Acute Brain Flashcards
As a result of an increase volume in the cranium.
Increased Intracranial Pressure
The_____ in an adult is a closed fixed space that can’t tolerate anything more than transient increase in the pressure.
cranium
This volume in the cranium is composed of three elements:
cerebral tissue, cerebrospinal fluid, and blood
Normal increased intracranial pressure is
0-15 mmhg
_______there are compensatory responses to the change in the volume in any of the components of volume in the cranium. So therefore if there’s an increase in csf, there will be a common reduction in blood flow. Brain tissue not so much, it’s very hard to decrease brain tissue. If there’s an increase of pressure in the brain tissue, csf and blood flow will compensatorily will be reduced
Monro-Kellie hypothesis
Increased _____can occur with space-occupying lesions, vasogenic or cytotoxic edema, or with obstruction or excessive production of CSF
ICP
Headache, vomiting, and altered level of consciousness (drowsiness)
Blurry vision, and edema of the optic disk (papilledema)
symptoms of
ICP
As ____ rises to higher levels, level of consciousness ____, pupil responsiveness to light becomes impaired; altered respiratory patterns and unresponsive to stimulation; unable to move, verbalize, or open the eyes
ICP; decreases
______ or ______ helps manage ICP
MRI and CT
CPP greater than _____mm Hg to ensure adequate blood flow and prevent ischemia
60
Removing ______ and improving cerebral ______ to manage brain injury
lesion; oxygenation
most sensitive indicator of altered brain function
change in level of consciousness
State of alertness and attentiveness dependent upon activity in _____ neurons
RAS
Standardized tool for assessing LOC in acutely brain-injured persons
Glasgow Coma Scale
Whats the most powerful predictor of patient outcome for Glasgow come scale?
motor response
Ranges for glasgow scale
Mild >12
Moderate 9-12
Severe <8
Indicates the function of the brainstem and cranial nerves (CN) II and III
Pupil Reflex
Changes in size, shape, and reactivity of the pupil early indicator of _____ and possible brain herniation
ICP
Eye movements controlled by ______ nerves
CN III, IV, and VI
________, dysconjugate movement, and ocular palsies may be present in brain injury
Nystagmus
Impaired reflex implies brainstem dysfunction
Oculovestibular Reflex
_____entails rotating the patient’s head from side to side
Normally eyes turn in opposite direction of the head rotation in ____
Doll’s eyes maneuver; Oculovestibular Reflex
_____inject cold water into ear
Normal response: tonic deviation of both eyes toward the side that is irrigated in______
Cold Calorics; Oculovestibular Reflex
Wisp of cotton touches cornea of the eye to elicit a blink response
Absence of blink response: indictor of severely impaired brain function
corneal reflex
Mean arterial pressure maintained above __ mm Hg
Cerebral perfusion pressure: ___mm Hg
70; 60
_____ may be used to reduce brain metabolism. Increased brain metabolism should be avoided
hypothermia
leading cause of death and disability in U.S.
TBI
What are the 2 types of TBI
Primary injury and intracranial hematomas
3 types of primary TBI injury
Focal
Polar
Diffuse
3 types of intracranial hematomas
Epidural
Subdural
Subarachnoid
TBI type localized to site of impact
Focal
TBI type due to acceleration-deceleration movement of the brain within the skull, resulting in double injury (usually opposite focal injury)
Polar
TBI type due to movement of the brain within the skull, resulting in widespread axonal injury
Diffuse
Mild traumatic brain injury; most common injury encountered by military personnel and athletes
Alteration or loss of consciousness (< 30 minutes) but no evidence of brain damage on CT
Headache, nausea, vomiting, dizziness, fatigue, blurred vision, cognitive and emotional disturbances
Concussion
CT or MRI reveals an area of brain tissue damage (necrosis, laceration, bruising)
Contusion
localized collection of blood within the cranium
Intracranial hematoma
Cardiopulmonary stabilization
Radiologic screening to evaluate need for emergent surgical management
Maintenance of normal body temperature or mild hypothermia, normal PaCO2, normal serum glucose level, and normal intravascular volume recommended
Treatment for _____
TBI
administration of mannitol (osmotic diuretic), sedation, hypothermia, and mild hyperventilation
Treatment for
Acutely elevated ICP
more aggressive measures; diuretics, hypertonic saline, moderate hyperventilation, and barbiturate coma
Treatment for
Severely high ICP
prophylactic antibiotics treatment for ______
open head injuries
CSF can seep out as clear fluid from the ears or nose (halo test); bilateral periorbital hematomas (black eyes, “raccoon sign”) and bruising under the ear (Battle’s sign) signs of
base skull fractures
