Exam 1 - CVA, Stroke, ICP Flashcards
(133 cards)
1
Q
Monro-Kellie Hypothesis
A
If one component of ICP increases, the volume of another component must decrease to compensate
2
Q
Compensatory mechanisms for increased ICP
A
Alter CSF volume
Alter blood volume
Alter brain tissue volume
3
Q
Common cause of IICP (increased ICP)
A
Brain edema
4
Q
Causes of brain edema
A
Space-occupying lesions
Cerebral infections
Vascular insult
Toxicity/encephalopathies
Hydrocephalus
5
Q
Space-occupying lesions (types)
A
Intracerebral hemorrhage
Epidural hemorrhage
Subdural hemorrhage
Tumor
Abscess
6
Q
Cerebral infections
A
Meningitis
Encephalitis
7
Q
Examples of vascular insult
A
Anoxic and ischemic episodes
Cerebral infarction (ischemic stroke)
8
Q
Toxic/metabolic encephalopathies
A
Lead or arsenic poisoning
Hepatic(liver)/uremic(kidney) encephalopathy
9
Q
Vasogenic cerebral edema
A
Changes in endothelial lining of cerebral capillaries allows leakage
10
Q
Causes of vasogenic cerebral edema
A
Brain tumors
Abscesses
Ingested toxins
11
Q
Cytotoxic cerebral edema
A
Disruption of cell membranes
- most often in gray matter
12
Q
What causes cytotoxic cerebral edema
A
Lesions
Trauma
Cerebral hypoxia
13
Q
Interstitial cerebral edema
A
Uncontrolled hydrocephalus causes CSF to leak into brain
14
Q
What causes death with cerebral edema
A
Edema -> IICP -> hypoxia -> further increased ICP and edema -> compression of brainstem and respiratory centers
15
Q
What is RAS responsible for
A
Reticular activating system
Sleep, wake, alertness
16
Q
Cushing’s triad
A
Classic sign of IICP
Elevated BP
Bradycardia
Widened pulse pressure
17
Q
Hypothalamus controls
A
Temperature
18
Q
Ocular signs of IICP
A
Dilation
Blurred vision
Diplopia
Abnormal eye movements
19
Q
Fixed unilateral pupil dilation may indicate
A
Brain herniation
20
Q
What causes blurred vision
A
Optic nerve compression
21
Q
What causes diplopia
A
Oculomotor nerve compression
22
Q
What motor function signs indicate IICP
A
Hemiparesis/hemiplagia
Decorticate or decerebrate posturing
Opisthotonus (spine arched)
23
Q
What causes projectile vomiting with IICP
A
Compression of chemoreceptor trigger zone (CTZ)
24
Q
Dx tests done for IICP
A
CT
MRI
EEG
PET
25
Gold standard for ICP monitoring
Ventriculostomy - also drains CSF
26
When is ICP monitoring indicated
GCS under 8
AND
abnormal CT/MRI findings
27
Normal ICP
10-15mmHg
28
Complications of IICP
Tentorial
Uncal
or
Cingulate herniation
29
Med tx for IICP
mannitol (25%)
Corticosteroids
Barbiturates
Antiepileptics
H2 blockers or PPI's
30
Why are H2 blockers and PPI's used for ICP
Prevent gastric ulcers and bleeding
- Stimulated vagus nerve increases gastric acid secretion (Cushing's ulcers)
31
Other tx for IICP
Hyperventilation therapy
Ventriculostomy - drains CSF
HOB above 30 degrees
Surgical decompression: for masses/tumors
Supplemental oxygen
32
Primary headache
Not caused by another medical condition
33
Examples of primary headaches
Tension
Migraine
Cluster
34
Examples of secondary headaches
Sinus infection
Neck injury
Stroke
35
Tension headache
Common
Band-like squeezing
Bilateral
36
Migraine
Recurring
Unilateral or bilateral
Associated with neuro/autonomic dysfunction (aura, prodrome, postdrome)
37
Most common type of migraine
Without aura
38
Cluster headache
Rare
Severe, sharp, stabbing pain around one eye
Occurs in clusters over weeks, months, then remission
39
Cause of migraine
Vascular, muscular, and biochemical factors
40
Cause of cluster headaches
Trigeminal nerve is implicated
41
Prodrome
Early symptoms
(before migraine)
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What symptoms can accompany cluster headaches
Swelling around eye
Lacrimation
Rhinitis
Constriction of pupil
Agitation/restlessness
43
Dx for headaches
No lab/test are routinely used
Dx based on hx and presentation
44
Tx for tension headaches
For symptoms:
NSAIDs
acetaminophen
aspirin
For prevention:
TCA's and anti-seizure meds
45
Tx for migraines
For symptoms:
NSAIDs
triptans
For prevention:
Beta blockers
Anti-seizure meds
Botox
46
Tx for cluster headaches
For symptoms:
100% oxygen
For prevention:
verapamil
lithium
ergotamine
divalproex
melatonin
anti-seizure meds
47
Seizure
Paroxysmal (sudden), uncontrolled electrical discharge of neurons in the brain
48
Epilepsy
Condition with spontaneously recurring seizures
49
What causes epilepsy
Underlying chronic condition
