Neuro 6

Question 1

what is contre-coup

Answer 1

injury affects the side opposite to the blow because of rebound (horizontal section)

Question 2

concussion vs contusion

Answer 2

concussion (swelling/bruise… goes away) and contusion (torn and bleeds)

Question 3

a TBI that changes the way your brain functions

Answer 3

concussion

Question 4

types of skull fractures

Answer 4

Hairline, depression, compound (multiple bones), hematomas

Question 5

describe epidural bleed

Answer 5

• bleeding between the dura mater and skull

- may see the bleeding out of nose, go unconscious quickly

Question 6

describe subdural bleed

Answer 6

• 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

Question 7

describe raccoon eyes

Answer 7

• hit to the back of the head (conte-coup injury)

- as brain pushed forward, have bleeding around eyes (occipital, really bad)

Question 8

s/s of concussion

Answer 8

Vomiting, amnesia, dizziness, lethargy

Question 9

over time, recurrent concussions cause

Answer 9

causes damage to internal structures of thalamus

Question 10

Blow to the head, brain hits the skull, not cause contusion, temporary dysfunction
Recovers 24-48 hrs

Answer 10

concussion

Question 11

management of mild concussion

Answer 11

Quiet and contained for 24-48 hrs (no rapid movement of eyes)

Question 12

• 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

Answer 12

contusion

Question 13

s/s of contusion

Answer 13

Scalp wound, drowsiness, loss of consciousness, labored respirations, hemiparesis, posturing, unequal pupils

Question 14

describe epidural hematoma

Answer 14

**lose consciuoness quickly (surgical intervention to stop bleed or remove blood)

Question 15

s/s of epidural hematoma

Answer 15

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

Question 16

describe subdural hematoma

Answer 16

take longer to develop but same s/s as epidural

slower onset

Question 17

a pool of blood forming underneath the skull

Answer 17

hematoma

Question 18

describe intracerebral hematoma

Answer 18

d/t leaking aneurism

Question 19

s/s of intracerebral hematoma

Answer 19

Unresponsive immediately, lucid and then progress to coma, motor deficits and posturing

Question 20

what are battle signs

Answer 20

bruising over mastoid bone/face/sinus bruising

Question 21

what should you look for if skull fracture suspected

Answer 21

Look for CSF leakage (ears or nose is REALLY BAD, fracture within skull, cannot put CSF back)

Question 22

s/s of skull fracture

Answer 22

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.

Question 23

treatment of TBI

Answer 23

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

Question 24

describe storming

Answer 24

• Diaphoresis, agitation, restlessness or flexion, hyperventilation, tachycardia and fever
• May occur with suctioning or turning
• Treated with Beta blockers

Question 25

what are the worst brain tumors and what is the general treatment

Answer 25

Gliomas are the worst | Remove tumors and do radiation

Question 26

brain tumor management

Answer 26

- After surgery: decadron, an anti-inflammatory steroid (given with radiation) - Radiation will make their brain swell/hot and make them vomit (give Zofran)

Question 27

brain tumor treatment

Answer 27

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

Question 28

describe cerebral aneurysm

Answer 28

-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

Question 29

describe AVM

Answer 29

- An abnormal connection between arteries and veins, usually in the brain or spine, that can rupture - May show up when pregnant (treat with clipping)

Question 30

what is an aneurysm

Answer 30

A ballooning and weakened area in an artery.

Question 31

Grading of Aneurysms

Answer 31

Hunt-Hess Scale

Question 32

sections of Hunt-Hess

Answer 32

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

Question 33

surgical treatment of aneurysms

Answer 33

clipping and coiling

Question 34

treatment of aneurysms

Answer 34

- 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

Question 35

why is nimodipine gien

Answer 35

Calcium channel blocker to prevent spasms and vasopressors to keep the systolic BP 20 mmHg greater than normal

Question 36

describe encephalitis

Answer 36

- Bacteria or virus that invades the brain (must have way to get in) - through head trauma, sinus cavity, or ear - equine virus through mosquitoes

Question 37

s/s of encephalitis

Answer 37

Inflammation of the brain Symptoms: Headache, fever, confusion, stiff neck and vomiting

Question 38

complications of encephalitis

Answer 38

Seizures, hallucinations, trouble speaking, memory problems and problems hearing

Question 39

causes of encephalitis

Answer 39

Viruses (herpes simplex, rabies) bacteria, parasites and fungus

Question 40

treatment of encephalitis

Answer 40

- 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

Question 41

supportive care of encephalitis

Answer 41

``` Antivirals or antibiotics Steroids Sedatives for restlessness Tylenol for fever Therapy ```

Question 42

encephalitis prognosis poor if...

Answer 42

Cerebral edema Thrombocytopenia Status epilepticus

Question 43

main drug to decrease inflammation if increased ICP

Answer 43

steroids

Question 44

basic treatment for neuro problems

Answer 44

Give oxygen, stable airway, maintain ICP and notify providers!