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Nursing Science 3 > WEEK 1 - Acute Cerebral Injury > Flashcards

WEEK 1 - Acute Cerebral Injury Flashcards

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1
Q

How much of cardiac output does the brain receive?

A

20% (800-1000mL)

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2
Q

Which gas is the primary regulator of cerebral blood flow?

A

CO2 (also controls pH)

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3
Q

Which three organ work together to ensure the brain has adequate blood flow all the time?

A

Brain, heart and lungs

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4
Q

What makes up cerebral blood flow (CBF)? (equation?)

A

CBF = CPP/CVR,
CPP - cerebral perfusion pressure
CVR - cerebral vascular resistance

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5
Q

What makes up vascular resistance? (3 parts)

A
  • Vessel diameter
  • Vessel length
  • Blood viscosity
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6
Q

What can CBF be affected by?

A
  • Metabolism - PaO2, PaCO2, pH
  • BP (cardiac function)
  • Blood viscosity
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7
Q

What is CBF autoregulation?

A

Brain’s intrinsic ability to maintain a constant CBF despite marked changes in systemic BP through vessel constriction and dilation

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8
Q

What are the parameters within which CBF aims to keep MAP?

A

60-140 mmHg

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9
Q

What is pulse pressure?

A

Recoil of an artery following the heart beat

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10
Q

Causes of acidosis?

A
  • Increased CO2
  • Decreased O2
  • Increased H+
  • Decreased pH
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11
Q

Causes of alkalosis?

A
  • Decreased CO2

- Increase of pH

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12
Q

Equation to form H+?

A

CO2 + H2O = H2CO3 (carbonic acid) = dissociates to form H+

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13
Q

Names of all the ventricles in the brain?

A

Lateral ventricles (left and right), third ventricle and fourth ventricle

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14
Q

What is contained in the ventricles and where is it made?

A

CSF in the ventricles

Made by the choroid plexus (lies in the lateral ventricles)

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15
Q

Describe the pathway CSF takes through the brain

A

Choroid plexus - lateral ventricles - interventricular foramen of Monro - 3rd ventricle - cerebral aqueduct - 4th ventricle - subarachnoid space - absorption via subarachnoid villi - venous blood

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16
Q

What is intracranial pressure (ICP?)

A

The pressure exerted by CSF that circulates around the brain and into the ventricles

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17
Q

What proportions of the cranial volume do CSF, blood and brain tissue make up?

A
  • CSF = 10%
  • Blood = 10%
  • Brain tissue = 80%
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18
Q

What is ICP determined by?

A

Changes in intracranial blood volume and changes in pressure exerted by CSF that circulates around the brain, spinal cord and ventricles

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19
Q

Why is ICP talked about as a RANGE of pressures and not as a single pressure?

A

Because ICP is in reference to atmospheric pressure = different areas of the brain vary in their pressures

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20
Q

What is the ICP reference range?

A

5-10 mmHg though 15 is considered the upper limit of the norm

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21
Q

What is a burr hole and when/why would this be used?

A

Burr hole - small hole drilled into the cranium

This would be used when ICP is elevated - holes help to relieve the pressure and let it out

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22
Q

What is the CPP of an adult?

A

80 mmHg

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23
Q

Equation for CPP?

A

CPP = MAP - ICP

24
Q

If the volume of one component of the cranium is increased, the others must decrease to compensate. What happens if this doesn’t occur?

A

Compliance of the brain is exhausted and ICP rises - also supercedes the ability of the brain to regulate CPP

25
Q

How does chronic hypertension change MAP?

A

resets the upper limit of MAP to 180-200 mmHg

26
Q

Name the three layers of the meninges?

A

Dura Mater
Arachnoid Mater
Pia Mater

27
Q

What is the role of the meninges?

A

Meninges help maintain CSF, allow for brain compliance within the skull and protect the brain

28
Q

What is the Monro-Kelli hypothesis

A

The cranium is a rigid structure, therefore the volumes that make up its contents must remain constant, otherwise an increase in one volume must be compensated by a reciprocal decrease in another

29
Q

In what context is cerebral oedema most common?

