Cerebral Dysfunction Flashcards
1
Q
what GCS core is considered coma?
A
< 8
2
Q
what vital signs would indicate increased ICP?
A
increased BP (late sign)
tachycardia (early)
bradycardia (late)
increased RR
3
Q
why would respirations be slow and deep?
A
sedatives
cerebral infection
4
Q
why would respirations be slow and shallow?
A
sedatives
opioids
5
Q
what might cause hyperventilation?
A
metabolic acidosis
poisoning
6
Q
what are some neurological warning signs when assessing the skin?
A
lacerations
ecchymosis
hematoma
needle marks
petechiae
bites
7
Q
pinpoint pupils are a sign of __________
A
poisoning
8
Q
early signs of increased ICP are __________
A
subtle
9
Q
how do infants compensate for increased ICP?
A
skull expansion
widened sutures
10
Q
what are some signs of increased ICP?
A
bulging fontanelles
high pitched cry
irritable
poor feeding
headaches
vomiting
seizures
flexion/extension
decreased motor and sensory response
cheyne-stokes respirations
papilledema
11
Q
what is a hallmark late sign of increased ICP?
A
bradycardia
12
Q
what are the 5 main causes of cerebral trauma?
A
falls
MVAs
bicycle injuries
shaken baby syndrome
sports
13
Q
what are some signs of shaken baby syndrome?
A
retinal hemorrhage
flaccid
decreased pupil response
decreased LOC
lethargic
14
Q
what is the GCS score for mild cerebral trauma?
A
13-15
15
Q
what is the GCS score for moderate cerebral trauma?
A
9-12
16
Q
what is the GCS score for severe cerebral trauma?
A
< 8
17
Q
why does cerebral trauma occur (pathophysiology)?
A
force of intracranial contents can’t be absorbed by skull
18
Q
what type of cerebral injury are infants especially vulnerable to?
why?
A
acceleration-deceleration injuries
large head size
lack musculoskeletal support
19
Q
what are the 3 types of cerebral injuries?
which is the most common?
A
concussion*
contusion and laceration
skull fractures
20
Q
what is a concussion?
A
altered neurological cognitive function
with or without los of consciousness
21
Q
what are the symptoms of a concussion?
A
confusion
dizziness
disorientation
22
Q
how long is the recovery for a concussion?
A
7-10 days
23
Q
what is the treatment for concussion?
A
rest until asymptomatic
24
Q
what is a contusion and laceration?
A
bruising and tearing
coo-contra-coo
25
the incidence of contusions and lacerations in infancy is ________
why?
low incidence
soft skull and brain tissue
26
what might cause contusions and lacerations?
shaken baby syndrome
27
what neurological impairments can shaken baby syndrome cause?
retinal hemorrhage
intracranial hemorrhage
seizures
28
skull fractures are ________ in infants
why?
uncommon
flexible skull
would require significant force
29
what are the different types of skull fractures?
linear*
comminuted
depression
basilar
open
diastatic
30
what is a linear fracture?
single fracture line
don't cross sutures
31
what is a depressed fracture?
bone breaks into fragments which put on brain
32
what is a comminuted fracture?
multiple linear fractures
33
what causes a comminuted fracture?
repeated, intense blows
34
what is a basilar fracture?
fracture line close to suture around brainstem
involves bleeding
35
what is an open fracture?
causes opening into skull and scalp or upper respiratory tract
36
what is a risk associated with open fractures?
CNS infection
CSF leakage
37
what are 4 complication of cerebral trauma?
epidural hemorrhage
subdural hemorrhage
cerebral edema
herniation
38
what is an epidural hemorrhage?
bleeding between dura and skull
39
epidural hemorrhage is __________ in children
why?
less common
middle meningeal artery is not embedded in bone until 2 years
40
what is a subdural hemorrhage?
bleeding between dura ad arachnoid membrane
41
what are the causes of a subdural hemorrhage?
falls
birth trauma
violent shaking
42
what are some signs of a subdural hemorrhage?
irritable
vomiting
increased head circumference
bulging fontanelles
seizures
43
what complication is expected after head trauma?
cerebral edema
44
what is cerebral herniation?
brain shifts within skull
increases ICP
45
what is the common intervention. for cerebral trauma?
cervical spine motion restriction
46
scalp lacerations increase risk of _____________, and require assessment for possible ___________
risk of blood loss
possible shock
47
"under 8 __________"
intubate
48
what are the 2 types of posturing?
flexion
extension
49
what does flexion posture indicate?
cerebral cortex dysfunction
50
what does extension posture indicate?
midbrain or brainstem lesions
51
what special tests are done after cerebral trauma?
