Neuro #2 Flashcards
3 types of subdural hematoma
Acute: symptomatic within 24 hours (children)
Subacute: symptomatic within 2-10 days
Chronic: symptomatic after 2 weeks (elderly - cerebral atrophy)
Epidural Hematoma
Bleeding between the skull and the dura mater.
- usually arterial (middle meningeal artery temporal region)
- cause Uncal herniation.
- results in ipsilateral pupil W contra lateral neuro deficits / posturing.
Define process that gives Uncal herniation findings.
Uncal herniation shifts brain down and away from where herniation is. If on R will shift brain down and to the L. Pinches L optic nerve.
- optic nerves come off the occipital lobe, supra-tentorial and come down through insecure, cross and connect to eyes.
- pinched all optic nerve crosses to R eye.
- R eye dilation w/ L sided neuro deficits.
Subdural Hematoma
Blood between the dura and arachnoid layers
- Usually venous in nature
- high morbidity & mortality
- can sneak up on you.
- 3 types
Subarachnoid Hemorrhage
Bleeding between arachnoid membrane and the Pia Mater
Where CHF is = increases infection potential
Trauma is most common cause
Or Berri Aneurysm (secondary to HTN)
Subarachnoid Hemorrhage complaints
“worse headache of my life”
N/V, stiff neck, visual disturbances, ALOC
Commonly confused w/ meningitis (lumbar puncture issue)
Lumbar puncture considerations with subarachnoid hemorrhage.
Contraindicated id subarachnoid bleed is possible.
CSF pressures could tamponade bleed. LP can cause runaway hemorrhage. CT prior to LP
Intracerebral Hemorrhage
Hemorrhage in brain parenchyma
- produced by shearing and tensile forces
- white matter of frontal and temporal regions
- associated with contusions, subdural hematoma, DAI
- less common, delayed onset
- if enters ventricle, bleed will progress quickly.
Intraventricular Hemorrhage.
Bleeding into the ventricles as a result of severe brain trauma
- sheering forces
- high mortality rate
- usually found in temporal and frontal lobes.
Closed head injury: Mild Cuncussion
Results from rotational force.
Reversible with no persistent sequelae
Retrograde amnesia of short duration.
Closed head injury: Classic Concussion
Rotational or direct forces
Reversible with memory and info processing problems
Brief LOC, retrograde and post-traumatic amnesia
Closed head injury: Diffuse Axonal Injury (DAI)
- Diffuse shearing injury, rotational acceleration
- irreversible with profound neuro, psych and personality deficits
- usually coma, entire brain has taken insult and is swelling. Increased ICP, frequently fatal, survival correlates with long term disability, personality changes.
Linear skull fracture
A line that extends toward the base of the skull
Linear stellate skull fracture
Multiple fracture that radiate from the compressed area
Diastatic skull fracture
Involves a separation of the bones at a suture line or a marked separation of bone fragments.
Depressed skull fracture
May be closed or open.
Basilar skull fracture
Fracture of the base of the skull
- battle signs: bruising behind ear on mastoid bone
- peri orbital ecchymosis: raccoon eyes, around eyes
- otorrhea- bleeding from ear w/ CSF Leak
- Rhinorrhea- bleeding from nose w/ CSF LEAK.
Basilar skull fracture Early and late signs
Early: otorrhea, Rhinorrhea
Late: Battles and raccoon eyes.
Pneumocephalus
Air trapped in the skull
Boyles law will cause gas expansion / cerebral compression
Consider with deterioration immediately after ascent.
LeFort 1
Fx of maxilla
Lefort 2
Pyramidal fracture along sides of nose
- causes a pyramid shape
- separates off top of maxilla
- nose and top of mouth become free floating segments.
Lefort 3
Fracture runs through zigomas though zygomatic arches
-entire face from eyes down are free-floating
Lefort fractures
- most common symptom
- trigeminal nerve considerations
Most common symptom: epistaxis
Increased risk of trigeminal nerve injury, resulting in facial sensory overload and clenching of the jaw (trismus)
