week 9 : Acute neurological disorders Flashcards
1
Q
Intracranial Regulation is closely linked to what?
A
perfusion
2
Q
Intracranial regulation is affected when there is :
A
impaired blood flow
damage brain tissue
compromised neurotransmission
impaired glucose regulation
3
Q
true or false. The brain cannot supply glucose, therefore it needs constant glucose?
A
this is true
4
Q
Brain is sensitive to a lot of things, recall what she said in the lecture that the brain i highly sensitive to ?
A
brain is sensitive to hypoglycemia, therefrore when u have prolonged hypoglycmia that causes injury of the nuerons, hyperglycemia is also damaging causing worsening brain injury
5
Q
Recall that compromised neurons causes intracranial regulation to be affected: define a type of attack that also causes compromised neurotransmission
A
seizures
6
Q
For the brain to have normal transmission of nerve impulses what does it require ?
A
requires fully functioning neurons, nerves. and neurotransmitters. Degenerative diseases such as parkinson disease, is an example where there is loss of neurons and loss of neurotransmitter ( dopamine )
7
Q
Recall that :
Intracranial regulation is affected when there is:
* Impaired blood flow
* Damage to brain tissue
* Compromised neurotransmission
* Impaired glucose regulation
when any of these situations occurs it can lead to ?
A
cerebral edema and/or increased intracranial pressure
8
Q
True or false. Cerebral edema always lead to high icp?
A
true
9
Q
initially when we are talking about neurological disorders, what are we talking about ?
A
intracranial pressure ( this is crucial )
10
Q
What type of structure is a skull ?
can the volume change within the skull ? if so why ? if not why ? what is a term for this ?
A
The skull is a rigid and protective covering of the brain.
The total volume cannot change. A change in 1 component requires a change in another.
This is termed “The Monro-Kellie doctrine.”
11
Q
How much percentage is the brain tissue consists? blood? cerebrospinal fluid ?
A
Brain Tissue = 78%
Blood = 12% Cerebrospinal Fluid = 10%
12
Q
what does normal brain function depends on ?
A
consistent supply blood ( for oxygen and nutrients/glucose)
brain relies on healthy heart and lungs for perfusion
13
Q
true or false. a fully functioning brain requires constant blood flow because this allow of oxygen and nutrients
A
true
14
Q
What happens when heart doesn’t work in terms of perfusion ?
if the lungs doesn’t work what happen in terms of delievery ?
A
if the heart doesnt work, we dont get enough perfusion to other organs
if the lungs doesn’t work we dont get enough adequate gas exchange and oxygen delivery to our tissues
15
Q
as the intracranial increases what happens to the cerebral perfusion?
A
it decreases
16
Q
true or false. you need supply of blood to the brain for adequate nutrients and oxygen
A
true
17
Q
what increases when u have brain trauma, infection?
A
you have increases in brain tissues, volume, and csf fluid
18
Q
Cerebral perfusion pressure: define it’s description
A
pressure needed to ensure adequate brain tissue perfusion
19
Q
what type of pressure undergoes cerebral perfusion pressure
A
CPP = MAP ( mean arterial pressure ) minus ICP ( intracranial pressure )
20
Q
define what MAP and ICP mean ?
A
MAP- what drives or pushes the blood to the brain
ICP - the force that compresses the arteries and keep the blood flow out
if the blood pressure too low - ischemic
too high- it’s limited
21
Q
what is the normal CPP ?
A
70-90 mmHg
22
Q
what is CPP largely affected by ?
A
blood pressure and intracranial pressure
23
Q
why does blood pressure and intracranial pressure highly affect CPP?
A
- Blood pressure (the lower the blood pressure, the lower cerebral blood flow will be)
- Intracranial pressure (the higher the intracranial pressure, the lower cerebral blood flow will be)
24
Q
true or false. auto regulation will begin to fail as CPP decreases to low
A
true
25
how is cerebral perfusion pressure regulated?
