Hematomas Herniations and Hemorrhages Stephens T#2 Flashcards
What is the glasgow coma scale?
Standard to determine level of consciousness
What three things can be abrupt onset
trauma vasuclar and infectious
Episodic onset
intermittent relapsing episodes, MS is an example, or vertebrobasilar insufficiency
When testing Sensory to the face by palpating the temporalis and masseter and the patient does not feel it, what nerve is damaged?
trigeminal
How do you test facial nerve?
Ask them to use any of their facial muscles
Unilateral hearing is impaired in your patient, what nerve could be damaged?
VIII
How do you tell damage to the vagus?
Dysphonia, Dysphagia, or perform a laryngoscopy
Patient has inability to shrug shoulders, flex and rotate head to the opposite side, what nerve is damaged?
Spinal Accessory
Tongue deviates to the right side when protruded, what nerve is damaged?
Right hypoglossal
What is the manifestation of a subarachnoid hemorrhage?
- Abrupt onset of signs
- Bursting headache
- vomit
- changes in conscioussness or convulsion
- bradycardia, with increased HR BP and Temp
Neurologic findings:
- Kemig’s sign
- Neck rigidity
- unequal pupils and slow reaction to light
- absent DTR’s
SAH neurologic findings, what causes primary and seondary focal signs?
Primary: ischemia
Secondary: destruction by rupture compression by a clot
Where do most cerebral aneurysms occur?
Anterior circularion which is usually ICA
In the US what is standard for suspecting SAH?
CT and lumbar puncture
What is Lateral Medullary Wallenburg Syndrome?
- Thrombosis of PICA
- Displacement of the PICA on angiograms of posterior cranial fossa can indicate a tumor
What is the significance of the Greater Anterior Artery of Adamkiewicz?
- It supplies blood to cervical and lumbar enlargements
- Major supply to the inferior two thirds of the spinal cord!!
- It can be compromised with a thorocolumbr fracture or when repairing an abdominal aortic aneurysm
- occlusion or damage can result in parapalegia
Veins of the spinal cord collectively drain into ____.
Internal Venous Plexus of Batson located in the epidural space. From here it goes to intervertebral veins and then segmental veins
What drains most of the coretex of the lateral aspect of the cerebral hemispheres?
Superficial middle cerebral vein
What is the clinical significance of the Great vein of Galen?
It drains most of the deep cerebrum so if it becomes obstructed it is typically fatal. It can also become dilated and form a venous varix.
- Great vein varix can compress pineal body and posterior commissure
What area does the superior sagittal sinus drain?
- Most of cerebral cortex
What area does the straight sinus drain?
- It receives great cerebral vein of galen
- Straight drains into left transverse
Where does the superior sagittal sinus empty into and the straight?
- Right transverse
- Left transverse
What does thrombosis of the posterior portion of the straight venous sinus or left transverse sinus result in?
- Results in ischemia and/or necrosis of deep brain cerebrum structures, this is usually fatal
What does throombosis of posteior portion of superior sinus or right transverse sinus result in?
Cortical ischemia and/or necrosis
What is a falx herniation?
It is also called a midline shift, this occurs when the cingulate gyrus to herniate across the midline below the free edge of the falx cerebri
What is a tentorial or uncal herniation?
- When profuse high pressure bleeding occurs and fills the epidural space it presses on the adjacent cerebral hemisphere, causing the cerebrum to herniate under the falx cerebri &/or through the tentorial notch.
- When the uncus herniates through it compresses and displaces the reticular formation so paitients have a progressive decrease in their consciousness
What is a tonsillar herniation?
- When there is a mass or the space is expaning in the posterior cranial fossa it can cause the cereballar tonsil to herniate throught the foramen magnum comressing the lower medulla upper cervical spinal cord.
- Arnold Chiari Malformation
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