Neuro trauma Flashcards
Physiological ICP is ≤ __ mm Hg in adults (in supine position)
15
Consequences of elevated ICP
1. low brain perfusion
2. Cushing triad/reflex
Thought to reflect ____ compression.
brainstem
This sign indicates a need for urgent treatment.
Cushing’s triad
2/2 elevated ICP & poor brain perfusion
(3)
- HTN
- Bradycardia (reflex carotid baroreceptors)
- Irregular breathing
widening pulse pressure
Cushing triad Reduced levels of consciousness Headache Vomiting Papilledema
Are signs of
elevated ICP
and low cerebral perfusion
hydrocephalus
&
hemiparesis (predominantly lower limbs)
suggests ____ herniation
Subfalcine
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
Uncal
Midline shift
Mass lesions
Effacement of the basilar cisterns (ventricals)
on MRI head suggest elevated ___
ICP
Generally, ICP > 20 mm Hg indicates intracranial ___, which requires treatment.
hypertension
(Hypertonic saline, HOB elevation, Antipyretics, Sedation, Seizure ppx, Hyperventilation, Osmotic Therapy, EVD to drain CSF, Craniotomy)
A monitoring device placed into the ventricles of the brain along with a CSF drainage system (an EVD)
Intraventricular catheter
Elevated ICP conservative management consists of: Patient positioning w/ \_\_\_\_ Sedation and analgesia \_\_\_\_\_ control Target euvolemia/normoglycemia avoid serum (hypo/hyper)osmolarity \_\_\_\_\_ ppx
head of bed elevation (∼ 30°)
Temp control w/ antipyretics
hypoosmolarity
Seizure ppx w/ anti-epileptics
Osmotic therapy used in Hyperosmolar elevated ICP:
IV ____
Mannitol
↓ brain volume by ↓ water, blood & CSF volume causing vasoconstriction
Surgical therapy for elevated ICP
- CSF drainage
- _______
Decompressive craniectomy
especially in large bleeds
Nonsurgical tx for refractory intracranial HTN:
- Controlled ___
- Therapeutic ___
hyperventilation
(First 30min : PaCO2 30–35)
(causes arterial vasoconstriction to ↓ ICP)
hypothermia
Cerebral edema can be Iatrogenic 2/2 rapid
rapid correction of hypernatremia
(leads to cerebral edema bc water moves from the serum into the brain cells)
(or rapid lowering of glucose)
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
Spinal Shock
Complete spinal cord injury
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.
Neurogenic bladder
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
Autonomic dysreflexia (hyperreflexia)
Autonomic dysreflexia is a medical emergency!
Management includes:
- Preventing ____
- Monitor & Manage ___
- Preventing hypertensive episodes
Prevent stimuli (UTI, constipation, skin lesions) via catheter, bowel reg, skin protection
- Monitor & Manage hypertensive episodes
Monitor blood pressure & start Antihypertensives
(obviously ABCs and spinal stabilization 1st)
Patients with spinal cord injuries at T6 or above are at the highest risk for ___
autonomic dysreflexia
The most common stimuli for autonomic dysreflexia are
3
UTIs/ Anuria (bladder irritation)
Constipation
Ulcers/ Cellulitis (skin lesions)
Rapid correction of severe hyponatremia can result in the following neurologic complication
osmotic demyelination
