Neuro Trauma Flashcards
meningitis hallmark
HA
Fever
Stiff neck
real clue to pay attention to with a patient
mental status change!
esp. with space occupying lesions
inflammation of meninges that line the brain and spinal cord
meningitis definition
inflammation of brain
encephalitis
MCC of encephalitis
viral infections
umbrella term used to describe several different medical conditions that cause a malfunction or failure of the Autonomic Nervous System (ANS)
Dysautonomia
generic term for presence of a greater than normal number of cells in cerebrospinal fluid
Pleocytosis
Functional tissue of a specific organ
Parenchyma
Micro-hemorrhages with small vessel leakage into surrounding tissue
Parenchyma contusion
Complete separation of tissue (type of parenchymal)
laceration parenchymal
injury occurs under the site of impact with an object
coup
injury occurs on the side opposite the area that was initially impacted
contrecoup
Symptoms of coup/contrecoup are directly related to…
nausea, vomiting, atxia, etc.
new pressure within the cranial cavity that creates swelling of the brain and micro-hemorrhages of the vessels
Torque injuries of brain
when coup and contrecoup occur, the brain sloshes and rotates. This creates a torque pressure and alteration on the brain stem. This effects the lifelines of respiration rates and heart rates.
Coup and Contrecoup cervical injuries
results in flexion/extension (compression and extension) fractures and/or connective tissue damages. Often times, the connective tissues are stronger and cause avulsion fractures of the cervical vertebrae (bone fragments are torn away from the main bone segment).
Inflammation / infection of the meninges and brain
two different things with the same presentation
Meningitis+ Encephalitis: Meningoencephalitis
aka Encephalomeningitis
Aseptic meningitis/encephalitis
due to a virus - not as contagious or deadly
meninges of the brain (superficial to deep)
dura mater
arachnoid mater
pia mater
Triad of Cushing’s Syndrome
As you increase ICP, see:
- elevated BP with widened pulse pressure
- decreased pulse rate
- irregular breathing patterns
epidural
above the dura mater
subdural
below the dura mater
subacrachnoid
below the arachnoid
bleeds below pia mater
usually venous bleeds
When the periosteum is torn…
check for depressed skull fracture
mental status changes –> more severe and should be admitted
a state of prolonged unconsciousness
coma
Exists when there is a brain tissue insult with transient alteration in mental status
concussion
Complex disorder in which various symptoms
Headaches, dizziness, concentration difficulties
Can last for weeks and sometimes months after the injury
Post-concussion syndrome
Lightheadedness, fatigue, nausea, numbness, ataxia, confusion, disorientation, hallucinations, HA’s
Generalized Hypoxia
cyanosis
local hypoxia
Neurological abnormality affecting muscle coordination and movements.
Non-specific manifestation of CNS dysfunction
Causes:
CVA, Tumors, MS, Hypothyroidism, Vitamin B-12 deficiency…
ataxia
Virus transmitted by arthropod vectors
Probably most common:
Ticks
Mosquitoes
Arbovirus
Named by their transmission-route through the intestine (enteric = intestinal)
Examples:
Polio, Hand-foot-mouth dz, Encephalitis, Pericarditis
Enterovirus
Eyesmove in the direction opposite to that of the head movement.
Positive/ normaldoll’s eyereflex
Eyesmove in the direction of the head movement
Negative doll’s eyereflex signifies severe brain damage or brain death
Four bacteria most commonly responsible for meningitis/encephalitis/brain abscesses
Strep pneumoniae (45-61%) Neisseria meningitides (13-16%) Haemophilus influenzae type B (5-7%) Listeria monocytogenes (2-4%)
Four bacteria most commonly responsible for meningitis/encephalitis/brain abscesses in infants <2months of age
Group B strep
MC to remember for Dr. Hatch for all ages is….
Strep pneumoniae
For Dr. Hatch, children less than three months with fever (101 rectal), no matter what…
they get a full work up and admission. Concerned for meningitis
ESP when no response to Tylenol and ibuprofen (10mg/kg)
brain abscess vs. meningitis/encephalitis…
brain abscess often does not have a fever
common causes of viral encephalitis and treatment
herpes simplex virus
arboviruses
treat with acyclovir
Empiric treatment of meningitis/encephalitis
ceftriaxone (rocephin)
risk factors of intracranial abscess includes…
endocarditis
congential heart disease
recent neurosurgery
inadequately treated subacute/chronic ear, nose, mastoid, dental infection
Prions cause what three neurodegenerative brain diseases
Creutzfeldt-Jakob
Fatal Familial Insomnia
Kuru disease
meningitis rash
purpuric rash that does not blanch
Posturing of meningitis
decerebrate (more severe and deadly)
decorticate (turn inwards towards core)
When you suspect ICP, perform ____ before an ___, due to prevention of ___.