A

Inflammation of the brain

30
Q

What is cerebral oedema?

A

An increase of the fluid content of the brain, or an increase in the extra/intracellular fluid surrounding the brain

May be localised or generalised

31
Q

What is the most common form of cerebral oedema?

A

Vasogenic Oedema

32
Q

Clinical manifestations of vasogenic oedema?

A
  • Altered consciousness
  • Neurological deficits
  • ‘Tight brain’
33
Q

Describe the pathophysiology of vasogenic oedema?

A

Junctions between endothelial cells of capillaries and astrocyte feet become loose = allows fluid and plasma proteins to move out of the vessel and into extracellular spaces

34
Q

What is cerebral herniation?

A

Movement of brain matter during stage 4 ICHTN from an area of high pressure to an area of low pressure

Pressure on the herniated tissue increases with an increase in intra-cranial volume, leading to decreased blood flow to that tissue

35
Q

Neurological signs of early herniation?

A

Confusion, irritability, headache

36
Q

What is the tentorium?

A

Membranous cover within the cranium formed by the dura mater

37
Q

What type of herniation compresses the brain stem?

A

Uncal herniaton - hernation of the innermost portion of the temporal lobe or hippocampal gyrus downwards towards the tentorium due to expansion of one hemisphere

38
Q

What is central herniation?

A

Downward shift of the diecephalon down towards the mouth

39
Q

What is tonsilar herniation?

A

Herniation through the foramen magnum

40
Q

What three types of herniation have the potential to herniate through the eye cavities?

A
  1. Uncal
  2. Central
  3. Cingulate gyrus
41
Q

What drug is given for raised ICP (vasogenic oedema) and what is its mechanism of action?

A

Mannitol IV - draws water out of tissues and into the vascular system through increasing plasma osmolality

42
Q

What is the primary goal of treatment for a traumatic brain injury?

A

Prevention or minimisation of a secondary injury eg. oedema or heriation

43
Q

What is a contusion?

A

Bruising of the brain due to blood leakage as a result of small tears in blood vessels caused by blunt or penetrating trauma

44
Q

What determines the severity of a contusion?

A

The amount of energy or force transmitted by the skull to the brain tissue by trauma

45
Q

What is a haematoma?

A

A bleed in the brain where clots may form and impinge on brain tissue

When blood is not resorbed = irritation to the brain

46
Q

What is a subdural haematoma and how is it caused?

A

Bleeding of the brain between the dura and arachnoid mater.

Caused by the tearing of bridging veins located over the convexities of the brain, may be due to skull fracture (falls, alcohol abuse)

47
Q

What is an epidural haematoma and how is it caused?

A

Bleeding of the brain between the periosteum and the dura mater

Most are due to a tear in the middle meningeal artery, caused by MVAs, falls, sporting accidents

48
Q

What is an intracerebral haematoma?

A

Bleeding of the brain within the brain parenchyma

49
Q

Is it easier to predict outcomes for diffuse or focal brain injuries? Give a reason why

A

Focal - this is because focal injuries impact smaller areas of the brain

50
Q

What is a diffuse axonal injury?

A

Widespread axonal damage commonly associated with acceleration/deceleration causing stretching or tearing of nerve fibres

51
Q

What characterises a mild concussion?

A

Temporary axonal disturbance WITHOUT loss of consciousness

52
Q

What characterises a classic concussion?

A

Cerebral disconnection from the brainstem reticular system, causes IMMEDIATE loss of consciousness lasting for less than 6 hours

Causes altered RR, decreased BP and HR

53
Q

What is meningitis?

A

Infection and inflammation of most commonly the pia mater and arachnoid mater but can also affect the dura mater

54
Q

What are the risk factors for meningitis? (x4)

A

Age <5 and >60 years, immunosuppression, communal living, splenectomy

55
Q

What are the 4 known causes of meningitis?

A
  1. Bacteria
  2. Fungi
  3. Parasites
  4. Viruses
56
Q

What pharmacological treatment is used for meningitis?

A
  • Antibiotics - eg. benzylpenicillin, cephtriaxone, vancomycin, ampicillin
  • Dexamethosone

Nursing Science 3 (21 decks)

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