Head and Face Flashcards

1
Q

scalp

A

-Strong flexible mass of Skin, Fascia, Muscular tissue
-Highly vascular
-Hair provides insulation

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2
Q

galea aponeurotica

A

-between scalp and skull
-fibrous connective sheath

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3
Q

subaponeurotica (areolar) tissue

A

-permits venous blood flow from the dural sinuses to the venous vessels of scalp
-emissary veins- potential route for infection
-abscess, thrombosis of superior sagital sinus, infection, purulent
-laceration to scalp can cause acute blood loss anemia

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4
Q

structures of the scalp

A

-SCALP
-skin
-connective tissue
-aponeurotica
-layer of areolar tissue
-periosteum of skull

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5
Q

skull bones

A

-facial bones
-cranium:
-vault fors brain
-strong, light, rigid, spherical bone
-unyielding to increased intracranial pressure (ICP)
-bones:
-frontal
-parietal
-occipital
-temporal
-ethmoid
-sphenoid

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6
Q

skull: foramen magnum

A

-largest opening of skull
-spinal cord exits

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7
Q

skull: cribriform plate

A

-inferior aspect (base)
-rough surface
-brain can be easily injured:
-abrasion
-contusion
-laceration
-pt may present with rhinorrhea - CSF -> can cause infection back up to brain
-NO NASAL GASTRIC TUBE WHO HAS BASILAR SKULL FRACUTRE, FACIAL TRAUMA -> worry about putting it through cribriform plate and into brain -> do oral

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8
Q

dura mater

A

-Layers:
-Outer: Cranium’s inner periosteum
-Inner: Dural layer
-Between: Dural sinuses - Venous drains for brain
-Provides continuous connective tissue
-Forms partial structural divisions:
-Falx cerebri
-Tentorium cerebelli
-Large arteries above- Provide blood flow to the surface of the brain

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9
Q

pia mater

A

-Closest to brain and spinal cord
-Delicate tissue
-Covers all areas of brain and spinal cord
-Very vascular- Supply superficial areas of brain

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10
Q

arachnoid membrane

A

-“Spider-like”
-Covers inner dura
-Suspends brain in cranial cavity- Collagen and elastin fibers
-Subarachnoid space beneath- CSF -Cushions brain

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11
Q

CSF

A

-Clear, colorless fluid
-Comprised of- Water, Protein, Salts
-Cushions CNS
-Made in largest two ventricles of brain
-Medium for nutrients and waste products to diffuse into and out of brain

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12
Q

brain

A

-Occupies 80% of cranium
-Comprised of 3 major structures:
-Cerebrum
-Cerebellum
-Brainstem
-High metabolic rate
-Receives 15% of cardiac output
-Consumes 20% of body’s oxygen
-Requires constant circulation
-IF blood supply stops:
-Unconscious within 10 seconds
-Death in 4–6 minutes

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13
Q

cerebrum

A

-Function:
-Center of conscious thought, personality, speech, and motor control
-Visual, auditory, and tactile perception
-Lobes:
-Frontal - Personality
-Parietal- Motor and sensory activity, Memory and emotion

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14
Q

occipital

A

-sight

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15
Q

temporal

A

-long term memory
-hearing
-speech
-taste
-smell

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16
Q

cerebrum: flax cerebri

A

-Divides cerebrum into right and left hemispheres

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17
Q

cerebrum: central sulcus

A

-Fissure splits cerebrum into right and left hemispheres
-Each hemisphere controls the opposite side of the body

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18
Q

cerebrum: tentorium

A

-Fibrous sheet within occipital region
-Brainstem perforates through incisura tentorium cerebelli.
-Oculomotor nerve (CN-III) travels along:
-Controls pupil size
-Compression results in pupillary disturbances
-dilated nonreactive pupil with injury

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19
Q

cerebrum: hemispheres

A

-left- DOMINANT:
-mathematical computations- occipital
-writing- parietal
-language interpretation- occipital
-speech- frontal
-right- NON-DOMINANT
-non verbal imagery

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20
Q

cerebellum

A

-located under tentorium
-fine tunes motor control
-allows smooth movement balance
-maintenance of muscle tone