MAP (mean arterial pressure) minus ICP (intracranial pressure)
26
how must cpp be maintained?
must be maintained narrow limits to maintain cerebral blood flow
27
Intracranial pressure normal and increased? what are the values ?
Normal = 5-15 mmHg Increased ICP = > 20mmHg
28
compensatory mechanisms
CSF volume
Autoregulation
- cerebral vasocon. or vasodial. based on :
1) carbon dioxide ( PaC02)
2) oxygen ( Pa02 )
3) pH
29
why does our brain constrict or dilate as a compensatory mechanism ?
by dialating and constricting the brain ensure blood flow
it causes diameter of cerebral blood vessels to change in response to metabolic demands
30
what is the purpose of autoregulation? ( again, again just wanna emphi )
the purpose of auto regulation is to ensure that the brain receives a constant supply in order to meet the demand of the brain and maintain cerebral perfusion
31
would carbon dioxide dilate or constrict when being utilize in autoregulating? ( when there is an increase in PaC02)
an increase in carbon dioxide will relax smooth muscle ( therefore it will vasodilate ) cerebral blood vessels and increase blood flow
32
would oxygen dilate or constrict when being utilize in auto regulating?
results in cerebral vasodilation because we need more oxygen to the brain tissue, this will increase blood flow to the brain as 02 levels drop into brain there is a build up of lactic acid ,this increases hydrogen ions in the brain - becomes acidic meaning our pH will drop
33
what happens when pH drops ? would this constrict or dilate ?
the drop in pH will also lead to vasodilation as than attempt to increase cerebral blood flow to correct depletion of oxygen
34
true or false. Carbon Dioxide (PaC02): a decrease in this will cause constriction of the cerebral vessels and there will be decrease cerebral blood flow
this is true
35
if one component has to decreased amongst auto regulating, what happens to the csf?
the brain will reduce the csf production and absorption to accomodate changes in volume of blood of brain tissue
36
true or false.when our blood pressure goes really really low or really really high that ability to auto regulate goes out the door
true
37
what happens when someone goes on hypotension, and our auto regulation has fall out of place.
in severe hypotension a person is in shock and their blood pressure drops
that perfusion to the brain is not going to happen and they will become in that case going to go into cerebral ishcemia and the brain cells will die because they’re not getting enough blood pressure to bring volume to the brain
38
what happens during a hypertensive crisis, when auto regulation fails
hypertensive crisis , we’re having an over amount of pressure and actually going to cause an increase in ICP and that’s not good for the brain
- risk of having rupture and stroke
39
what concepts are included in electrical impulses?
* Sodium-Potassium Pump
* Membrane Resting Potential
* Action Potential
* Depolarization
* Repolarization
40
True or false : recall When pressure are outside the range of 60-150 mmHg, the blood vessels ability to auto regulate pressure through dilation and constriction is lost and cerebral perfusion is determined by blood pressure without auto regulation, in essence what can hypotension or hypertension result ?
thus, hypotension can result in severe cerebral ischemia and hypertension can result in stroke or rupture
41
what is moving from the presynaptic to the postsynaptic
neurotransmitters
42
Increased ICP : causes
brain tissue : tumor
abscess
cerebral edema ( several causes )
blood : intracranial hemorrhage
intracranial hematoma
csf : hydrocephalus
43
what do seizures do?
fixes the excitatory and conduction if we have too much excitatory happening
44
what are the two outcomes when a neurotransmitter crosses a synapse
depolarization or causes inhibiton of impulse
45
what value is elevated icp ?
above 20 mmHg
46
true or false: when neurotransmitter crosses a synapse - needs a electrical or chemical conduction
true
47
True or false. Increased csf fluid would be from hydocephalus and meningitis
true
48
true or false: unexcited neuron maintains the resting action potential
true
49
true or false. elevated ICP, will decrease our blood flow, which can lead to ischemia and infraction.
true
50
what are the two neurotransmitter? are they excitatory or inhibitory?
glutamate - excitatory
GABA, gamma-aminobutyric acid - inhibitory
BALANCE IS REQUIRED
51
what is seizure?
