationThe Neurologic Examination: High-Yield Strategies
The Neurologic Examination: High-Yield Strategies S. Andrew Josephson, MD Assistant Professor, Department of Neurology Divisions of Neurovascular and Behavioral Neurology University of California San Francisco
More informationUnit VIII Problem 5 Physiology: Cerebellum
Unit VIII Problem 5 Physiology: Cerebellum - The word cerebellum means: the small brain. Note that the cerebellum is not completely separated into 2 hemispheres (they are not clearly demarcated) the vermis
More informationPRACTICE GUIDELINE. DEFINITIONS: Mild head injury: Glasgow Coma Scale* (GCS) score Moderate head injury: GCS 9-12 Severe head injury: GCS 3-8
PRACTICE GUIDELINE Effective Date: 9-1-2012 Manual Reference: Deaconess Trauma Services TITLE: TRAUMATIC BRAIN INJURY GUIDELINE OBJECTIVE: To provide practice management guidelines for traumatic brain
More informationD is for Disability Altered Mental Status in Children
D is for Disability Altered Mental Status in Children Joshua Ross, MD, FAAP Pediatric Emergency Medicine Emergency Care and Trauma Symposium June 22, 2015 Objectives Describe a basic approach to evaluating
More informationSYNCOPE. DEFINITION Syncope is defined as sudden and transient loss of consciousness which is secondary to period of cerebral ischemia CAUSES
SYNCOPE INTRODUCTION Syncope is a symptom not a disease Syncope is the abrupt and transient loss of consciousness associated with absence of postural tone, followed by complete and usually rapid spontaneous
More informationDelirium & Dementia. Nicholas J. Silvestri, MD
Delirium & Dementia Nicholas J. Silvestri, MD Outline Delirium vs. Dementia Neural pathways relating to consciousness Encephalopathy Stupor Coma Dementia Delirium vs. Dementia Delirium Abrupt onset Lasts
More informationA Hypothesis Driven Approach to the Neurological Exam
A Hypothesis Driven Approach to the Neurological Exam Vanja Douglas, MD Assistant Clinical Professor UCSF Department of Neurology Disclosures None 1 Purpose of Neuro Exam Screen asymptomatic patients Screen
More informationCHILD IN NON - TRAUMATIC COMA
May / 2018 PELC / SLCP 1 CHILD IN NON - TRAUMATIC COMA PELS May / 2018 PELC / SLCP 2 Objectives Recognize depressed mental status Know the causes of depressed mental status in children Assessment and workup
More informationVESTIBULAR SYSTEM. Deficits cause: Vertigo. Falling Tilting Nystagmus Nausea, vomiting
VESTIBULAR SYSTEM Objectives: Understand the functions of the vestibular system: What is it? How do you stimulate it? What are the consequences of stimulation? Describe the vestibular apparatus, the 2
More informationThe Neurologic Examination: High-Yield Strategies
The Neurologic Examination: High-Yield Strategies S. Andrew Josephson, MD Examination Approach Two types of neurologic examinations 1. Screening Examination 2. Testing Hypotheses Select high-yield tests
More informationPHYSIOLOGY OF THE BRAIN STEM
PHYSIOLOGY OF THE BRAIN STEM Dr Syed Shahid Habib Professor & Consultant Clinical Neurophysiology Dept. of Physiology College of Medicine & KKUH King Saud University OBJECTIVES At the end of this lecture
More informationThe management of medical coma
Journal ofneurology, Neurosurgery, and Psychiatry 1993;56:589-598 589 NEUROLOGICAL EMERGENCY Department of Neurology, University of Newcastle Upon Tyne, UK D Bates The management of medical coma David
More informationCNS pathology Third year medical students. Dr Heyam Awad 2018 Lecture 5: disturbed fluid balance and increased intracranial pressure
CNS pathology Third year medical students Dr Heyam Awad 2018 Lecture 5: disturbed fluid balance and increased intracranial pressure ILOs Understand causes and symptoms of increased intracranial pressure.
More informationThe NIHSS score is 4 (considering 2 pts for the ataxia involving upper and lower limbs.
