Damage To The Brain And SC Flashcards
What is an epidural hematoma?
When blood diffuses into epidural space and is due to rupture of the middle meningeal A from trauma
What does an epidural hematoma cause?
Midline shift of cerebral hemispheres (falx and/or uncal herniation pts)
What are the signs and sx for epidural hematomas?
Initial unconsciousness with rapid recovery, papilledema (due to increased intracranial pressure), lethargy, seizures and HAs
Requires emergency evacuation of the hematoma or pt will die
What is a subdural hematoma?
Blood in the subdural space due to trauma causing rupture of cerebral (bridging) veins
What are the signs and sx for subdural hematoma?
Same as epidural hematoma but can be delayed for days or weeks with a more insidious progression
What is a subarachnoid hemorrhage?
Blood in subarachnoid space, RBCs found in CSF, due to rupture of any of the major blood vessels
Associated neurological findings and can be noted using a LP
What occurs post subarachnoid hemorrhage (SAH)?
Arachnoid villi can become clogged -> transient hydrocephalus
Hemolyzed RBCs in CSF -> secondary (chemical) meningitis
What is an uncal herniation?
Profuse high pressure bleeding -> rapidly expands epidural space
What is a transtentorial herniation?
Cerebrum herniates through tentorial notch
What is a falx (subfalcine) herniation?
Cerebrum herniates under falx cerebri
What does an uncal herniation cause?
Compression of midbrain reticular formation leading to progressive decrease in consciousness
Uncal herniation can occlude the PCA leading to what?
Ischemic necrosis of primary visual cortex -> contralateral homonymous hemianopsia with macular sparing
What is a tonsillar herniation?
Masses in posterior cranial fossa cause the cerebellar tonsil to herniate through foramen magnum
Seen in Arnold-Chiari malformation
What does a tonsillar herniation cause?
Compression of lower medulla/upper spinal cord
What is central cord syndrome?
Ischemia of the central region of the SC due to disruption of flood flow to the ASpA
What is central cord syndrome characterized by?
Central necrosis and cavitation of spinal cord and the development of a syrinx
What are signs and sx of central cord syndrome?
Abrupt onset of neurological S/S with amelioration
What is anterior cord syndrome?
Injury to anterior portion of spinal cord due to flexion injuries or injury to ASpA
What are some signs and sx for anterior cord syndrome?
Motor paralysis below level of lesion, loss of pain and temp/at below lesion
What is posterior cord syndrome?
Injury to posterior portion of SC
S/S: loss of proprioception and vibration sensation below level of injury
What are general manifestations of a subarachnoid hemorrhage?
Abrupt onset of S/S, bursting type HA, changes in level of consciousness, vomiting, convulsion at onset, fever with leukocytosis, bradycardia followed by increase HR, BP and temp, age of onset (40-60), systemic complications (cardiac or pulmonary)
What are neurologic findings for a subarachnoid hemorrhage?
Neck rigidity (Brudzinski’s sign), Kernig’s sign, radiological evidence of vascular malformations or space occupying mass, unequal pupils with slow reaction to light, absent DTRs, enlarged ventricles or blood CSF Focal signs due to primary ischemia or secondary destruction by rupture, compression by clot