CT scan
MRI
behavioural assessment
52
what is the prognosis for nervous system tumours?
why?
poor
difficult to treat
53
what are the 2 types of nervous system tumours?
brain tumor
neuroblastoma
54
what are the clinical signs of a nervous system tumor?
same as increased ICP
can be vague
getting their history is important
55
what tests should be done for nervous system tumours?
CT scan
MRI
lumbar puncture
EEG
56
what are the intervention for nervous system tumours?
surgery
radiation
chemotherapy
57
what is the most optimal treatment for nervous system tumours?
surgery
58
what is the purpose of a lumbar puncture for a nervous system tumor?
to measure ICP and rule out meningitis
59
radiotherapy is not done in children ________________
les than 3 years
60
what is Cushing's Triad?
hallmark sign of increased ICP
bradycardia
hypertension
irregular respirations
61
what is meningitis?
inflammation of meninges and CSF
62
the incidence of meningitis has decreased since ___________ was introduced?
Hib vaccine
63
what are the 6 causes of meningitis?
which is the most common?
H. influenzae
S. aureus
N. meningitides
S. pneumoniae
GBS*
E. coli
64
what is N. meningitidis?
meningococcus
65
what is the only form of meningitis transmitted by droplet?
N. meningitidis
66
what is the mot common way of acquiring meningitis?
vascular dissemination from elsewhere in the body
67
what is the onset of meningitis clinical manifestations?
very sudden
68
what are some clinical manifestations of meningitis?
fever
chills
headache
N/V
seizures
irritable
delirium
photophobia
nuchal rigidity
bulging fontanelles
poor feeding
69
how is meningitis diagnosed?
lumbar puncture
blood culture
urine culture
gram stain
culture+sensitivity
proteins
glucose
blood cell count
70
what is the purpose of a lumbar puncture?
to measure pressure in CSF
71
how does crying affect cerebral ICP?
how is this prevented?
increases
sedatives
- fentanyl
- midazolam
72
how does meningitis affect WBC count?
increased
73
how are glucose levels affected by meningitis?
bacterial: decreased
viral: normal
74
how are protein levels affected by meningitis?
increased
75
what are some contraindications for a lumbar puncture?
recent seizure
decreased LOC
pupil changes
respiratory changes
76
if increased ICP is found when assessing for meningitis, what test is recommended?
why?
CT scan
bulging fontanelles
papilledema
77
what is the management for bacterial meningitis?
IV antibiotics
isolation
fluid restriction
ventilation and perfusion
hemodynamic stability
prevent shock
control seizures
control body temperature
78
what is nonbacterial meningitis?
aseptic
caused by viruses
less severe
79
what are the viral causes of nonbacterial meningitis?
which is the most common?
HSV
adenovirus
HIV
enterovirus*
80
what are the clinical manifestations of nonbacterial meningitis?
similar to bacterial meningitis
headache
fever
photophobia
nuchal rigidity
81
what diseases is nonbacterial meningitis often associated with?
mumps
measles
herpes
leukemia
82
how is nonbacterial meningitis diagnosed?
clinically based on symptoms
83
how is nonbacterial meningitis treated?
based on symptoms
84
what is encephalitis?
inflammation of brain
85
causes of encephalitis are mostly _____________
viral
86
what are the 2 causes of encephalitis?
virus invades CNS
post infectious involvement after viral disease
87
how is encephalitis diagnosed?
based on. clinical findings
88
what are some complications associated with encephalitis?