Neuroscience case 5 1. Speech comprehension, ability to speak, and word use were normal in Mr. Washburn, indicating that aphasia (cortical language problem) was not involved. However, he did have a problem
More informationNervous system Reflexes and Senses
Nervous system Reflexes and Senses Physiology Lab-4 Wrood Slaim, MSc Department of Pharmacology and Toxicology University of Al-Mustansyria 2017-2018 Nervous System The nervous system is the part of an
More informationPRACTICE EXAM QUESTIONS
PRACTICE EXAM QUESTIONS 1. A patient presents with muscle weakness. To assess his condition, you test his knee-jerk reflex by tapping his patella tendon with your hammer. Next you examine the jaw-jerk
More informationNeurological Prognosis after Cardiac Arrest Guideline
Neurological Prognosis after Cardiac Arrest Guideline I. Associated Guidelines and Appendices 1. Therapeutic Hypothermia after Cardiac Arrest 2. Hypothermia after Cardiac Arrest Algorithm II. Rationale
More informationExperiences as a Donation Support Physician. Dead or not Dead? Are the following statements consistent with neurological
Experiences as a Donation Support Physician Dead or not Dead? Are the following statements consistent with neurological determination of death (dead)? or not (not dead)? With thanks to Drs. Alex Manara,
More informationUpper and Lower Motoneurons for the Head Objectives
Upper and Lower Motoneurons for the Head Objectives Know the locations of cranial nerve motor nuclei Describe the effects of motor cranial nerve lesions Describe how the corticobulbar tract innervates
More informationArielle Bokhour, class of 2017
Arielle Bokhour, class of 2017 Objectives 1. Understand the actions and innervation of the extrinsic and intrinsic eye muscles 2. Describe the pathways for pupillary constriction and dilation 3. Understand
More informationDEVELOPMENT OF BRAIN
Ahmed Fathalla OBJECTIVES At the end of the lecture, students should: List the components of brain stem. Describe the site of brain stem. Describe the relations between components of brain stem & their
More informationexamination in Companion Animals
Peer reviewed The Neurologic examination in Companion Animals Part 2: Interpreting Abnormal Findings Helena Rylander, DVM, Diplomate ACVIM (Neurology) In the January/February issue of Today s Veterinary
More informationProceedings of the European Veterinary Conference Voorjaarsdagen
Close this window to return to IVIS www.ivis.org Proceedings of the European Veterinary Conference Voorjaarsdagen Apr. 13-15, 2016 Next Meeting: April 1 -, 201 The Hague, The Netherlands Reprinted in IVIS
More informationPosterior Circulation Stroke
Posterior Circulation Stroke Brett Kissela, MD, MS Professor and Chair Department of Neurology and Rehabilitation Medicine Senior Associate Dean of Clinical Research University of Cincinnati College of
More informationThe assessment of comatose patients requires a comprehensive neurologic
DIAGNOSIS AND PROGNOSIS UPDATE Clinical Scales for Comatose Patients: The Glasgow Coma Scale in Historical Context and the New FOUR Score Eelco F.M. Wijdicks, MD, PhD Department of Neurology, Mayo Clinic,
More informationThe dura is sensitive to stretching, which produces the sensation of headache.
Dural Nerve Supply Branches of the trigeminal, vagus, and first three cervical nerves and branches from the sympathetic system pass to the dura. Numerous sensory endings are in the dura. The dura is sensitive
More informationNeurology Clerkship Learning Objectives
Neurology Clerkship Learning Objectives Clinical skills Perform a neurological screening examination of the cranial nerves, motor system, reflexes, and sensory system under the observation and guidance
More informationPontine haemorrhage: a clinical analysis of 26 cases
Journal of Neurology, Neurosurgery, and Psychiatry 1985;48:658-662 Pontine haemorrhage: a clinical analysis of 26 cases SHOJI MASIYAMA, HIROSHI NIIZUMA, JIRO SUZUKI From the Division ofneurosurgery, Institute
More informationTHE VEGETATIVE STATE IN INFANCY AND CHILDHOOD
THE VEGETATIVE STATE IN INFANCY AND CHILDHOOD Stephen Ashwal MD, Professor of Pediatrics and Neurology, Chief, Division of Child Neurology, Department of Pediatrics, Loma Linda University School of Medicine,
More informationPROPOSED REVISIONS OF ISMA BRAIN DEATH GUIDELINES
RESOLUTION 17-04 Introduced by: Action: PROPOSED REVISIONS OF ISMA BRAIN DEATH GUIDELINES Emil Weber, MD Adopted as Amended RESOLVED, that ISMA adopt updated brain death guidelines for adults and children,
More informationCASO CLINICO: DELIRIUM O ENCEFALOPATIA ACUTA?
