NEUROLOGIC CONS - MANIFESTATIONS OF BRAIN LESIONS (PT. 1)

Consciousness

Awareness of the internal or external world, and disorders of consciousness

1. Level of consciousness

2. Content of consciousness

Consciousness can affect either the ff:

1. Drowsiness

2. Delirium

3. Stupor

4. Coma

4 LEVELS OF CONSCIOUSNESS

1. Dementia

2. Amnestic disorders

2 CONTENTS OF CONSCIOUSNESS

Abnormalities in the level of consciousness

This is characterized by the ff:

• Impaired arousal/wakefulness

• Result from acute lesions of the ascending reticular activating system or both cerebral hemispheres

Reticular Activating System

It is responsible for the sleep and wake cycle of the nervous system

DROWSINESS

● Ready arousal

● Ability to respond verbally and fending-off movements

● Induced by painful stimuli in the absence of hemiparesis or aphasia.

Acute confusional state

Other term for Delirium (A.K.A)

DELIRIUM

○ The patient responds to at least some stimuli in a purposeful manner – but is sleepy, disoriented, and inattentive.

Disorders that lead to increased circulating catecholamines like:

• Intoxication w/ stimulant drugs (amphetamines)

• High fever

• Withdrawal from sedatives (alcohol, benzodiazepines, & barbiturates)

CAUSES OF DELIRIUM

STUPOR

• A state in which the patient can be roused only by

vigorous and repeated stimuli, at which time he

opens his eyes, looks at the examiner, and does not

appear to be unconscious

• Response to spoken commands is either absent or

slow and inadequate.

• Restless or stereotyped motor activity is common

in stuporous

• Reduction in the natural shifting of positions

COMA

• Most severe degree of depressed consciousness

• Unresponsive and unarousable.

• Appears to be asleep and is at the same time incapable of being aroused by external stimuli or inner need

SLEEP

Shares similar features with coma +

○ (+) Yawning

○ Closure of eyelids

○ Cessation of blinking and

swallowing

○ Upward deviation or divergence or

roving movements of the eyes

○ Loss of muscular tone

○ Decrease/loss of tendon reflexes

○ Even in the presence of Babinski

signs + irregular respirations

○ Sometimes Cheyne-Stokes in type.

The sleeping person can be roused to normal consciousness but a

coma patient cannot be roused.

Keyword: aroused or roused

Main difference between Sleep vs. Coma

Spontaneous- 4

To speech- 3

To pain- 2

No eye opening- 1

4 stages of EYE OPENING and their corresponding scores

Oriented & Appropriate- 5

Confused- 4

Inappropriate- 3

Incomprehensible- 2

No response/no sounds- 1

5 stages of VERBAL RESPONSE and their corresponding scores

Obeys commands- 6

Localizes pain- 5

Withdraws to pain- 4

Abnormal flexion (decorticate rigidity)- 3

Abnormal extension (decerebrate rigidity)- 2

No response-1

5 stages of MOTOR RESPONSE and their corresponding scores

Poor prognosis

In the GCS, For each response, a GCS score of 7 and < indicates?

Sum of the appropriate score

To obtain the GCS, get the?

Language

A function of the dominant cerebral hemisphere

1. Emotional

2. Symbolic or propositional

Language is divided into 2:

Symbolic or propositional

• Conveying thoughts, opinions, and concepts.

• Acquired via culture, education, and normal cerebral development.

Emotional

The instinctive expression of feelings representing the earliest forms of language acquired in infancy.

MUTISM

● Absence of any attempt at oral communication

● Severe bilateral frontal lobe or 3rd ventricle pathology (akinetic mutism)

PALILALIA

● Repetition of last words, seen in extrapyramidal disease.

(Repeating your own words or phrases)

ECHOLALIA

● Constant repetition of words/sentences heard in severe dementing disorder.

(Repeating someone else’s words or phrases)

LOGORRHEA

● Prolonged speech monologues

● Associated with Wernicke’s aphasia

Wernicke’s aphasia

It is an aphasia where the patient is able to speak properly but cannot comprehend what is being said = answer is not comprehensible.

DYSARTHRIA

● Disturbance of articulation in which the content of speech-language is unaffected.

1. Ataxic dysarthria – scanning or explosive speech (cerebellar disease)

2. Hypokinetic (slow)

3. Hyperkinetic (fast)

4. Flaccid dysarthria

Types of Dysarthria:

DYSPHASIA OR APHASIA

● Loss of production or comprehension of spoken and or written language.

1. Broca’s aphasia

2. Receptive aphasia

3. Conductive aphasia

4. Global aphasia

Types of Dysphasia or Aphasia:

● Comprehension

● Repetition

● Fluency

● Naming

● Reading

● Writing

ESSENTIAL ELEMENTS OF LANGUAGE

Aphasia or dysphasia

Defined as an impairment or loss of comprehension or production of spoken or written language or both due to an acquired disease of the brain.

Anomia

Failure to name objects

Alexia or Visual Verbal Agnosia

Inability to read by a person who was literate

Agraphia

Is a loss of ability to write

Auditory verbal agnosia or word deafness

Specifies a loss of understanding of spoken words

Dysarthria

A purely motor disorder of the muscles of articulation, language function being intact

Aphonia or dysphonia

Inability to vocalize, articulation and language function being unaffected

1. Global Aphasia

2. Broca Aphasia

3. Wernicke Aphasia

4. Anomic Aphasia

4 MAJOR APHASIC SYNDROMES

1. Conduction Aphasia

2. Transcortical Aphasia, Motor, and Sensory

2 MINOR OR RESTRICTED (DISCONNECTION) SYNDROMES

1. Pure word blindness

2. Pure word deafness

3. Pure word mutism

4. Agraphia

4 MODALITY SPECIFIC APHASIAS

TINNITUS

Major manifestation of cochlear and auditory disease

Tinnitus aurium

“Ringing of the ears”

buzzing, humming, whistling, roaring, hissing, clicking, chirping, or pulse-like sounds

● Loudness recruitment

● Audiometry

● Brainstem Auditory Evoked Response (BAER)

● Acoustic stapedial reflex

TESTS FOR HEARING by audiologists

DIZZINESS

• Applied by the patient to a number of different sensory experiences—

• a feeling of rotation or whirling as well as non-rotatory swaying, weakness, faintness, light-headedness, or unsteadiness.

• Blurring of vision, feelings of unreality, syncope, and even petit mal or other seizure phenomena may be called “dizzy spells”

VERTIGO AND PSEUDOVERTIGO

This is when the patient states that objects in the environment have spun around or moved rhythmically in one direction or that a sensation of whirling of the head and body was experienced.

Subjective vertigo

A sense of turning of one’s body

Objective vertigo

An illusion of movement of the environment