Neuro 6 Flashcards
what is contre-coup
injury affects the side opposite to the blow because of rebound (horizontal section)
concussion vs contusion
concussion (swelling/bruise… goes away) and contusion (torn and bleeds)
a TBI that changes the way your brain functions
concussion
types of skull fractures
Hairline, depression, compound (multiple bones), hematomas
describe epidural bleed
- bleeding between the dura mater and skull
- may see the bleeding out of nose, go unconscious quickly
describe subdural bleed
- bleeding between the arachnoid mater and dura mater
- may take up to 4 days to show signs of problem (may be too late)
- *this type is worse as it is less obvious
describe raccoon eyes
- hit to the back of the head (conte-coup injury)
- as brain pushed forward, have bleeding around eyes (occipital, really bad)
s/s of concussion
Vomiting, amnesia, dizziness, lethargy
over time, recurrent concussions cause
causes damage to internal structures of thalamus
Blow to the head, brain hits the skull, not cause contusion, temporary dysfunction
Recovers 24-48 hrs
concussion
management of mild concussion
Quiet and contained for 24-48 hrs (no rapid movement of eyes)
- Most common in 20-40 years old
- BLEED d/t fracture
- arterial bleeding, blood between skull and dura, linear skull fx over middle meningeal artery or venous sinus
contusion
s/s of contusion
Scalp wound, drowsiness, loss of consciousness, labored respirations, hemiparesis, posturing, unequal pupils
describe epidural hematoma
**lose consciuoness quickly (surgical intervention to stop bleed or remove blood)
s/s of epidural hematoma
Unconscious, then lucid for minutes to hours, severe headache, progressive loss of consciousness, compression of brain stem, respirations become shallow and irregular, pupil dilation, seizures
describe subdural hematoma
take longer to develop but same s/s as epidural
slower onset
a pool of blood forming underneath the skull
hematoma
describe intracerebral hematoma
d/t leaking aneurism
s/s of intracerebral hematoma
Unresponsive immediately, lucid and then progress to coma, motor deficits and posturing
what are battle signs
bruising over mastoid bone/face/sinus bruising
what should you look for if skull fracture suspected
Look for CSF leakage (ears or nose is REALLY BAD, fracture within skull, cannot put CSF back)
s/s of skull fracture
Motor and sensory deficits depending on where trauma occurs, periorbital ecchymosis (raccoon eyes), CSF leakage from ears, ecchymosis over the mastoid bone (battle’s sign)facial paralysis with basilar skull fractures, posterior basilar fractures may disrupt respirations.
treatment of TBI
Same as treatment of ICP:
- Assess cognition, level of arousal
- Assess eyes, motor, brainstem, respiratory function
- Control ICP, maintain CPP and oxygenation
- Prevent seizures, normal temp, normal fluid and electrolytes
- evacuate bleed if there is one
- Prevent sympathetic storming
describe storming
- Diaphoresis, agitation, restlessness or flexion, hyperventilation, tachycardia and fever
- May occur with suctioning or turning
- Treated with Beta blockers
what are the worst brain tumors and what is the general treatment
Gliomas are the worst
Remove tumors and do radiation
brain tumor management
- After surgery: decadron, an anti-inflammatory steroid (given with radiation)
- Radiation will make their brain swell/hot and make them vomit (give Zofran)
brain tumor treatment
1) Radiation Therapy: First line treatment is stereotactic (gamma knife or linear accelerator)
2) Surgery: Craniotomy- surgery for brain tumor
3) Medications: Corticosteroids to reduce cerebral edema and antiepileptic medications
4) Chemotherapy: Orally, IV or in the resected area of the brain
describe cerebral aneurysm
-is a bulging, weakened area in the wall of an artery in the brain, resulting in an abnormal widening, ballooning, or bleb.
-Not good, If not caught in time will kill you once major arteries rupture
Clipping or coiling with aneurysm
describe AVM
- An abnormal connection between arteries and veins, usually in the brain or spine, that can rupture
- May show up when pregnant (treat with clipping)
what is an aneurysm
A ballooning and weakened area in an artery.
Grading of Aneurysms
Hunt-Hess Scale
sections of Hunt-Hess
1) mild headache, GCS 15, no motor deficits, normal mental status
2) severe headache, GCS 13-14, no motor deficits, normal mental status
3) somnolent, confused, GCS 13-14, MOTOR DEFICITS,
4) stupor, GCS 7-12, w/ or w/out motor deficits (moderate to severe)
5) coma, reflex posturing or flaccid, GSC <6, w/ or w/out motor deficits
surgical treatment of aneurysms
clipping and coiling
treatment of aneurysms
- Monitor for bleeding, vital signs, neuro status
- After surgery- monitor for vasospasms, 3-12 days after, watch for headaches, change in LOC
- Treatment is Nimodipine
- ICU for 2 days after surgery
why is nimodipine gien
Calcium channel blocker to prevent spasms and vasopressors to keep the systolic BP 20 mmHg greater than normal
describe encephalitis
- Bacteria or virus that invades the brain (must have way to get in)
- through head trauma, sinus cavity, or ear
- equine virus through mosquitoes
s/s of encephalitis
Inflammation of the brain
Symptoms:
Headache, fever, confusion, stiff neck and vomiting
complications of encephalitis
Seizures, hallucinations, trouble speaking, memory problems and problems hearing
causes of encephalitis
Viruses (herpes simplex, rabies) bacteria, parasites and fungus
treatment of encephalitis
- MRI, lumbar puncture for elevated ICP and testing of CSF
- Polymerase chain reaction (PCR) testing of CSG to detect viral DNA
- *Remove fluid, Ventilated, EVD drain to decrease swelling
supportive care of encephalitis
Antivirals or antibiotics Steroids Sedatives for restlessness Tylenol for fever Therapy
encephalitis prognosis poor if…
Cerebral edema
Thrombocytopenia
Status epilepticus
main drug to decrease inflammation if increased ICP
steroids
basic treatment for neuro problems
Give oxygen, stable airway, maintain ICP and notify providers!
