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20005 > concussion and intercranial pressure > Flashcards

concussion and intercranial pressure Flashcards

1
Q

what is a primary brain injury

A
  • an injury that has already happened, usually physical
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2
Q

what is a secondary brain injury

A
  • an injury that may follow a primary injury
  • usually caused from reduced perfusion, inadequate oxygenation and raised intercranial pressure
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3
Q

what assessments need to be done on a someone with a possible brain injury

A
  • primary survey
  • diability/ neurological assessment
  • AVPU
  • GCS
  • pupil response
  • limb tones
  • cranial nerve exam
  • limb function
  • gait
  • cerebral function
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4
Q

what are the signs and symptoms of a concussion

A
  • headache
  • loss of consciousness
  • drowsiness
  • vomiting
  • memory disruption
  • presentation form immediate - 3 weeks
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5
Q

what is coup

A

a single impact site on the brain tissue

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6
Q

what is contrecoup

A

double impact sites on opposite sides

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7
Q

what is the difference between coup and contrecoup

A
  • coup is when the skull hits the brain due to rapid acceleration of the skull
  • contrecoup when the brain hits the skull from deceleration of the skull
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8
Q

what are the different layers of the meninges

A
  • extradural space
  • dura mater
  • subdural space
  • arachnoid mater
  • subarachnoid space (CSF)
  • pia mater (attached to brain)
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9
Q

where is the CSF produced

A

in the choroid plexus and found in the subarachnoid space

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10
Q

what happens if there are changes to the CSF

A
  • it is absorbed by the arachnoid villi but if there are blood leakages into the CSF this can prevent absorption
  • an increase in intracranial pressure
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11
Q

what are symptoms of shock

A
  • decreased BP
  • increase HR
  • increased RR
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12
Q

what are the symptoms of increased intracranial pressure

A
  • increased BP
  • decreased HR
  • decreased RR
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13
Q

what is the Cushing reflex

A

a haemodynamic response to an acutely elevated ICP

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14
Q

what are the stages of Cushing’s reflex

A
  1. cerebrospinal fluid pressure
  2. intracranial tension grows
  3. compression of the brain and arteries
  4. cut of brains blood supply
  5. CNS ischemic response starts and arterial pressure rises
  6. relieved brain ischemia
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15
Q

what is Cushing’s triad

A
  • widening pulse pressure
  • bradycardia
  • irregular respirations (cheyne Stokes)
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16
Q

what are the stages of Cushing’s triad

A
  1. cushings reflex - bp and hr increase
  2. hypertensions persists and bradycardia
  3. brain stem compression = irregular breathing
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17
Q

why does the heart become bradycardic in stage 2 of cushing’s triad

A

the sympathetic nervous system is activated and then the parasympathetic system activates slowing down the HR

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18
Q

how is CCP calculated

A

CCP = BP-ICP

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19
Q

how does o2 treatment help the ICP

A

more o2 to the brain reduces the demand for greater blood flow so reducing the intracranial pressure

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20
Q

how does a brain injury affect blood getting to the brain and CPP

A
  1. intracranial mass lesion
  2. increases ICP
  3. reduces CPP
  4. leads to hypoxia/ ischemia
  5. induces oedema
  6. increases ICP
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21
Q

what is coning

A

when the brain is forced through the small gap at the base of the skull

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22
Q

what are the types of coning

A
  • sub-falcine herniation
  • trans-tentorial herniation
  • tonsillar herniation
23
Q

what is uncal herniation

A
  • a herniation caused by an increase in intracranial pressure and the uncus slide downwards across the tentorium cerebrelli compressing the brainstem
24
Q

what are the causes of uncal herniation

A
  • expanding mass lesions within the skull
  • severe head trauma leading to severe head bleeds
  • hx of large ischemic strokes
25
Q

symptoms of uncal herniation

A
  • headache
  • nausea
  • vomiting
  • changes in mental state
  • Cushing’s triad
  • compression of CNIII
26
Q

what is sub-falcine herniation

A
  • the hemisphere is displaced beneath falx
  • cause ventricular dilation
27
Q

what is tonislar herniation

A
  • the cerebellum is pushed through teh foramen magnum
  • an the inferior descent of the cerebellar tonsils
28
Q

what causes tonsillar herniation

A
  • secondary to high intracranial pressure
  • stroke
  • tumour
  • haemorrhage
  • abscess
  • pons, medulla compression
29
Q

how to prevent coning

A
  • oxygenation 100%
  • ensure MAP stays below 80mmHg
  • saline bolus
30
Q

parasympathetic pupillary reflex

A
  • reduces incoming light
  • direct reflex
  • pupil constrictions
31
Q

sympathetic pupillary reflex

A
  • increases incoming light
  • dilates the pupils
32
Q

what is the consensual reflex

A
  • equalising constriction between the eyes
  • light into the right eye will cause the left to constrict
33
Q

what is anisocoria

A

mismatched dilated

34
Q

what is accommodation of the lenes

A
  • the contraction and relaxation of the ciliary muscle altering lens thickness to allow refracted light from distant and far objects to fall on the fovea centralis
35
Q

what happens to muscles in distance focus

A
  • ciliary muscle relaxed
  • lengthened suspensory ligaments
36
Q

what happens to muscles and close focus

A
  • ciliary muscles contract
  • suspensory ligaments shortened
37
Q

what is pupillomotor

A

can your eyes pull in and constrict

38
Q

what is relative afferent pupillary defect (RAPD)

A
  • both eyes are dilated even with a bright light on them
  • damage to the optic nerve or the retina
  • signal cant get to the back of the eye so there is an issue before the chiasm
39
Q

what is the pupil response in increased intracranial pressure

A

dilated and sluggish due to increase pressure compressing vessels

40
Q

sensation for corneal reflex

A

ophthalmic division of trigeminal (CNV) to brainstem

41
Q

motor response for corneal reflex

A

facial nerve nuclei, bilateral (CNVII) causes contraction of orbicularis oculi

42
Q

what cranial nerves aren’t working in a negative corneal reflex

A

V and/ or VIII

43
Q

which cranial nerves aren’t working in a failed pharyngeal reflex

A

glossopharyngeal (IX) or vagus (x)

44
Q

symptoms of vestibulo-ocular reflex impairment

A
  • dizziness
  • nausea
  • loss of balance
  • blurred vision
45
Q

what is nystagmus

A

a twitch of the eye

46
Q

how to test for nystagmus

A
  • get patient to follow finger drawing an H
  • pause at each of the 6 points and wait for twitching
47
Q

what is papilloedema

A

swelling of the optic disk due to due to an imbalance of cerebral fluid and pressure in or around the brain

48
Q

how does papilloedema occur

A
  • ICP presses on the back of the eye
  • optic nerve bulges into the eye
  • increase the size of the optic disc
49
Q

what is haemotympanum

A

bleeding form the ears

50
Q

what is retrobulbar haemorrhage

A

bleeding from the eyes

51
Q

what indicats a basilar skull fracture

A
  • clear/ pale red fluid from the nose
  • bruising behind the ears or eyes
52
Q

what are signs of retrobulbar haemorrhage

A
  • severe pain
  • progressive vision loss
  • proptosis
  • fixed dilated pupils
53
Q

cerebrospinal fluid leakage

A
  • usually caused by a tear in the dura
  • leads to watery discharge
  • tramlining (blood on outer edges and CSF washed central blood away)
  • drying drips - CSF dissipating outwards
  • reservoir sign - discharge when chin on chest

20005 (29 decks)

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