Change in astrocyte function
50
Common causes of seizures in children
Birth injury
Infection
Trauma
Genetics
51
Common causes of seizures in adults
Lesions (tumor, stroke)
Vascular disease
52
Generalized seizures
Involve both hemispheres
53
Types of generalized seizures
Tonic-clonic (grand mal)
Absence (petit mal)
Myoclonic
Atonic
Clonic
54
Tonic-clonic seizure
Grand mal
LOC
Tonic phase (stiff), clonic phase (jerking), then postictal phase (confusion)
55
Absence seizure
Petit mal
Brief LOC
Looks like daydreaming
56
Myoclonic seizure
Brief, sudden jerking movements
57
Atonic seizure
Sudden loss of muscle tone (drop attacks)
58
Tonic seizure
Sudden stiffening of muscles
59
Clonic seizure
Repetitive jerking movements
60
Focal (partial) seizures
Begin in a specific area of the brain
61
Simple focal seizure
**No LOC**
May involve motor, sensory, or psychic symptoms
62
Complex focal seizure
**Loss or alteration of consciousness**
May involve automatisms (involuntary, repetitive movements)
63
Dx imaging for seizures
EEG: for type and location
CT
MRI
Blood tests: rule out metabolic disorders
64
Tx for epilepsy
Anti-seizure drugs
Surgical intervention: temporal lobectomy
Vagal nerve stimulation: activate with magnet before seizure
Ketogenic diet
65
Frontal lobe deficit
Unilateral hemiplegia
Seizures
Memory deficit
Personality and judgement changes
66
Parietal lobe deficit
Speech problems
Unilateral neglect
Sensory loss
Apraxia (loss of purposeful movement)
67
Temporal lobe deficit
Few symptoms
Seizures
Dysphagia
Hallucinations
Auras
68
Occipital lobe deficit
Vision changes
Seizures
69
Brainstem deficit
Drowsiness
Vomiting
Facial weakness
Hearing loss
Dysphagia
Dsyarthria
70
Cerebellum deficits
Ataxia (lack of coordination)
71
Glucocorticoid effects on brain tumor symptoms
Improves neuro functioning
Decreases headache and nausea
Reduces vision problems
- reduces inflammation/edema
72
Why are glucocorticoids a controversy for brain tumors
Cushings syndrome with long term use
Immunocompromises pt
73
Location of posterior fossa tumor
Occipital area
74
Tx of hydrocephalus d/t tumor
Ventricular shunt
Drains CSF to decrease ICP
75
Complication of radiation after tumor removal and its tx
Cerebral edema and IICP
Tx: Corticosteroids
76
Signs of CSF leak
Clear drainage from nose or incision site
Headache
Neck pain
Dizziness
77
Signs of meningitis
Headache
Fever
Neck stiffness
Altered mental status
78
Intracerebral hemorrhage
Bleeding within the brain tissue itself
79
Subarachnoid hemorrhage
Bleeding within the middle meninge
80
Classic symptom of subarachnoid hemorrhage
"thunderclap", or worst headache of their life
81
Causes of intracerebral hemorrhage
**HTN**
Rupture of aneurysm
Trauma
Malformation
Anticoagulants
82
Causes of subarachnoid hemorrhage
Rupture of aneurysm
Arteriovenous malformation
Anticoagulants
83
Modifiable stroke risk factors
HTN
DM
HLD
Smoking/alcohol/drugs
Obesity/inactivity
AFib
Hormones or birth control pills (increases clotting)
84
Non-modifiable stroke risk factors
Age - 2x each decade after 55
Sex - men
Genetics/family history
African Americans, Hispanics, Asians (d/t HTN and DM)
Congenital/structural heart defects
Hx of TIA
85
FAST
Face drooping
Arm weakness
Speech difficulty
Time to call 911
- tPA within 3 hours for ischemic stroke
86
Transient ischemic attack (TIA)
Warning sign for future stroke
Symptoms for less than 1 hour
1/3 have stroke after TIA
87
Right-brain stroke sx
Hemiplegia on L side
L-sided neglect
Spatial-perceptual deficits
Deny/minimizes problems
Rapid performance, short attention span
Impulsive - safety
Impaired judgement
Impaired time concepts
88
Left-brain stroke sx
Hemiplegia on R side
Impaired speech
Impaired R/L discrimination
Slow, cautious
Aware of deficit - depression, anxiety
Impaired comprehension of language and math
89
Purpose of CT scan for strokes
ID type (ischemic vs hemorrhagic)
Shows tumors, edema, structural abnormalities
90
Purpose of MRI for strokes
Detects early ischemic strokes
More sensitive than CT
Shows brain damage, tumors
91
Purpose of CTA for strokes
(Computed tomography angiography)
Shows narrowed or blocked arteries
92
Purpose of MRA for strokes
Assesses blood vessels without dye
- Good for pt with kidney disease
93
Purpose of cerebral angiography for strokes
Gold standard
Detailed imaging of cerebral arteries, blockages, aneurysms, or malformations
