Neuro trauma

Question 1

Physiological ICP is ≤ __ mm Hg in adults (in supine position)

Answer 1

15

Question 2

Consequences of elevated ICP
1. low brain perfusion
2. Cushing triad/reflex
Thought to reflect ____ compression.

Answer 2

brainstem

This sign indicates a need for urgent treatment.

Question 3

Cushing’s triad
2/2 elevated ICP & poor brain perfusion
(3)

Answer 3

1. HTN
2. Bradycardia (reflex carotid baroreceptors)
3. Irregular breathing

widening pulse pressure

Question 4

Cushing triad
Reduced levels of consciousness
Headache
Vomiting
Papilledema

Are signs of

Answer 4

elevated ICP

and low cerebral perfusion

Question 5

hydrocephalus
&
hemiparesis (predominantly lower limbs)

suggests ____ herniation

Answer 5

Subfalcine

Question 6

1 fixed and dilated pupil (Ansocoria) → Ipsi CN3 palsy

ipsilateral paralysis + weakness → Contralateral cerebral peduncle

Homonymous hemianopia (both eyes with loss of L or R field) → Ipsilateral PCA

suggests compression s/t ____ herniation

Answer 6

Uncal

Question 7

Midline shift
Mass lesions
Effacement of the basilar cisterns (ventricals)

on MRI head suggest elevated ___

Answer 7

ICP

Question 8

Generally, ICP > 20 mm Hg indicates intracranial ___, which requires treatment.

Answer 8

hypertension

(Hypertonic saline, HOB elevation, Antipyretics, Sedation, Seizure ppx, Hyperventilation, Osmotic Therapy, EVD to drain CSF, Craniotomy)

Question 9

A monitoring device placed into the ventricles of the brain along with a CSF drainage system (an EVD)

Answer 9

Intraventricular catheter

Question 10

Elevated ICP conservative management consists of: 
Patient positioning w/ \_\_\_\_
Sedation and analgesia
\_\_\_\_\_ control
Target euvolemia/normoglycemia
avoid serum (hypo/hyper)osmolarity
\_\_\_\_\_  ppx

Answer 10

head of bed elevation (∼ 30°)
Temp control w/ antipyretics
hypoosmolarity
Seizure ppx w/ anti-epileptics

Question 11

Osmotic therapy used in Hyperosmolar elevated ICP:

IV ____

Answer 11

Mannitol

↓ brain volume by ↓ water, blood & CSF volume causing vasoconstriction

Question 12

Surgical therapy for elevated ICP

1. CSF drainage
2. _______

Answer 12

Decompressive craniectomy

especially in large bleeds

Question 13

Nonsurgical tx for refractory intracranial HTN:

1. Controlled ___
2. Therapeutic ___

Answer 13

hyperventilation
(First 30min : PaCO2 30–35)
(causes arterial vasoconstriction to ↓ ICP)

hypothermia

Question 14

Cerebral edema can be Iatrogenic 2/2 rapid

Answer 14

rapid correction of hypernatremia

(leads to cerebral edema bc water moves from the serum into the brain cells)

(or rapid lowering of glucose)

Question 15

Flaccid Areflexic paralysis → Paraplegia, tetraplegia
Anesthesia →below the level of the lesion
Autonomic dysfunction → Loss of bladder/bowel control
Absent bulbocavernosus reflex → fecal incontinence

Diagnosis

Answer 15

Spinal Shock

Complete spinal cord injury

Question 16

A condition that manifests with detrusor underactivity (flaccidity) or sphincter overactivity (spasticity) resulting in urinary retention-overflow leak incontinence (functional obstruction).

Causes: spinal cord injury, diabetic neuropathy, and multiple sclerosis.

Answer 16

Neurogenic bladder

Question 17

Complication of spinal cord injuries at T6 or above.

Loss of autonomic responses that control heart rate and vascular tone → HTN & Diaphoresis

pt can be → brady or tachy!!!!

pt can be → pale or flushed

Answer 17

Autonomic dysreflexia (hyperreflexia)

Question 18

Autonomic dysreflexia is a medical emergency!
Management includes:

1. Preventing ____
2. Monitor & Manage ___

Answer 18

1. Preventing hypertensive episodes

Prevent stimuli (UTI, constipation, skin lesions)
via catheter, bowel reg, skin protection

2. Monitor & Manage hypertensive episodes

Monitor blood pressure & start Antihypertensives

(obviously ABCs and spinal stabilization 1st)

Question 19

Patients with spinal cord injuries at T6 or above are at the highest risk for ___

Answer 19

autonomic dysreflexia

Question 20

The most common stimuli for autonomic dysreflexia are

3

Answer 20

UTIs/ Anuria (bladder irritation)
Constipation
Ulcers/ Cellulitis (skin lesions)

Question 21

Rapid correction of severe hyponatremia can result in the following neurologic complication

Answer 21

osmotic demyelination