Neurology Flashcards
What are some causes of Neurological Deterioration?
- Alcohol
- Epilepsy
- Insulin
- Opiates
- Uraemia
- Tumour
- Injury
- Psychiatric
- Stroke
- Sepsis
(AEIOU TIPSS)
What is Increased intra-cranial pressure (ICP)?
Occurs when there is an imbalance inside the cranium, following brain injury or other medical conditions that cause an increase in pressure inside the skull.
What are the main elements generating ICP?
Brain tissue, blood volume and cerebrospinal fluid (CSF)
What is the patho of raised ICP?
A rise in ICP greater than cerebral perfusion pressure, (CPP), results in reduced blood flow to the brain as vessels are squashed from the pressure
Reduced blood flow = reduced oxygen and glucose delivery which results cerebral ischaemia.
What is the Monro-Kellie Hypothesis?
States that the sum of volumes of brain, cerebrospinal fluid (CSF) and intracerebral blood is constant
An increase in one should cause a reciprocal decrease in either one or both remaining two
What is Cushings Triad?
- Rise in ICP greater than CPP causes reduced blood flow to the brain. Reduced blood flow means less O2/glucose delivery to tissue causing cerebral ischaemia.
- Cerebral ischaemia stimulates a sympathetic response (adrenaline release to increase BP & HR) in order to increase blood flow and therefore O2 delivery
- Parasympathetic response initiated by increase BP is detected by baroreceptors. This results in an attempt to reduce BP by decreeasing HR
- Ongoing increased BP causes further rise in ICP and further restriction of blood flow. A switch of aerobic cellular respiration to anaerobic respiration results in decreased ATP production for cellular function (cerebral ischaemia)
- Breakdown of Na+/K+ pump causes water to enter the cell, resulting in cell death. As cerebral oedema worsens, the brainstem is compressed causing irregular respirations before death is imminent
What are the early signs of raised ICP?
Confusion
Drowsiness
Headache
Forgetfulness
Limb weakness
Nausea
Photophobia
Diplopia
Oval pupils (from round)
Impaired extra-ocular movement
What are the late signs of raised ICP?
Projectile vomiting
Seizures
Fixed and dilated pupil/s
Loss of gag reflex
Abnormal flexion/extension of upper and lower limbs
Hypertension (widening pulse pressure)
Bradycardia
Irregular respiratory pattern
How would someone’s LOC be with raised ICP?
Drowsiness
Lethargy
Dizziness
How would someone’s speech be with raised ICP?
Slurred (dysarthria)
Delayed
Word finding difficulty (expressive/receptive dysphasia)
No speech (aphasia)
How would someone’s motor strength be with raised ICP?
Mild/mod/severe weakness
Hemiplegia (one sided arm/leg/face weakness)
Sensation changes
Swallowing difficulties (dysphagia)
Uncoordinated
How would someone’s behaviour be with raised ICP?
Disinhibition
Personality change
Emotional
How would someone’s pupils be with raised ICP?
Unequal
Sluggish
Oval
Pinpoint
How would someone’s cognition be with raised ICP?
Poor memory
Inability to sequence
Change in comprehension
Confusion
What are the two priority assessments you would preform to assess neurological function?
AVPU
GCS
