Week 3 & 4 Flashcards
glasgow coma score
Eye opening, verbal response, motor response; total score is 3-15
• Mild – 13-15 with negative CT/MRI findings
• Moderate – 9-12 or 13-15 with positive radiological findings (i.e. fracture)
• Severe – 3-8
1 mmHg PaCO2 increase CBF by ___
3%
1*C rise in temp increases CMRO2 (cerebral metabolic rate of O2) by ___
7%
does concussion cause structural abnormality
no
3 signs of basilar skull fracture
Raccoon’s eye – frontal fossa
Hemotympanum (blood in ear) – middle fossa
Battle’s sign (behind ear) – posterior fossa
subdural hematoma location
- Between arachnoid and dura mater; torn bridging veins;
* Needs urgent intervention
epidural hematoma location
focal injury of meningeal artery, often seen with skull fracture
above what ICP do you start treatment for cerebral edema
20 mmhg
CPP =
MAP - ICP
cushing triad
increased BP, decrease HR, decreased RR
uncal cerebral herniation
What is it
What does it cause
side of brain down into cerebellar area = CN3 palsy, contralateral motor deficit
subfalcine cerebral herniation
What is it
What does it cause
to other hemisphere – problems with ACA causing contralateral leg paresis
transcalvarial cerebral herniation
What is it
What does it cause
outside, skull fracture
usually lethal
diffuse axonal injury
result of traumatic shearing forces that occur when the head is rapidly accelerated or decelerated, as may occur in car accidents, falls, and assaults, often with loss of consciousness
risk factors for atheroma
HTN
smoking
diabetes
pathophysiology of small vessel disease
lipohyalinosis or microatheroma due to HTN
2 types of stroke
cerebral infarction / ischemic
hemorrhagic
hypotensive watershed stroke
period of hypotension (i.e. due to cardiac arrest) can lead to ischemia in two areas: between the middle and posterior cerebral arteries
intracranial venous thrombosis
blood clot in vein, from surgery, infection, tumor; results headaches, seizures, confusion, raised ICP
MCA stroke symptoms
arm and face weakness and sensory loss
language disorder if on dominant side
contralateral hemianopia
ACA stroke symptoms
leg predominant weakness
PCA stroke symptoms
vision - contralateral homonymous hemianopia
thalamic syndrome
locked in syndrome if basilar artery
lacunar stroke (5 symptoms)
pure motor hemiparesis ataxic hemiparesis clumsy hand pure sensory sensorimotor
pure motor hemiparesis
internal capsule lesion
face, arm and leg weakness
ataxic hemiparesis
motor hemiparesis with cerebellar ataxia on that side, could be lesion in posterior internal capsule, midbrain or pons
dysarthria clumsy hand
dysarthria with tongue and face weakness with hand clumsiness on the same side, basilar pons lesion
pure sensory
hemisensory loss of superficial sensation, usually from thalamic lesions
contraindications for thrombolysis in stroke
onset > 4.5 hours no motor deficit PMH of epilepsy or ICH recent LP, surgery or pregnancy BP > 185/110
what is the most common COD following stroke
ischemic heart disease
anterior circulation TIA
o Amaurosis fugax (fleeting blindness) – in one eye ‘like a shutter coming down’
o Aphasia, or other language problems such as dyslexia or dysgraphia
posterior circulation TIA
o Homonymous visual field loss (same side of both eyes)
o Brainstem symptoms: vertigo, diplopia, dysphagia
o Bilateral weakness or sensory loss
Subarachnoid Hemorrhage symptoms
o Sudden severe headache - ‘as if hit by a bat’
o Transient loss of consciousness and vomiting
o Neck stiffness
Subarachnoid Hemorrhage pathophysiology
rupture of an intracranial aneurysm into subarachnoid space that is usually full of CSF
Epidural hematoma shape on imaging
convex bulge
Subdural Hematoma on imagine
crescent shape that follows bumpy contours
rule of pupil
if pupil is dilated –> means aneurysm rupture
most common etiology of hemorrhage is _____ and occurs in _______
HTN
deep cerebral nuclei
