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1. Medical emergency
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2.  Dysfunction of
 Either cerebral hemispheres or
 Midbrain tegmentum
▪ Reticular activating system
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3.  Function
 Maintains the cerebral cortex in a state of
wakeful consciousness
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4.  Upper brainstem
 Medial thalamus
 Very close to area concerned with pupillary
function and eye movements
 Pupillary enlargement
 Loss of movements of the eyes
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5.  Reticular activating system
 Ascending projections to the cortex
 Cortex
 Corticothalamic connections
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6.  75 mL per 100 g/min in gray matter
 30 mL per 100 g/min in white matter
 Mean
 55 mL per 100 g/min
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7.  120 seconds
 Glucose utilization
 5 mg per 100 g/min
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8.  Last 10 s after the cessation of blood flow
 Oxygen consumption
 3.5 mL per 100 g/min
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9.  120 seconds
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10.  Acute confusion with agitation
 Hallucinations
 Perception without a stimuli
▪ Sight, sound, touch, smell or taste
 Illusions
 Misperceptions of stimuli
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15. 1. Metabolic
2. Damage to RAS
3. Damage of large portions of cerebral
hemispheres
 Small focal lesions of one or both cerebral
hemispheres
 Do not cause coma
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16. Suppression of thalamo-cerebral function
 Drugs
 Toxins
 Hypoglycemia
 Anoxia
 Azotemia
 Hepatic failure
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17.  What is the date, day, month and year?
 Where are you now?
 Which is the state capital?
 Why are you in the hospital now?
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18.  Immediate memory
 Repeat 3 to 5 numbers
 Show the patient 3 to 5 objects (e.g., pen,
key) to remember
 10 minutes later ask him which objects
were shown
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19.  Evaluated while the history is being taken
 Serial subtraction of 3 from 30 or 7 from 100
 Can detect even mild confusional states
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20.  Normal light reflex
 Normal LP
 Normal CT
 Bilateral asterixis
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