neutrotrauma Flashcards
what is a life threatening pathology
Brain herniation
what is a herniation
limited space - increased volume within the space - CSF displaced - changes in the cerebral blood flow/volume
compression of the flow of CSF can further increase ICP
what is Cushing Triad
elevated ICP = Hypertension, Bradycardia, Irregular breathing
what is it called when a patient reports with hypertension, bradycardia and irregular breathing
Cushing Triad
what is an uncal transtentorial herniation
most common
uncus of temporal lobe is pushing inferiorly
through the tentorium
most common due to compression of temporal and lateral middle fossa
*COMPRESS CNIII (OCULOMOTOR) CAUSING IPSILATERAL FIXED DILATED PUPIL
needs immediate surgery - or death
what is burr hole the treatment for
emergent release of uncontrolled bleed
what is central transentorial herniation
bilateral pinpoint pupils
typically with midline lesion (frontal or occipital)
Babinksi sign
increased tone
hyperventilation
decorticate posturing
what is decorticate posturing
arms flexed up and in and plantar flexion
first
what is decerebrate posturing
arms extended and wrist flexed and plantar flexion
second
what is Cerebellotonsilar herniation
cerebellar tonsils are pushing through the foramen magnum
pinpoint pupils
flaccid paralysis
death
what are the layers of the Dura
Scalp
skull
periosteal dura matter
meningeal dura matter
arachnoid mater
subarachnoid space
pia matter
cerebral cortex
what is an epidural hemorrhage
least common head bleed - most lethal
bleeding between skull and dura mater
most common in the temporal fossa
involves the middle meningeal artery
can result in herniation
what are the common symptoms of epidural hemorrhage
N/V
HA
Stupor/coma
ipsilateral CNIII palsy
contralateral hemiparesis
what is a subdural hemorrhage
most common traumatic intracranial mass
tearing of veins between the dura and arachnoid leading to collection of blood
often occurs in the elderly and ETOH abuse
may be acute, chronic or subacute
can cross suture lines
what is the presentation of subdural hematoma
headache
drowsiness
agitation
slowing of cognition
confusion
LOC
respiratory changes
pupillary dilation
visual field defects
faze palsy (compression of the CN)
what is a key presentation of an epidural bleed
lucid interval
what is a chronic subdural hematoma
develops over weeks to months
presents with symptoms of expanding mass - increased ICP
can compress vessels - alteration in cerebral blood flow
can lead to herniation
over time, vascular membrane will form around the hematoma but area of bleeding may continue to increase
what are intraparenchymal hematoma
bleeding within the tissue of the brain (not a dural space)
may have singular or multiple bleeds
most commonly in temporal or frontal lobes
may be from penetrating or shear trauma which break local vessels
what is diffuse axonal injury
clinical diagnosis initially after trama (often coup, countrecoup injury)
shearing injury of axonal fibers - reduces conduction - would see physical tearing with electron microscope
what are the types of diffuse axonal injury
mild coma: 6-24 hours
moderate: 24 hours without posturing
severe: >24 hours with brainstem impairment
What is a cerebral contusion
edema at area of contusion
may have no imaging abnormalities
can be severe enough to have significant edema noted on imaging
what is a secondary brain injury
initial insult leads to:
cerebral edema
increased ICP
decreased cerebral perfusion pressure
cerebral ischemia
disruption of the BBB and neuronal death
brain herniation
Where are autonomic motor nuclei located within the spinal cord
grey matter
what does the ventral root do
carry motor out of the cord
what does the doral root do
carries sensory information to the cord
what carries motor out of the cord
ventral/visceral efferent fibers
what carries sensory information to the cord
dorsal root - somatic afferent fibers
what is a complete spinal injury
traumatic disruption of the entire cord
insensate, areflexic and immobile distal to the site of the injury
what is an incomplete spinal cord syndrome
only a section of the cord has been injured
may not only be associated with trauma but also malignancy or other compressive pathology
Upper motor neurom defect
+ Babinski
hyperreflexia
NOT much atrophy
NO fasiculation/fibrillation
Spastic paralysis
Lower motor neuron defect
NO babinksi
hyporeflexia
fasciculationa nd fibriltation
atrophy
flaccid paralysis
what do patients with neurogenic shock present with
hypotension and bradycardia
what is neurogenic shock
disruption of the autonomic pathway (sympathetic and parasympathetic)
hemodynamic compromise
circulatory failure due to loss of vascular resistance - can lead to multiorgan failure and mortality
typically resolves in 24-48 hours
what is spinal shock
trauma to the cord itself leads to transient neurogenic upset
immediately after the cord injury patient will be areflexic and have flaccid paralysis
resolves within 24-72 hours