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21
Q

brainstem

A

-Central processing center
-Communication junction among:
-Cerebrum
-Spinal cord
-Cranial nerves
-Cerebellum
-Structures:
-Midbrain
-Pons
-Medulla oblongata

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22
Q

midbrain

A

-Upper portion of brainstem
-Structures
-Hypothalamus- Endocrine function, vomiting reflex, hunger, thirst, Kidney function, body temperature, emotion
-Thalamus- Switching center between pons and cerebrum
-thalamus is Critical element in Ascending Reticular Activating System (A-RAS) -> ESTABLISHES CONSCIOUSNESS
-thalamus is Major pathways for optic and olfactory nerves
-Associated structures

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23
Q

pons

A

-communication interchange between cerebellum, cerebrum, midbrain, and spinal cord
-bulb shaped structure above medulla
-sleeping phase of the RAS

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24
Q

medulla oblongata

A

-bulge in the top of spinal cord
-centers:
-respiratory center- controls depth, rate, and rhythm
-cardiac center- regulates rate and strength of cardia contractions
-vasomotor center- distribution of blood and maintains BP

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25
CNS circulation
-arterial: -4 major arteries- 2 internal carotid arteries from common carotid AND 2 vertebral arteries -circle of willis- internal carotids and vertebral arteries -> encircle the base of brain -venous: -venous drainage occurs through bridging veins -bridge dural sinuses -drain into internal jugular veins
26
blood brain barrier
-less permeable than elsewhere in body -DOES NOT allow flow of interstitial proteins -Reduced lymphatic flow -Very protected environment -Blood acts as irritant resulting in cerebral edema -NO highly charged, large, not lipid soluble can go through -hepatic disease- fugal flow -> reverse flow ends up into systemic circulation before going through liver -> ammonia -> hepatic encephalopathy -edema when blood brain barrier abnormal -> irritation of parenchyma -> high ICP
27
cerebral perfusion pressure
-Pressure within cranium (ICP) resists blood flow and good perfusion to the CNS -> Pressure usually less than 10 mmHg -Mean Arterial Pressure (MAP): Must be at least 50 mmHg to ensure adequate perfusion -at least MAP 65 and higher than ICP -ICP > 20 danger zone -MAP = DBP + 1/3 Pulse Pressure -Cerebral Perfusion Pressure (CPP): -Pressure moving blood through the cranium -CPP = MAP - ICP -if ICP is higher than MAP -> we cant perfuse -> anoxia -go up on MAP or go down on ICP -> better flow -ex. raise the BP and catheter into ventricle to remove pressure -rapid increase in ICP - herniation at 60 -pressure on the pons
28
CCP and MAP calculation ex
-BP = 100/70 -DBP = 70 -MAP = 80 -CCP = 80-10 = 70
29
cerebral perfusion pressure: autoregulation
-changes in ICP result in compensation -Increased ICP = Increased BP -This causes ICP to rise higher and BP to rise. -Brain injury and death become imminent
30
cerebral perfusion pressure: expanding mass inside cranial vault
-displaces CSF -if pressure increases, brain tissue is displaced
31
ascending reticular activation system
-Tract of neurons in upper brainstem, pons, and midbrain -Responsible for sleep-wake cycle -Monitors input stimulation -Regulates body functions: -Respiration -Heart rate -Peripheral vascular resistance -Injury may result in prolonged waking state
32
facial bones
-zygoma- prominent bone of cheek that protects the eyes -> attachment for muscles controlling eye and jaw movement -maxilla- upper jaw, supports nasal bone, provides lower border of orbit -mandible- jaw bone -nasal bones
33
face
-covered with skin -flexible and thin -highly vascular -minimal layer of subcutaneous tissue -circulation- external carotid artery -> supplies fafcial area -branches- facial, temporal, maxillary arteries
34
buccinator nerve
-buccal branch of buccinator nerve does not innervate muscle -> innervates cutaneous sensation to zygomatic area and sensory of vestibule of oral cavity -buccal branch of facial nerve innervates buccinator muscles -> facial nerve does facial expression
