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Flashcards in Neuro #2 Deck (23):
1

3 types of subdural hematoma

Acute: symptomatic within 24 hours (children)
Subacute: symptomatic within 2-10 days
Chronic: symptomatic after 2 weeks (elderly - cerebral atrophy)

2

Epidural Hematoma

Bleeding between the skull and the dura mater.
-usually arterial (middle meningeal artery temporal region)
-cause Uncal herniation.
-results in ipsilateral pupil W contra lateral neuro deficits / posturing.

3

Define process that gives Uncal herniation findings.

Uncal herniation shifts brain down and away from where herniation is. If on R will shift brain down and to the L. Pinches L optic nerve.
-optic nerves come off the occipital lobe, supra-tentorial and come down through insecure, cross and connect to eyes.
-pinched all optic nerve crosses to R eye.
-R eye dilation w/ L sided neuro deficits.

4

Subdural Hematoma

Blood between the dura and arachnoid layers
-Usually venous in nature
-high morbidity & mortality
-can sneak up on you.
-3 types

5

Subarachnoid Hemorrhage

Bleeding between arachnoid membrane and the Pia Mater
Where CHF is = increases infection potential
Trauma is most common cause
Or Berri Aneurysm (secondary to HTN)

6

Subarachnoid Hemorrhage complaints

"worse headache of my life"
N/V, stiff neck, visual disturbances, ALOC
Commonly confused w/ meningitis (lumbar puncture issue)

7

Lumbar puncture considerations with subarachnoid hemorrhage.

Contraindicated id subarachnoid bleed is possible.
CSF pressures could tamponade bleed. LP can cause runaway hemorrhage. CT prior to LP

8

Intracerebral Hemorrhage

Hemorrhage in brain parenchyma
-produced by shearing and tensile forces
-white matter of frontal and temporal regions
-associated with contusions, subdural hematoma, DAI
-less common, delayed onset
-if enters ventricle, bleed will progress quickly.

9

Intraventricular Hemorrhage.

Bleeding into the ventricles as a result of severe brain trauma
-sheering forces
-high mortality rate
-usually found in temporal and frontal lobes.

10

Closed head injury: Mild Cuncussion

Results from rotational force.
Reversible with no persistent sequelae
Retrograde amnesia of short duration.

11

Closed head injury: Classic Concussion

Rotational or direct forces
Reversible with memory and info processing problems
Brief LOC, retrograde and post-traumatic amnesia

12

Closed head injury: Diffuse Axonal Injury (DAI)

-Diffuse shearing injury, rotational acceleration
-irreversible with profound neuro, psych and personality deficits
-usually coma, entire brain has taken insult and is swelling. Increased ICP, frequently fatal, survival correlates with long term disability, personality changes.

13

Linear skull fracture

A line that extends toward the base of the skull

14

Linear stellate skull fracture

Multiple fracture that radiate from the compressed area

15

Diastatic skull fracture

Involves a separation of the bones at a suture line or a marked separation of bone fragments.

16

Depressed skull fracture

May be closed or open.

17

Basilar skull fracture

Fracture of the base of the skull
-battle signs: bruising behind ear on mastoid bone
-peri orbital ecchymosis: raccoon eyes, around eyes
-otorrhea- bleeding from ear w/ CSF Leak
-Rhinorrhea- bleeding from nose w/ CSF LEAK.

18

Basilar skull fracture Early and late signs

Early: otorrhea, Rhinorrhea
Late: Battles and raccoon eyes.

19

Pneumocephalus

Air trapped in the skull
Boyles law will cause gas expansion / cerebral compression
Consider with deterioration immediately after ascent.

20

LeFort 1

Fx of maxilla

21

Lefort 2

Pyramidal fracture along sides of nose
-causes a pyramid shape
-separates off top of maxilla
-nose and top of mouth become free floating segments.

22

Lefort 3

Fracture runs through zigomas though zygomatic arches
-entire face from eyes down are free-floating

23

Lefort fractures
-most common symptom
-trigeminal nerve considerations

Most common symptom: epistaxis

Increased risk of trigeminal nerve injury, resulting in facial sensory overload and clenching of the jaw (trismus)