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