35
nasal cavity
-Upper Border: Bones- Junction of ethmoid, nasal, and maxillary bones -Bony Septum- Right and left chamber -Turbinates- Vascular mucosa support -> Warm, humidify, and filter incoming air -Lower Border: -Bony hard palate -Soft palate- Moves upward during swallowing -Nasal Cartilage- Forms nares
36
oral cavity
-Formed Structures -Maxillary bone -Palate -Upper teeth meeting the mandible and lower teeth -Floor: -Tongue -Connects to hyoid bone- Free-floating U-shaped bone inferior and posterior to the mandible -Mandible- Articulates with the TMJ joint
37
salivary glands
-first stage in digestion -location: -anterior and inferior to ear -under tongue -inside inferior mandible
38
tonsils
-posterior wall of pharnyx
39
sinuses
-hollow spaces in cranium and facial bones -function: -Lighten head -Protect eyes and nasal cavity -Produce resonant tones of voice -Strengthen area against trauma
40
pharynx
-Posterior and inferior to the oral cavity -Aids in swallowing: -Bolus of food propelled back and down by tongue -Epiglottis moves downward -Larynx moves up- Combined effect seals airway -Peristaltic wave moves food down esophagus
41
ear
-Hearing -Positional sense -Structures: -Pinna- Outer visible portion that is formed of cartilage and has poor blood supply -External Auditory Canal- Glands that secrete cerumen (wax) -Middle and Inner Ear- Structures for hearing and positional sense
42
structures of hearing
-Tympanic membrane -Ossicle bones -Cochlea -Auditory nerve
43
structure of proprioception
-Semicircular canals- Sense position and motion -Present when eyes are closed -Vertigo- Continuous movement sensation
44
eye
-Structures: -Sclera -Cornea -Conjunctiva -Anterior chamber- Aqueous humor, Iris -> Pupil -Lens -Posterior chamber- Vitreous humor -Retina -Lacrimal Fluid- Bathes, protects, and nourishes cornea
45
scalp injury
-contusions -lacerations -avulsions -significant hemorrhage -ALWAYS know MOI -any type of head injury can cause neck injury
46
trauma must be extreme to fracture cranial injury
-linear -depressed -open -impaled object
47
basal skull
-unprotected -spaces weaken structure -relatively easier to fracture
48
basal skull fracture signs: battles signs and raccoon eyes
-Battle’s Signs: -Retroauricular ecchymosis -Associated with fracture of auditory canal and lower areas of skull -Raccoon Eyes: -Bilateral periorbital ecchymosis -Associated with orbital fractures
49
basilar skull fracutre: dura tear
-permit CSF to drain through external passageway -may mediate rise of ICP -evaluate for "target" or "halo" sign
50
brain injury
-As defined by the National Head Injury Foundation: -“A traumatic insult to the brain capable of producing physical, intellectual, emotional, social and vocational changes” -Classification -Direct- Primary injury caused by forces of trauma (ex. blockage of blood to brain) -Indirect- Secondary injury caused by factors resulting from the primary injury -> lack of oxygen (ex. pneumothorax -> decreased O2 -> lack of oxygen to brain)
51
direct brain injury types
-coup- injury at site of impact -contrecoup- injury on opposite side from impact -baby's and elderly have less brain tissue -> more space -focal: occur at specific location in brain -focal differentials- cerebral contusion, intracranial hemorrhage (epidural, subdural hematoma), intracerebral hemorrhage -diffuse: concussion, moderate diffuse axonal injury, severe diffuse axonal injury
52
cerebral contusion
-Blunt trauma to local brain tissue -Capillary bleeding into brain tissue -Common with blunt head trauma -Confusion -Neurologic deficit- Personality changes, Vision changes, Speech changes -Results from Coup-contrecoup injury -frontal contusion/damage/bleed- personality changes
53
epidural hematoma
-Bleeding between dura mater and skull -Involves arteries- Middle meningeal artery most common -Rapid bleeding and reduction of oxygen to tissues -Herniates brain toward foramen magnum -hematoma -> talking and fine -> all the sudden they arnt -> death -football- self enhancing -shift > 5mm -> problem
