III- Coma and Intracranial Pressure Flashcards

1
Q

● Greatest danger in neurologic disease

A

increased intracranial pressure

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2
Q

PROGRESSION OF INCREASED ICP

A
  1. Headache – very early sign
  2. Vomiting – progression; ICP is worsening
  3. Decrease sensorium
  4. Herniation
  5. Brain death
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3
Q

EARLY SIGNS OF INCREASING INTRACRANIAL PRESURE:

A

● Cushing’s phenomenon
o Can occur before other clinical signs of ICP occur
o ↑ ICP = ↑ BP + ↓ HR

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4
Q

LEVEL OF SENSORIUM (FROM HIGH TO LOW)

A
  1. Alert/Awake
  2. Drowsy, Lethargic
  3. Stupor
  4. Coma or Unconscious
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5
Q

(highest level of sensorium) – eyes
open spontaneously

A

awake/alert

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6
Q

eyes open to verbal stimulation
or light touch

A

drowsy/lethargic

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7
Q

eye opening to pain stimuli

A

stupor

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8
Q

no eye opening no matter
what stimulus (has different levels:)

A

unconscious/coma

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9
Q

when you give a pain stimulus, px can locate the
stimulus and try to remove it

A

Purposeful withdrawal to pain (lightest coma)

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10
Q

try to move
but cannot locate where the pain stimulus is given

A

Non-purposeful withdrawal to pain

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11
Q

flexion response of UE and
LE extension

A

Decorticate posturing

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12
Q

extensor response where
UE are extended

A

Decerebrate posturing

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13
Q

no movement when you
stimulate the px

A

Unresponsive coma

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14
Q

pressure of all the substances inside the
cranium (skull)

A

Intercranial Pressure

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15
Q

amount of blood that goes up
to the brain

A

Cerebral blood flow

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16
Q

How many mL of blood enters the brain in every minute?

A

700 mL

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17
Q

power or force that drives blood
into the brain

A

Cerebral perfusion pressure

18
Q

ICP is composed of the ff:

A
  1. Brain substance
  2. Blood volume
  3. CSF
19
Q

brain parenchyma

A

brain substance

20
Q

the amount of blood inside the
arteries, arterioles, venous systems and sinuses

A

blood volume

21
Q

inside the
ventricles or canals

A

CSF

22
Q

CAUSES OF INCREASED BRAIN PARENCHYMA

A
  1. Cerebral edema (most common cause) – free water
  2. Brain tumors – growth of new abnormal brain cells
  3. Damaged neurons and glial cells that are swollen
23
Q

T or F
145 mL CSF can be accommodated by ventricles
and subarachnoid space

A

False: 135 mL

24
Q

T or F
blood inside all of the
arterioles, arteries, veins, and
sinuses can be 150 Ml

A

T

25
Q

Defined as free water in certain areas or free spaces
of the brain

A

Edema

26
Q

TYPES OF EDEMA

A
  1. Vasogenic
  2. Cytotoxic
  3. Interstitial Edema
27
Q

extracellular accumulation of fluid from
disruption of the blood brain barrier
o From the blood vessel
o Common in tumors and bleeding into the brain

A

Vasogenic

28
Q

– intracellular accumulation of fluid
causing the cell to swell
o Located in the neuron or glial cells
o Fluid is inside the cells
o Seen in infarcts

A

Cytotoxic

29
Q

outflow of CSF into the
interstitial area of the brain
o Flow of free water or CSF goes out due to high
pressure in the ventricles into the interstitial
spaces

A

interstitial edema

30
Q

Openings of herniation

A
  1. Tentorial Notch
  2. Foramen Magnum
31
Q

where the diencephalon
connects with the midbrain (tentorium cerebelli
that separates the cerebral hemisphere with the
diencephalon on top, while the brainstem and
cerebellum are below)

A

tentorial notch

32
Q

where medulla connects to
the cervical spinal cord
● Uncus is the one that enters the tentorial notch
because the temporal lobe is above the tentorium
● Tonsils of cerebellum enters the foramen magnum

A

Foramen Magnum

33
Q

it is the uncus of the medial part
of the temporal lobe enters the tentorial notch

A

Uncal Herniation

34
Q

SIGNS OF UNCAL HERNIATION

A

o Decreased sensorium
o CN 3 damage (which is responsible for moving the
eyes inward or adduction, pupillary constriction,
and eyelid opening)
a. Ipsilateral medial rectus palsy (2
nd pic)
b. Ipsilateral dilating pupil (not reactive to light –
NRTL) (1
st pic)
c. Ipsilateral ptosis
● All of the symptoms of CN 3 damage (a and b)
should go with decreased sensorium for it to be
considered as uncal herniation

35
Q

If uncus come down left and right (both side of the
brain)

A

central herniation

36
Q

SIGNS OF CENTRAL HERNIATION

A

o Decreased
sensorium
o Bilateral medial
rectus palsy
o Bilateral
dilating
non-reactive
pupil

37
Q

Tonsils from medial part of cerebellum will come
down and pass through the foramen magnum

A

Tonsillar Herniation

38
Q

SIGNS OF TONSILLAR HERNIATION

A

● At the lower medulla is the inspiratory center thus
one sign is apnea
● Apnea = absence of breathing
● Decreased sensorium
● When patient has
decreased sensorium and
suddenly stops breathing =
(+) tonsillar herniation
● Increased in ICP in the
infratentorial area (either
bleeding in the cerebellum
or brainstem)
● Increased ICP – doctors
perturbate and put a tube
in right away and connect them to the ventilator
o If not, patients will die due to cardiac death
immediately

39
Q

where part of the hemisphere goes
under the falx cerebr

A

Falx herniation

40
Q

Control of ICP

A
  1. Elevate head 15-30 degrees
  2. Control fever aggressively
  3. Ventilatory Support (Controlled Respiration)
  4. Osmotic Diuretics mannitol/ hypertonic saline
  5. Dexamethasone (steroid for vasogenic edema)