AMS and head trauma Flashcards
bilateral fixed/dialated pupils, think?
severe anoxia, ICP > 20, herniation and death
what is cushings triad?
triad of vital signs in ICP – ↑BP, ↓HR, irregular RR
Abnl pupillary light reflex, think?
mass lesions, pupil drugs, hypoxia, eye drops
Unilateral fixed/dilated pupil, think:
herniation w/ CN III compression (ipsilateral)
Pinpoint pupils, think:
narcotics, ICH (in pons)
waxing-and-waning change in level of consciousness; can also have visual hallucinations, short attention span, and impaired recent memory
How to dx? etiologies?
delirum
Dx with MMSE (<25)
Etiology: AEIOU TIPSS – Alcoholand drug toxicity or withdrawal, Electrolyte imbalance, Iatrogenic, Oxygen hypoxia, Uremia/hepatic encephalopathy,
Trauma, Infection, Poison, Seizures, Stroke
damage to RAS or bilateral
hemispheres → depressed LOC,
unresponsive to any stimuli
how to Dx?
coma
GCS </= 8
coma-like state but pt is fully
conscious and can control
blinking, vertical eye movement
where is damage?
locked in syndorme w/ damange to ventral pons
duret hemorrhage, think?
brainstem herniation
what is the defn of brain death?
how is it Dx?
irreversible absence of brain function despite adequate oxygenation/ventilation, no brainstem reflexes
Dx with EEG showing no activity
temporal bone fx → tear in middle meningeal artery → LOC w/ lucid interval
how is it dx? tx?
EDH
dx with head CT (convex lens hemorrhage)
tx with emergent craniotomy
tear in bridging veins → ∆MS, headache, cortical dysfxn, possible herniation if acute
how is it dx? tx?
SDH
dx head CT (crescent moon hematoma |)
tx with craniotomy (acute), reassurance (chronic)
RF for SDH
shrunken brain states (alcoholics, elderly)
defn on concussion
brief LOC following blunt head trauma w/ confusion, dizziness, impaired concentration, etc.
how to distinguish between normal aging and dementia
no impairment of daily functioning w/ normal aging
typical duration of delirum
3 days to 2 weeks
delerium with present with nml or abn EEG
abn
dementia will present wiht nml or abn MRI
abn
what does not change in dementia
level of conciousness
3 MC causes of dementia
Alzheimer (#1), vascular (#2), Lewy body (#3
severe depression that can
present like dementia in elderly
tx?
pseudodementia
SSRIs
dementia can be secondary to… (remember, it is still not reversible)
hypothyroid B12/folate deficiency, thiamine deficiency, neurosyphilis medication use
pathophys of Alzheimes + how to Dx and treat
dec Ach
Amyloid cascade hypothesis: high risk genes (presenilin I, presenilin II, APP, apoE4) can
predispose to Aβ-amyloidosis)
Dx MMSE (<25), head CT (diffuse atrophy w/ enlarged ventricles, flat sulci)
Tx
AChE-inhibitors for mild/moderate AD (tacrine, donepezil)
NMDA antagonist for severe AD (memantine)
Why do downs pt get AD
triple apoE4 expression (on chrom 21)
stepwise loss of function + focal neurological sx
how to dx?
vascular dementia
Dx MMSE (<25), head CT (multiple small lacunar infarcts)
dementia, waxingand-waning
parkinsonism, visual hallucinations, sensitivity
to antipsychotics
Lewy body dementia
Lewy body and neurite accumulations in the basal ganglia
profound changes in personality and social conduct, disinhibition, hyperorality, hypersexuality; good memory and language though
how to dx?
Picks disease (frontotemporal demetia)
Dx MMSE (<25), head CT (marked atrophy of frontal and temporal lobes)
neutropenia → infection → rapid decline in memory, cognition, behavior, motor skills; depression and social withdrawal also common
HIV assc dementia
give them HAART
abnormal prion accumulation → rapidly progressive dementia, myoclonus (muscle spasms), personality changes
how to dx
Creutzfeldt-Jakob disease
Dx EEG (generalized sharp waves), confirm w/ postmortem brain bx (spongiform change)
Wet (urinary incontinence), Wobbly (gait
apraxia), Wacky (dementia)
Dx with? Tx?
normal pressure hydrocephalus
Dx with MRI
Tx CSF shunt