54
subdural hematoma
-Bleeding within meninges -Beneath dura mater and within subarachnoid space -Above pia mater -Slow bleeding- Superior sagittal sinus -tears to bridging VEINS MC** -banana shape -Signs progress over several days- Slow deterioration of mentation -can cause cardiac arrhythmias -> medulla oblongata injury -VENOUS -no dye given -> blood appears white if acute -gray shades -> chronic -> alcoholics who hit their head and dont remember -hygroma -banana -shift causes edema -can drain in ER in emergency bc venous and lower pressure
55
intracerebral hemorrhage
-Ruptured blood vessel within the brain -Presentation similar to stroke symptoms -Signs and symptoms worsen over time -bleeding within parenchyma of brain -fall and then stroke or stroke and then fall -> we dont know! but same process
56
diffuse brain injury (DAI)
-Due to stretching forces placed on axons. -Pathology distributed throughout brain -Types: -Concussion -Moderate diffuse axonal injury -Severe diffuse axonal injury -sheering of axons on brain -scan- grey white differentiation*
57
diffuse brain injury: concussion
-Mild to moderate form of diffuse axonal injury (DAI): Nerve dysfunction without anatomic damage -Transient episode of: Confusion, disorientation, event amnesia -Suspect if patient has a momentary loss of consciousness. -Management: -Frequent reassessment of mentation -ABCs
58
diffuse brain injury: moderate diffuse axonal injury
-“Classic Concussion” -Same mechanism as concussion: Additional: minute bruising of brain tissue -Unconsciousness: If cerebral cortex and RAS involved -RAS takes a while to recover -> concussion require recovery -May exist with a basilar skull fracture -Signs and Symptoms: -Unconsciousness or persistent confusion -Loss of concentration, disorientation -Retrograde and antegrade amnesia -Visual and sensory disturbances -Mood or personality changes
59
diffuse brain injury
-Brainstem Injury. -Significant mechanical disruption of axons: Cerebral hemispheres and brainstem -High mortality rate. -Signs and Symptoms: -Prolonged unconsciousness -Cushing’s reflex -> increase BP -> increase ICP -Decorticate (flex) or decerebrate (extend) posturing
60
intracranial perfusion
-Cranial volume fixed -80% = Cerebrum, cerebellum, and brainstem -12% = Blood vessels and blood -8% = CSF -Increase in size of one component diminishes size of another -Inability to adjust = increased ICP
61
intracranial perfusion
-compensating for pressure: -compress venous blood vessels -reduction in free CSF- pushed into spinal cord -decompensating for pressure: -increase in ICP -rise in systemic BP to perfuse brain -further increase of ICP- dangerous cycle
62
intracranial perfusion: role of CO2
-increase of CO2 in CSF -Cerebral vasodilation: -Encourage blood flow -Reduce hypercarbia -Reduce hypoxia -Contributes to increase ICP -Causes classic- Hyperventilation (tidal volume and respiration rate) and hypertension -Reduced levels of CO2 in CSF- Cerebral vasoconstriction- > Results in cerebral anoxia
63
factors affecting ICP
-Vasculature Constriction -Cerebral Edema -Systolic Blood Pressure: -Low BP = Poor cerebral perfusion -High BP = Increased ICP -Carbon Dioxide -Reduced respiratory efficiency
64
pressure and structural displacement: increased pressure***
-compresses brain tissue -Against and around- Falx cerebri and Tentorium cerebelli -Herniates brainstem -Compromises blood supply -Signs and Symptoms: -Upper brainstem*- Vomiting, Altered mental status, Pupillary dilation -Medulla oblongata*- Respiratory, Cardiovascular, Blood pressure disturbances
65
signs and symptoms of brain injury
-Altered Mental Status: Altered orientation, Alteration in personality, Amnesia, Retrograde, Antegrade -Cushing’s Reflex*: Increased BP, Bradycardia, Erratic respirations -Vomiting: Without nausea, Projectile -Body temperature changes -Changes in pupil reactivity -Decorticate posturing -obtain blood glucose level on all pts with AMS
66
pathophysiology of changes with brain injury
