Coma

Workup

• cerebrum: higher function but not critical

  • EEG to determine function

• brainstem: critical. Reflexes used:

  • corneal reflex: q tip

  • cold water calorics: COWS

    • cold water left ear: eyes move left slowly, then quick beating nyastagmus opposite

    • absent reflex: eyes move left slowly, no nyastagmus beating

    • brain dead: eyes don't move at all

  • Doll's eyes: move head, eyes fixed

• heart: keeps blood going for brain

  • EKG

• peripheral nerves: permits feel and see

  • physical exam

Different Brain Function

	Cerebrum	Brainstem	Heart	Motor
Normal	+	+	+	+
Coma	depressed	+	+	+
Persistent Vegetative State	-	+	+	+
Brain death	-	-	+	-
Locked in syndrome	+	+	+	Can feel, can't move except blink eyes

• coma: can be reversible

  • hypoglycemia

  • narcoid induced

• PVS: still can have motor function that's part of brainstem (tracking with eyes, swallow)

• Brain death: really dead. Disconnect ventillator and if don't breath = dead. Absence of brainstem reflex

  • no EEG

  • loss of grey/white junction

• Locked in syndrome: pontine stroke. Looks like PVS but can move eyes and aware of surrounding