coma and seizures exam 2 Flashcards
normal Intracranial pressure
5-10 mmHg
ICP regulation, what is altered first when trying to decrease pressure. what is second?
shunt CSF to the spinal subarachnoid space, then decrease csf production. finally decrease cerebral blood flow
decrease in cerebral blood flow is detremental to brain health. what happens if intracranial pressure is high while mean art BP is low.
mABP-ICP. if ICP is higher than mABP then the cerebral blood flow will be very low.
transtentorial herniations caudal and rostral cause what compression?
midbrain compression
which herniation has RAS system affected, cranial nerves IX-XII, and death
foramen magnum herniation. puts pressure on medulla
what is a clinically detrimental ICP?
greater than 30 mmHg will decrease cerebral blood flow
difference between decerebellate and decerebrate
decerebellate is opisthcontus with twisted torso, pelvic limbs flexed.
decerebrate: opisthcontus, extension of all four limbs, the fronts are rigid and the back are not flexed
what does the occulocephalic reflex test
interruption between vestibular and the nuclei because the CN for eye movement are not recieving messages from VIII
what do we try and treat in a TBI
secondary brain injuries. inflam, ischemia,
when do we do a CT:MRI on TBI patients
if we plan on doing surgery on the thing we find. if we dont plan on doing surgery, it really isnt indicated.
forebrain, midbrain, cerebellar, medulla. which are better prog than other areas for TBI
forebrain and cerebellar injury have better prog
SACS score of _____ has a 50% survival in first 48 ours
8
what is the first goal when treating a TBI
restoration of vital parameters. normovolemic, normotensive and ventilating. use what ever fluid you have.
goal 2 of treating TBI
after restoration of vitals, reduce ICP.
what pharma method is used to decrease ICP
mannitol diuretic.. draws water into circulation
what meds are commonly used to induce a coma
phenobarbital and NMDA agonists (ketamine)
difference between reactive seizure ad epilepsy
reactive seizures are a response from a normal brain to a disturbance or toxin
epilepsy is a disease of the brain
three types of epilepsy?
idiopathic structural and epilepsy of unknown cause
what can occur in the pre-ictal period
prodrome; marked abnormal behavior days prior to the seizure (dog stops herding)
aura: abnormal sensation seconds prior to the seizure.
what is the difference between syncope and a epileptic seizure
syncope lasts for seconds and is a sudden collapse. triggered by excitement
how to differentiate epileptic seizure from narcolepsy
excitement stimulates narcolepsy, it is sudden collapse, can last minutes.
myotonia, MG vs epilepsy
mytonia has a stiff gait, very long lasting, either stiff or flaccid collapse
paroxysmal dyskinesia
episodic movement disorder from a gluten synstitvity. normal consciousness, hyper muscle tone.
three ways we have reactive epileptic seizures
changes in resting membrane potential, too much excitation, too little inhibition