-Frontal Lobe Injury- Alterations in personality -Occipital Lobe Injury- Visual disturbances -Cortical Disruption- Reduced mental status or amnesia -Retrograde- Unable to recall events before injury -Antegrade- Unable to recall events after trauma, “Repetitive questioning” -Focal Deficits*- Hemiplegia, weakness, or seizures -new onset seizures in adult without trauma- tumor
67
upper brainstem compression
-Increasing blood pressure -Reflex bradycardia- Vagus nerve stimulation -Cheyne-Stokes respirations -Pupils become small and reactive -Decorticate (flexure) posturing -Neural pathway disruption***
68
middle brainstem compression
-Widening pulse pressure -Increasing bradycardia -CNS hyperventilation - Deep and rapid -Bilateral pupil sluggishness or inactivity -Decerebrate (extend) posturing***
69
lower brainstem injury
-Pupils dilated and unreactive -Ataxic respirations- Erratic with no pattern -Irregular and erratic pulse rate -ECG changes**- stimulation altered -> common in subarachnoid hemorrhage -Hypotension -Loss of response to painful stimuli
70
recognition of herniation
-Cushing’s Reflex: -Increasing blood pressure -Decreasing pulse rate -Respirations that become erratic -Lowering level of consciousness: GCS <9 and dropping -Singular or bilaterally dilated and fixed pupils* -> very bad -> brain death -Decerebrate (extend) or decorticate (flex) posturing** -No movement with noxious stimuli
71
glasgow coma scale
-eye opening 4-1 - spontaneous, to verbal command, to pain, no response -verbal response 5-1 - oriented and converses, disoriented and converses, inappropriate words, incomprehensible sounds, no response -motor 6-1 - obeys verbal commands, localizes pain, withdraws from pain (flexion), abnormal flexion in response to pain (decorticate rigidity), extension in response to pain (decerebrate rigidity), no response -<8 -> need assistance, tubes, etc.
72
brain injury eye signs
-Physiological Issues: -Indicate pressure on CN 2, 3, 4, 6 -CN-3 (Oculomotor nerve)- Pressure causes eyes to be sluggish, then dilated, and finally fixed -Reduced peripheral blood flow -Pupil Size and Reactivity: -Reduced pupillary responsiveness- Depressant drugs or cerebral hypoxia -Fixed and dilated -Extreme hypoxia
73
intraventricular bleed: eyes
-may not be pupillary changes because the primary brain injury is not causing compression of the cranial nerves -Do NOT think that because a patient has responsive pupils that they cannot have a brain injury
74
facial soft tissue injury
-Highly vascular tissue- Contributes to hypovolemia -Superficial injuries are rarely life threatening and rarely involve the airway. -Deep injuries can result in blood being swallowed and endangering the airway. -Soft-tissue swelling reduces airflow. -Consider likelihood of basilar skull fracture or spinal injury -massive bleeds with facial injury
75
common facial fractures
-Mandibular- Deformity along jaw and loss of teeth, Possible airway compromise if patient placed supine, Evaluate for multiple fracture sites -Maxillary and Nasal- Le Fort I, II, and III Criteria -Orbit- Involve zygoma, maxilla, and/or interior shelf, Reduction of eye movement (Possible diplopia), Limitation of jaw movement
76
le fort fracture
-caution applying bag valve mask to pt -pressure of apply may cause airway obstruction by posterior displacement of maxilla and in some cases mandible
77
nasal injury
-Rarely life threatening. -Swelling and hemorrhage interfere with breathing. -Epistaxis- Most common problem -AVOID NASOTRACHEAL INTUBATION- Passage of ET tube into the cerebral cavity -> oral tube
78
ear injury
-External Ear: -Pinna frequently injured due to trauma -Poor blood supply -Poor healing -Internal Ear: -Well protected from trauma -May be injured due to rapid pressure changes: -Diving, blast, or explosions -Temporary or permanent hearing loss -Tinnitus may occur -check for rupture of eardrum with explosion
79
eye injury