94
Purpose of carotid doppler ultrasound with strokes
Assesses blood flow in carotid arteries
Shows atherosclerosis or narrowing/occlusion of carotid arteries
95
Purpose of lumbar puncture for strokes
Collects CSF to check for infections or bleeding
Shows subarachnoid hemorrhage, meningitis/encephalitis, IICP
96
Purpose of cardiac imaging with stroke
ECG
ID cardiac source of emboli
Shows Afib (embolic stroke risk)
97
When to use tPA
Ischemic stroke - confirmed with CT/MRI before giving
Within 3-4.5 hours of symptoms
98
Anticoagulant indications
Afib
Mechanical heart valve
Venous thromboembolism (VTE)
99
Antiplatelet indication
Hx of TIA or ischemic strokes
((Aspirin or Clopidogrel (Plavix))
100
Mechanical embolectomy
Removes clots from cerebral arteries for ischemic strokes when tPA is not effective
101
Merci Retriever device
Mechanical device used in thrombectomy in **cerebral arteries**
102
Carotid endarterectomy
Surgical removal of plaque in **carotid arteries** to prevent stroke d/t narrowed arteries
103
Carotid angioplasty and stenting
Widens narrowed carotid arteries with balloon and stent
104
When not to use antiplatelets or anticoagulants
Hemorrhagic stroke or before stroke type is identified with CT/MRI
105
Hemorrhagic stroke tx
Manage BP with IV antiHTN: labetalol, nicardipine, hydralazine
106
SAH tx
Aneurysm clipping/coiling
107
Decompressive craniectomy
For severe IICP d/t hemorrhage
Remove part of skull to allow brain to swell
Decreases risk of brain herniation
108
Surgical evacuation of hematoma
For large intracerebral hemorrhage
Remove hematoma to decrease ICP and improve brain function
109
Complications of SAH
Rebleeding
Vasospasm
Hydrocephalus
110
Rebleeding post SAH management
Aneurysm clip
BP control
Bed rest, minimal stimulation
111
Vasospasm post SAH management
Leads to cerebral ischemia
Triple H therapy:
**Hypertension (induced) - vasopressors**
Hypervolemia - IV fluids
Hemodilution - colloids, IV fluids
nimodipine - crosses BBB, vasodilator
112
How does hydrocephalus occur with SAH
Blood from SAH blocks CSF drainage, increasing ICP
113
Hydrocephalus post SAH management
External ventricular drain
Permanent ventriculoperitoneal (VP) shunt
Serial lumbar punctures
114
Hunt and Hess Grading scale for SAH
5 point grading system to predict severity and prognosis of SAH
115
Explanation of Hunt and Hess grades for SAH
Grade 1-2: best prognosis, can undergo early aneurysm repair
Grade 3-4: high risk for complications, aggressive management needed
Grade 5: Poor prognosis, often fatal
116
Damage to hypothalamus or pituitary gland can cause
Diabetes insipidus
- Brain structures are responsible for ADH
117
Supratentorial tumor location
Above tentorium cerebilli in the cerebral hemispheres
118
Types of supratentorial tumors
Gliomas
Meningiomas
Astrocytomas
Metastatic tumors
119
Posterior fossa tumor location
Affects cerebellum and brainstem
120
Types of posterior fossa tumors
Medulloblastomas
Ependymomas
Brainstem gliomas
Cerebellar astrocytomas
121
Pituitary adenoma symptoms
If nonfunctioning d/t compression = hypothyroid symptoms (Hashimoto's, fatigue, weight gian, cold intolerance, bradycardia)
TSH secreting adenoma = hyperthyroidism (Grave's, wt loss, heat intolerance, tachycardia, bulging eyes)
122
Supratentoral, posterior fossa, or pituitary tumor surgical tx
Craniotomy
123
First line tx for ischemic stroke
IV benzos -
lorazepam (Ativan)
diazepam (Valium)
midazolam (Versed)
124
Cerebellum location
Posterior
Above brainstem
125
Pituitary gland location
Behind nose
Below hypothalamus
126
Hypothalamus location
Below thalamus
Above pituitary
127
Cerebellum function
Coordination of movement and balance
*Ataxia
128
Hypothalamus function
Controls ANS (HR, BP)
Regulates homeostasis (temp, thirst, hunger, sleep)
Sends stimulating or inhibiting hormones to pituitary
- No ADH = DI
Regulates emotion and behavior
129
Open vs Closed ICU units
Open: Drs have other duties and consult specialists
Closed: Recommended; dedicated ICU team led by critical care dr
130
CAM-ICU
Confusion Assessment Method for ICU
Detects delirium
4 factors
131
RASS
Richmond Agitation-Sedation Scale
Measures LOC and agitation
-5 to +4
132
SAS
Sedation-Agitation Scale
Measures sedation and agitation (similar to RASS)
1-7
133
Displacement of brain tissue to the right hemisphere beneath the falx cerebri is
Cingulate herniation
