Level of Awareness

LEVEL

SUMMARY

DESCRIPTION

Conscious

Normal

Able promptly and spontaneously; oriented

Confused

Disoriented; impaired
thinking and responses

Do not respond quickly; may have slow thinking

and possible memory time loss. Sleep
deprivation, malnutrition

Delirious

Disoriendted;
Restless or agitated, deficit in attention
restlessness,
hallucinations, sometimes
delusions

Somnolen
t

Sleepy

Excessive drowsiness and responds to stimuli

only with incoherent mumbles or disorganized
movements

Obtunded

Decreased alertness;
slowed psychomotor
responses

Decreased interest in their surroundings, slowed

responses and sleepiness

Stuporous

Sleep-like state; little or

Respond by grimacing; drawing away from

Activating Driving Systems of the

Brain
(1) by stimulating the background level ofactivity
throughout wide areas of the brain
(2) By ctivating neurohumoral systems that release
specific facilitatory or inhibitory hormone-like
neurotransmittersinto selected areas of the brain.

Control of Cerebral Activity by

Continuous
Excitatory Signals from the Brain
StemExcitatory Area Is Located in the Reticular
Reticular
Formation of the Pons and Midbrain
-The central driving component of this system is an excitatory area
located in the reticular substance of the pons and mesencephalon.
This area is also known by the name bulboreticular facilitory area.
-forms descending spinal projections to the spinal cord that exert an
excitatory influence on motor neurons that innervate antigravity
musculature
-same reticular area also sends fibers rostrally to various l locations
including the thalamus, where neurons distribute to all regions of the
cerebral cortex.

Two types of Signals

Rapidly transmitted- arises from the large cholinergic
reticular neurons
excites thevcerebrum for only a
few milliseconds.

Slow action potentials-from small reticular neurons;

terminate mainly
in the intralaminar and
reticular nuclei of the
thalamus

Excitation of the Excitatory Area by

Peripheral Sensory Signals
The level of activity in the reticular excitatory area is
determined largely by input from ascending somatosensory
pathwaysthe pain pathways, in particular.
This was deduced from animal experiments in which the brain
stem was transected just rostral to the entry of the trigeminal
nerve (5th Cerebral nerve) . This effectively eliminates all
ascending somatosensory input, and the excitatory reticular
area goes silent as the animal enters a coma-like state.

Increased Activity of the Excitatory Area Caused by

Feedback Signals Returning from the Cerebral Cortex

the cortex also provides descending excitatory input to

the excitatory reticular area, which serves as positive
feedback and allows cerebral activity to reinforce the
action of the ascending reticular system; leading to an
awake mind

Thalamus is Distribution Center that

Controls Activity in Specific Regions
of the Cortex
The thalamus and cortex are linked by reciprocal
connections.

Electrical stimulation of a specific point in the thalamus

generally activates its own specific small region of the
cortex.
Signals of these two regions reverberate back and forth
by way of return fibers.
thinking process may involve memory formation

The Lower Brain Stem in the Ventromedial

Medulla Contains a Reticular Inhibitory Area
-Located medially and ventrally in the medulla.
-this region provides descending spinal projections that
inhibit the activity of antigravity muscles
-the inhibitory reticular area projects rostrally to decrease
the excitatory levels of the cerebrum through
serotonergic systems