-Penetrating Trauma: -Can result in long-term damage. -Suspect small foreign body if patient complains of sudden eye pain and sensation of something on the eye. -DO NOT REMOVE ANY FOREIGN OBJECT. -Corneal Abrasions and Lacerations- Common and usually superficial -Hyphema- Blunt trauma to the anterior chamber of the eye -> Blood in front of iris or pupil -Sub-conjunctival Hemorrhage: -Less serious condition -May occur after strong sneeze, severe vomiting or direct trauma -soft tissue lacerations -self limiting - no pain
80
acute retinal artery occlusion
-Nontraumatic origin -Painless loss of vision in one eye -Occlusion of retinal artery
81
retinal detachment
-Traumatic origin -Complaint of dark curtain/obstruction in the field of view -Possibly painful depending on type of trauma -curtain down on eye
82
parts of brain
-Telencephalon is on top: Forebrain/Cerebral Hemispheres -All others below in alphabetical order -Diencephalon: Forebrain: Thalamus/hypothalamus -Mesencephalon: Midbrain/Tectum/Tegementum (tecum: colliculi auditory and visual) -Tegenebtum: periaqueductal gray (opiate drug mediation), Substantia Nigra/Red Nucleus (Sensorimotor function) -Metencephalon: Hindbrain: Pons ascending and descending tracts -Myelencephalon: Hindbrain: Medulla: RAS, sleep, attention (definitely important for language), movement, the maintenance of muscle tone, and various cardiac, circulatory, and respiratory reflexes
83
scalp injuries and infections
-loose connective tissue layer- danger area of scalp bc pus or blood spreads easily -Infection can spread to cranial cavity through emissary veins -> pass through calvaria -> reach intracrania like meninges -infection cant go into neck bc occipital belly of occipitofrontalis muscle attaches to occipital bone and mastoid parts of the temporal bones -infection cant spread past zygomatic arches bc epicranial aponeurosis is continuous with temporal fascia -can enter eyelids and root of nose bc frontal belly of occipitofrontalis muscle inserts on skin and not bone -> black eyes -Ecchymoses as result of extravasation of blood into the subcutaneous tissue
84
quiz
-dracula expression muscle -right sided cortical injury- contra/ipsi upper/lower drooping ? -upper lip bleeding- which artery -what attaches flexi - cribiform plate? -pituitary tumor
85
cortical lesion
-understand that diagram -one affects upper and lower, other affects just the lower
86
bell's palsy
-viral infections- herpes simplex 1 -can happen overnight -parotid tumors (benign or malignant)- facial nerve
87
hypoglossal nerve
-hoarseness upon damage -travels similarly to lower branches of facial nerve
88
tongue
-posterior 1/3 of tongue- bitter -lingual nerve- branch of mandibular branch cont. -injuries, tumors, of neck - many nerves here
89
superior lingual/labial artery
-injury to upper vermillion border of mouth -watch for scabbing -> if scab falls off and exanguates -can lose a lot of blood -burns -common in children, fights
90
fontanelles
-window to intracranial pressure -depressed fontonelle- child is hypovolemic, dehydrated, pancreatitis, blood loss -all fluid compartments are connected -decreased intraocular pressure -fontanelle can become flat -bulging fontanelles- tumor, overload -assess fluid status -sunset sign- iris/pupil is down at bottom of eye -> increased fontanelle size (hydrocephalus)
91
pituitary gland
-pressure on optic chiasm
92
trigeminal neuralgia / tic de leroux
-very painful -trigeminal nerve compression -physical exam is important -MC cause- pressure caused by artery or vein* squashing (compressing) the trigeminal nerve
93
optic nerve
-big optic nerve -high intracranial pressure -U/S
94
frontal bone
-sinusitis -abscess on frontal aspect -can go through bone -cavernous sinusitis -> even a pimple on the nose
95
know foramen
-if edema or tumor at that foramen which nerves are affected
96
optic injury
-optic edema- ultrasound -optic nerve -orbital blowout -> hematoma of optic muscles -> lack of movement -muscles of eye are paper thin -PE- make an H and see the pt move their eyes -dendritic pattern- herpes- viral -vitreous fluid must be clear -retina detachment- fundoscopy -retinal blastoma- one red reflex -> one eye not
97
parenchymal bleed
bleeding inside tissue itself
98
MC of subarachnoid bleed
trauma -subarachnoid bleed -> whispy bleed