15 Congresso Nazionale Associazione Nazionale Psicogeriatria FIRENZE PALAZZO DEI CONGRESSI 16/18 APRILE 2015 CASO CLINICO: DELIRIUM O ENCEFALOPATIA ACUTA? N. Latronico Università degli Studi di Brescia
More informationPost-Cardiac Arrest Syndrome. MICU Lecture Series
Post-Cardiac Arrest Syndrome MICU Lecture Series Case 58 y/o female collapses at home, family attempts CPR, EMS arrives and notes VF, defibrillation x 3 with return of spontaneous circulation, brought
More informationProceedings of the World Small Animal Veterinary Association Sydney, Australia 2007
Proceedings of the World Small Animal Veterinary Association Sydney, Australia 2007 Hosted by: Australian Small Animal Veterinary Association (ASAVA) Australian Small Animal Veterinary Association (ASAVA)
More informationBilaga 4 till rapport 1 (17)
Bilaga 4 Tabeller, beskrivning av studier Bilaga 4 till rapport 1 (17) Bilddiagnostik vid misstanke om total hjärninfarkt en systematisk litteraturöversikt, rapport 282 (2018) SBU Statens beredning för
More informationAspazija Sofijanova University Children s Hospital Clinical Center Skopje/Republic of Macedonia
Aspazija Sofijanova University Children s Hospital Clinical Center Skopje/Republic of Macedonia Absence of self awareness and of the environment Coma scales: Glasgow, up to 5 years modified Jаmеs Max.
More informationStatus Epilepticus in Children
PedsCases Podcast Scripts This is a text version of a podcast from Pedscases.com on Status Epilepticus in Children. These podcasts are designed to give medical students an overview of key topics in pediatrics.
More informationNervous System The Brain and Spinal Cord Unit 7b
Nervous System The Brain and Spinal Cord Unit 7b Chetek High School Mrs. Michaelsen 9.12 Meninges A. Meninges 1. The organs of the CNS are covered by membranes a. The meninges are divided into 3 layers:
More informationHead & Brain Trauma. Presented By: Steven Jones, NREMT-P
Head & Brain Trauma Presented By: Steven Jones, NREMT-P Head & Brain Trauma ~ 4 million head injuries in US per year ~ 450,000 require hospitalization Most are minor injuries Major head injury most common
More informationNeurological assessment
Article 481. Shah S (1999) Neurological assessment. Nursing Standard. 13, 22, 49-56. This article relates to the UKCC Professional Development categories: Care enhancement and Reducing risk. Neurological
More informationPrinciples of Anatomy and Physiology
Principles of Anatomy and Physiology 14 th Edition CHAPTER 14 The Brain and Cranial Nerves Introduction The purpose of the chapter is to: 1. Understand how the brain is organized, protected, and supplied
More informationStroke: clinical presentations, symptoms and signs
Stroke: clinical presentations, symptoms and signs Professor Peter Sandercock University of Edinburgh EAN teaching course Burkina Faso 8 th November 2017 Clinical diagnosis is important to Ensure stroke
More informationThe Child with Alterations in Cerebral Function
The Child with Alterations in Cerebral Function Neurologic Assessment VS HR, BP, Respirations, Temperature LOC Orientation Pediatric Glasgow Coma Scale Eyes Pupillary response and movement, extraoccular
More informationModule 5. Ischemia in Vertebral-basilar Territory
T I Module 5. Ischemia in Vertebral-basilar Territory Introduction and Key Clinical Examples Ischemia in Vertebrobasilar branches Objectives for Module 5 Knowledge! List 4 common symptoms that patients
More informationName Date Period. Human Reflexes Lab
Name Date Period Introduction: Human Reflexes Lab Neurons communicate in many ways, but much of what the body must do every day is programmed as reflexes. Reflexes are rapid, predictable, involuntary motor
More informationALTERED LEVEL OF CONSCIOUSNESS
INTRODUCTION An altered level of consciousness (LOC) refers to a change in a patient s state of awareness (ability to relate to self and the environment) and arousal (alertness) ranging from a state of
More informationLecturer. Prof. Dr. Ali K. Al-Shalchy MBChB/ FIBMS/ MRCS/ FRCS 2014
Lecturer Prof. Dr. Ali K. Al-Shalchy MBChB/ FIBMS/ MRCS/ FRCS 2014 Dorsal root: The dorsal root carries both myelinated and unmyelinated afferent fibers to the spinal cord. Posterior gray column: Long
More information