cerebral edema
fluid and electrolyte imbalances
status epilepticus
cardiac or resp arrest
89
how is encephalitis managed?
supportive unless caused by HSV
nutrition
hydration
anntimicrobials
90
what antimicrobials are used to treat encephalitis?
bacterial: vancomycin
viral: acyclovir
91
what is Reye's syndrome?
toxic encephalopathy with other organ involvement
92
what are the causes of Reye's syndrome?
viral illness
aspirin
93
what viruses cause Reye's syndrome?
influenza
varicella
94
what are some clinical manifestations of Reye's syndrome?
fever
vomiting
impaired consciousness
livery dysfunction
95
how is Reye's syndrome diagnosed?
liver biopsy
neurological signs
96
what is the most common podiatry neurological disorder?
seizures
97
what is the most common type of seizures in children?
febrile
98
what are the causes of acute symptomatic seizures?
head trauma
meningitis
99
what are the causes of remote symptomatic seizures?
previous brain injury
encephalitis
stroke
100
what are cryptogenic seizures?
no clear cause
101
what are idiopathic seizures?
genetic origin
102
what are some other causes of seizures?
Electrolyte imbalances
Infection
Hypoglycemia
Drugs
Brain tumor
Brain bleed
103
what are the 3 types of seizures?
focal (partial)
generalized
epileptic spasms
104
what are focal (partial) seizures?
local onset
involve small part of brain
105
what are generalized seizures?
tonic/clonic
involve both hemispheres
no local onset
impaired awareness
bilateral motor involvement
106
what are epileptic spasms?
neck, true and extremities spasm
107
what is epilepsy?
2+ unprovoked seizures more than 24 hours apart
108
what is the cause of epilepsy?
unknown
109
what are absence seizures?
brief loss of consciousness
"day dreaming"
can still walk
no change in muscle tone
110
what causes febrile seizures?
febrile illness
not a CNS infection
111
what is the age of onset for febrile seizures?
3 months - 6 years
112
what is the duration of febrile seizures?
15 minutes
113
what is the goal of treatment for seizures?
determine and treat cause
114
how are seizures treated?
medications
diet
vagus nerve stimulation
surgery
115
what medications are used to treat seizures?
anti epileptics
- keppra
116
how should antiepileptic drugs be stopped? why?
slowly wean off
rip of inducing seizures
117
what diet is recommended for seizures?
keto
- high fat
- low carb
118
what is vagus nerve stimulation for seizures?
implantable device
if medication is ineffective
119
what is status epileptics?
frequent seizures or seizures lastig 5-30 minutes
120
how is status epileptics treated?
support airway and breathing
IV antiepileptics
121
what IV anti epileptics are used to treat status epilepticus?
Lorazepam (ativan)*
Midazolam
Diazepam
122
what is hydrocephalus?
imbalance between production and absorption of CSF
123
why are the 2 type of hydrocephalus?
1. communicating
2. noncommunicating
124
what is communicating hydrocephalus?
impaired absorption of CSF in subarachnoid space
125
what is noncommunicating hydrocephalus?
obstructed flow of CSF
126
how does hydrocephalus preset in early infancy?
increased head circumference
127
what are the causes of hydrocephalus?
Developmental abnormalities
Neoplasms
Infections
Trauma
128
hydrocephalus is often associated with ____________
myelomeningocele
129
what are the clinical manifestations of hydrocephalus?
Head enlargement
Increased ICP symptoms
130
How is hydrocephalus diagnosed?
Based on head circumference
Fetal ultrasound
CT
MRI
131
how is hydrocephalus treated?
remove obstruction
OR
ventriculoperitoneal shunt
132
what is a ventriculoperitoeal shunt?
drains CSF from ventricles to peritoneum
133
what is a complication of ventriculoperitoneal shunts?
shunt infection
134
when is there greatest risk for a shunt infection?
1-2 months after
135
what are the signs of a shunt infection?
signs of increased ICP
136
what are the causes of a shunt infection?
Septicemia
Bacterial endocarditis
Wound infection
Shunt nephritis
Meningitis
137
how is a shunt infection treated?
remove shunt
antibiotics
