Head injuries, brain trauma, stroke Flashcards
primary and secondary headaches
primary - first start between 20 and 40 years old including migraines and tension headaches
secondary - caused by problems elsewhere in the head or neck e.g. meds, meningitis, tumour
neuro emergencies can effect CBF because of:
structural changes or damage
circulatory changes
alteration in ICP
CPP =
MAP - ICP
MAP =
SBP + (2 x DBP)
over 3
Abnormal CPP
lower than 30mmHg
raised ICP
greater than 20mmHg
glucose metabolism
glucose is broken down through glycolysis to produce pyruvic arid which is broken down to produce ATP, H2o and Co2
categories of brain injury
mild diffuse injury
moderate diffuse injury
diffuse axonal injury
focal injury
RAS
a network of nerve fibers in the thalamus, hypothalamus, brain stem and cerebral cortex
essential for wakefulness, attention, concentration and introspection - GCS
signs and symptoms of concussion
vomiting combativeness transient visual disturbances defect in equilibrium and coordination changes in BP, HR and resps (rare)
moderate diffuse injury
results in small petechial bruising of brain tissue
involves the brain stem and RAS leading to unconsciousness
diffuse axonal injury
results from movemennt of the brain within the skull secondary to acceleration or decceleration forces
focal injury
lesions that result from skull fracture, contusion, oedema with increased ICP, ischaemic, haemorrhage, penetrating injury y
cerebral ischaemia can result from
vascular injuries
secondary vascular spasm
increased ICP
types of haemorrahge
epidural.extradural
subdural
subarachnoid
intracerebral haematoma
Epidural haematoma
blood between the cranium and dura in the epidural space
subdural haematoma
blood between the dura and the surface of the brain in the subdural space
subarachnoid haemaorrhage
bleeding into the CSF
meningeal irritation
intracerebral haemorrhage
blood of more than 5ml somewhere within the substance of the brain
signs of severe brain trauma
abnormal posturing - flexor spasms, extensor spasms, flaccidity
pupillary changes
relaxation of the sphincter tone of the bowels and bladder
altered resps
Cushing’s triad
increased SBP and widened pulse pressure
bradycardia
irregular or abnormal resps
5th and 7th nerves
5th trigeminal - sensory innervation to the skin of the face
7th facial - innervates muscles of facial expression and supplies the anterior 2/3 of the tongue with taste fibers
le forte 1 fractures
horizontal fractures crossing the lateral wall of the maxillary sinus up to the level of the nasal sinnus
le forte II fractures
include the bony nasal skeleton and the middle third of the face including the medial orbits
le forte III fractures
craniofacial dislocation involving all bones of the face and creating a mobile mid face
signs of le forte fractures
mid facial oedema unstable maxilla lengthening of the face epistaxis numb upper teeth nasal flattening nasal CSF leakage
acute treatment of ischaemic stroke
thrombolytics - tPA
anticoagulants - warfarin, heparin
antiplatelet - aspirin
osmotic agents - mannitol