Cause abnormalities of cerebral perfusion
Transient ischemic attacks (TIA), ischemic stroke, and hemorrhagic stroke
CVD/Stroke
is a sudden onset of neurologic dysfunction due to cardiovascular disease that results in an area of brain infarction
stroke
Most common form of stroke
ischemic
Females affected more often than males
Risk factors are similar to those for other atherosclerotic vascular diseases (hypertension, DM, hyperlipidemia, smoking, advancing age, family history)
Stroke
Results from sudden occlusion of cerebral artery secondary to thrombus formation or emboli
ischemic stroke
________strokes associated with atherosclerosis and coagulopathies
thrombotic
______strokes associated with cardiac dysfunction or dysrhythmias (atrial fibrillation)
embolic
Clinical manifestations: contralateral hemiplegia, hemisensory loss, and contralateral visual field blindness
ischemic stroke
Treatment: salvaging the penumbra is the aim of early ______therapy; however, treatment must be instituted within 3 hours of symptom onset to be maximally effective in _____
thrombotic; ischemic stroke
If neurologic deficits completely resolve
transient ischemic attack (TIA)
Neurologic symptoms typically last only minutes, but they may last as long as 24 hours
Symptoms resolve completely without evidence of neurologic dysfunction
transient ischemic attack (TIA)
important warning signs of thrombotic disease and carry a significant risk for subsequent stroke
transient ischemic attack (TIA)
Treatment: daily aspirin; carotid endarterectomy or angioplasty if 70% occluded
transient ischemic attack (TIA)
Hemorrhage within the brain parenchyma
Hemorrhagic Stroke
Usually occurs secondary to severe, chronic hypertension
Most occur in basal ganglia or thalamus
Hemorrhagic Stroke
Degree of secondary injury and associated morbidity and mortality is much higher in _________ than ischemic stroke
Hemorrhagic Stroke
Cardiovascular stabilization
Brain CT determines type and location
ICP monitoring and management
Treatment for ______
stroke
treatment aimed at minimizing infarct size and preserving neurologic function
Thrombolytics, anticoagulant, antiplatelet, endarterectomy, angioplasty, stents
Ischemic stroke
treatment aimed at blood pressure management (keep mildly hypertensive at first)
Hemorrhagic stroke
Brain imaging CT Scan MRI ( MR DWI-diffusion weighted imaging) CTA MRA Transcranial doppler diagnose \_\_\_\_\_\_
stroke
Initially____ deficits occur as flaccidity or paralysis; recovery of function occurs with onset of spasticity
motor
Contralateral to the side of the brain where the stroke occurred
Active/passive range of motion exercises should be started in acute phase of recovery
for ________
Motor Deficits
Elevate edematous limbs, use elastic stockings, and maintain body alignment
Aggressive rehabilitation commonly required
for ________
Motor Deficits
______ disturbances occur in same locations as motor paralysis and may involve neglect or visual impairment
sensory
Loss of visual field on the paralyzed side also contributes to neglect
Contralateral field blindness: homonymous hemianopsia, the same side of the retina in each eye is blinded
Assess fall risk
sensory deficits
occurs with brain damage to the dominant cerebral hemisphere and can involve all language modalities
aphasia
(verbal motor/expressive) consists of poor articulation and sparse vocabulary
Broca aphasia
(sensory, acoustic, receptive) characterized by impaired auditory comprehension and speech that is fluent but does not make sense
Wernicke aphasia
Evidenced as language impairment, impaired spatial relationship skills and short-term memory, and poor judgment
Concentration, memory, and reasoning may be impaired
May require rehabilitative services
Cognitive deficits
Organisms may gain access to the CNS through the bloodstream, direct extension from a primary site or along peripheral and cranial nerves, or through maternal-fetal exchange
Risk factors: immunocompromise, debilitation, poor nutrition, radiation, steroid therapy, contact with vectors
CNS infections
Meningitis and cerebral abscess commonly associated with _____ infections; encephalitis usually ____
bacterial; viral
Bacteria usually reach the CNS via the bloodstream or extension from cranial structures like sinuses or ears
in
Meningitis
Most common bacteria are Streptococcus pneumoniae
in ______
Meningitis
Bacteria invade leptomeninges; accumulation of inflammatory exudate can result in obstructive hydrocephalus
Meningitis
Classic presentations: headache, fever, stiff neck (meningismus), and signs of cerebral dysfunction (confusion, delirium)
Meningitis
Diagnosis: lumbar puncture
Meningitis
Treatment: intravenous antibiotic therapy and supportive measures; corticosteroids (controversial)
Meningitis
Prevention: vaccinations for Hib and N. meningitidis
Meningitis