When you suspect ICP, perform CT before an LP, due to prevention of brain herniation through relief of the ICP.
Check papilledema to see if there is swelling of optic disc - performed when you don’t have a CT. If present, NO LP!!
Common risks of LP’s
Post procedure headache - prevented by hydration (2L of normal saline) & after the procedure, do not allow the patient to sit up - keep them flat for an hour. Then sit up at 30degrees for one more hour. Then sit upright for another hour.
Acute inflammatory demyelinating polyradiculopathy
Considered an autoimmune disorder
Guillian-Barre Syndrome (GBS)
Most cases of GBS are preceded by an infection following…
Viral or febrile illness
Campylobacter jejuni
Vaccinations
Surgery / Trauma
Classic GBS generally preceded by viral prodromal sx’s, followed by acute / sub-acute ascending symmetric weakness or paralysis and loss of DTR’s
Guillian-Barre Syndrome (GBS)
Does Guillian-Barre Syndrome (GBS) affect diaphragm?
Yes - requires intubation/mechanical ventilation
When these conditions occur, consider GBS
- HIV peripheral neuropathy
- Neurotoxic fish/shellfish poisoning
- Spinal cord compression/syndromes
- Tick paralysis
- Vitamin deficiencies
- West Nile
For GBS, the LP should show…
elevated protein and low cell counts
Treatment for GBS
AIRWAY management
AVOID corticosteriods - may not be beneficial and can be harmful
Acute peripheral facial (Facial, CN VII) nerve palsy
Bell’s palsy
Bell’s palsy is difficult to dx due to resemblance of a…
stroke!
or Ramsay Hunt syndrome! (herpes zoster in the eye/CN 7 and 2)
Bell’s palsy common risk factors include…
Recent fever, viral infection, tooth extraction, chilling episode from cold exposure
Facial nerve paralysis associated with ipsilateral zoster
Vertigo and ipsilateral hearing loss (CN VII)
Tinnitus
Otalgia
Headaches
Fever
Cervical adenopathy
Ramsay Hunt Syndrome
Often times starts as blisters in the conchal bowl of the pinna
Cardinal sign of bell’s palsy that helps to distinguish between stroke and Ramsay Hunt
unable to raise eyebrows and furrow the forehead
If the patient can raise the eyebrow / wrinkle forehead
then it is NOT Bell’s Palsy!!
If unable to close affected eye =
If unable to close affected eye = Bell’s palsy
Difference b/w Bell’s Palsy and stroke…
Bell’s Palsy will not be able to wrinkle the forehead as all three divisions of the trigeminal nerve are affected.
Coma state is a…
spectrum. Ranges from awake/confused to frank/dense state of unresponsiveness.
Thiamine of coma cocktail
treats for alcohol intoxication
Glucose of coma cocktail
treats for diabetics
Narcan of coma cocktail
treats for opioid OD
Oxygen of coma cocktail
treats for hypoxia
Romazicon of coma cocktail
treats for benzos
Common age-related causes of Altered Mental Status and Coma:
Infant
infection
trauma
abuse
metabolic
Common age-related causes of Altered Mental Status and Coma:
Child
toxic ingestion
Common age-related causes of Altered Mental Status and Coma:
Adolescent, young adult
toxic ingestion
recreational drug use
trauma
Common age-related causes of Altered Mental Status and Coma:
elderly
med changes OTC meds infection (check skin, lungs, urine) alterations in living environment stroke trauma
Post concussion syndrome treatment for headaches
- amitriptyline
- propranolol
- neurontin
On CT, epidurals (arterial) are shaped like…
lemons
On CT, subdurals (venous) are shaped like…
bananas
Full comatose LOC followed by fully lucid interval with subsequent rapid neurological demise
epidural bleed
Progressive drop in LOC is likely a ___ bleed
Subdural bleed
Subdurals are common in…
elderly, alcoholics, children <2
