acute intracranial problems 2 Flashcards
causes of hydrocephalus
- excess CSF production
- obstruction of flow
- inability to reabsorb the CSF
tx of hydrocephalus
ventriculostomy or ventriculoperitoneal (VP) shunt
cerebral edema
increased accumulation of fluid in the extravascular spaces of brain
causes of cerebral edema
- mass lesions
- head injuries
- brain surgery
- cerebral infx
- vascular insult
- toxic or metabolic encephalopathic conditions
vasogenic cerebral edema
- leakage of macromolecules from the capillaries into the surrounding extracellular space
- most common type
cytotoxic cerebral edema
disruption of the integrity of cell membranes
interstitial cerebral edema
result of hydrocephalus
consciousness
- clear state of awareness of self and the environment in which attention is focused on immediate matter
- state of awareness and orientation to time, place, and person
- controlled by the RAS
unconsciousness
abnormal state of complete or partial unawareness of self or environment
cause of unconsciousness
- interruptions of impulses from the RAS
- alterations in functioning of the cerebral hemispheres
dramatic consciousness
- coma
- d/t direct compression; decreased O2, glucose; toxic effects
subtle consciousness
- flattening affect
- change in orientation
- decrease in level of attention
unconscious pt: immediate considerations
- assess respiratory and CV function
- no response to painful stimuli
- no swallow, cough, corneal, and pupillary reflexes
- incontinent
head injury
any injury to the scalp, skull, or brain
poor outcome of head injury
- intracranial hematoma
- older age
- abnormal motor response
- impaired/absent eye mvmts
- decreased BP, O2; increased CO2, ICP
- GCS
head injury death points
- immediately
- within 2 hours
- in 3 weeks
scalp lacerations
- profuse bleeding, easy to see
- complications: blood loss and infection
skull fx
type and severity depends on:
- velocity
- momentum
- direction and shape of the injuring agent
- site of impair
diffuse brain injury
generalized
focal brain injury
localized
s/s of frontal skull fx
CSF rhinorrhea or pneumocranium
s/s of orbital skull fx
- raccoon eyes
- optic nerve injury
s/s of temporal skull fx
- battle’s sign (bruising behind ear)
- CSF otorrhea
- middle meningeal artery disruption
- epidural hematoma
s/s of parietal skull fx
- bulging tympanic membrane
- Battle’s sign
- CSF/brain otorrhea
- deafness
- facial paralysis
- loss of taste
s/s of posterior fossa skull fx
- occipital bruising resulting in cortical blindness
- visual field defects
- ataxia
s/s of basilar skull fx
- battle’s sign
- bulging of tympanic membrane
- CSF/brain otorrhea
- tinnitus
- rhinorrhea
- facial paralysis
- vertigo
fluid leaking from ears/nose
must be tested for CSF
- dextrostix (tes-tape strip)
- or halo/ring sign test
concussion
sudden, transient, mechanical head injury with disruption of neural activity and a change in LOC
- may or may not lose total consciousness
- diffuse injury
s/s of concussion
- brief disruption in LOC
- retrograde amnesia
- HA
postconcussion syndrome
2 weeks to 2 months after the injury
s/s of post concussion syndrome
- persistent HA
- lethargy
- personality and behavioral changes
- shortened attention span
- decreased short term memory
- changes in intellectual ability
s/s of diffuse axonal damage
- widespread axonal dmg
- decreased LOC
- increased ICP
- decortication or decerebration
- global cerebral edema
contusion
- focal injury
- bruising of the brain tissue within a focal area
coup-contrecoup injury
brain moves inside the skull d/t high energy or high impact injury mechanism
-similar to whiplash, hitting both back (countecoup) and front(coup) of head
complications of coup-contrecoup injury
- hemorrhage
- sz
lacerations
- focal injury
- actual tearing of the brain tissue
delayed responses to lacerations
- hemorrhage
- hematoma formation
- seizures
- cerebral edema
complications of brain injuries
hematomas: epidural, subdural, intracerebral
epidural hematoma
- bleeding between the dura and the inner surface of the skull
- a neurological emergency
- associated with a linear fx crossing a major artery in the dura, causing a tear
- can be venous or arterial
s/s of epidural hematoma
- initial period of unconsciousness at the scene
- with a brief lucid interval followed by a decreased in LOC
- HA
- n/v
tx of epidural hematoma
- immediate surgical intervention
- burrhole
subdural hematoma
- bleeding between the dura mater and the arachnoid layer of the meninges
- results from injury to the brain tissue and its blood vessels
- usually venous, but can also be arterial
acute subdural hematoma s/s
- 24-48 hours after severe trauma
- immediate deterioration
- decreased LOC
- HA
- drowsy, confused, or unconscious
- ipsilateral pupil dilation
tx of acute subdural hematoma
- craniotomy
- evacuation and decompression
subacte subdural hematoma s/s
- 48hr - 2 weeks
- alteration in mental status
- progression depends on size and location
tx of subacte subdural hematoma
evacuation and decompression
chronic subdural hematoma s/s
- weeks or months, usually >20 days
- non specific, non localizing progression
- progressive alteration in LOC
tx of chronic subdural hematoma
- evacuation and decompression
- membranectomy