“abnormal, sudden, excessive, uncontrolled electrical discharge of neurons within the brain that may result in change in level of consciousness, motor, sensory ability, and behavior”
52
what is this describing: “abnormal, sudden, excessive, uncontrolled electrical discharge of neurons within the brain that may result in change in level of consciousness, motor, sensory ability, and behavior”
symptom of an underlying condition
seizures
53
true or false.
cerebral edema , regardless of the type it's always going to lead into problem.
true
54
what leads to an increase in brain size and it impacts perfusion and oxygenation to the brain
cerebral edema
55
pathogenesis unknown
seizures
56
chronic disorder in which repeated unprovoked seizure activity occurs. seizures at least 2 times in the last 24 hours
epilepsy
57
what are the risk factors? (age)
< 6 months old
Severe birth injury, congenital defects, infections
2-20 years old
Birth injury, infection, head injury, genetics
20-30 years old
Head injury, brain tumors, vascular disease
> 50 years old
Stroke, metastatic brain tumors
58
give the description for cerebral edema
increased fluid in intracellular or extracellular of brain tissue
59
is this true about seizures? metabolic changes that lead to seizures: These include hypoglycemia, hypoxia, alcohol electrolyte, imbalance, barbiturate
withdrawal, acidosis, dehydration and water intoxication, Water intoxication, dehydration, hypoglycemia and hypoxia. These all affect the brain cells
true
60
this can result in an increase in volume of brain tissue, leading o increases in ICP
cerebral edema
61
what are the 3 types of cerebral edema
vasogenic
cytotoxic
interstial
62
what leads to cerebral edema ?
neuro : ischemia, hemorrhage, hypoxia, brain trauma, infection, and hydrocephalus,
non neuro : HTN, hepatic encepalopathy ( liver failure )
63
what are the three broad categories of seizures?
generalized seizures
focal onset seizures
unclassified seizures
64
what is generalized seizures?
Affect both sides of the brain
* Include: tonic-clonic seizures, absence seizures, tonic seizures, clonic seizures, atonic seizures, and myoclonic seizures
* Because the entire brain is affected, there may be no warning signs or aura
* Often the patient loses consciousness for a few seconds to minutes
65
may be no warning signs, patient loses consciousness for few seconds to minutes
generalized seizures
66
tonic clonic seizures
aka grand mal, major motor seizures
* Patients may experience “auras”or warning signs before the seizure starts
* Characterized by loss of consciousness
* Lasts approximately 2-5 minutes
67
what is the most improtant type of cerebral edema ?
vasogenic
68
describe what vasogenic
causes by changes to permeability of capillary endothelium
allows for leakage of proteins into the extravascular
often caused by brain tumours, head trauma, abscesses
69
what is the tonic stage?
stiffening of the muscles (particularly arms and legs) for 10-20 seconds and then loss of consciousness
first stage - cyanotic of blue
70
where does vasogenic begin ?
begins in the area of injury and spreads with fluid accumulating in the white matter
71
what is the clonic phase?
Clonic phase- rhythmic jerking of extremities for 30-40 seconds
72
what is this describing: * Cyanosis, biting of the tongue and cheek, incontinence, and excessive salivation often occur
*Exhaustion, muscle soreness, and confusion can last for up to an hour after the seizure
tonic clonic seizure
73
True or false. Edema promotes more edema because of ischemia from increasing ICP ?
this is true, this falls under vasogenic
74
what are the clini mani of vasogenic ?
focal neurological deficits, changes in conciousness and severe increases in ICP
75
Give me a summary of what vasogenic is :
it makes ICP go up and when it goes up causes ischemia and that promotes ischemia and that promotes further edema
76
what's another word for cytotoxic
metabolic edema this is happening within the cells
77
how does cytotoxic edema develop
Develops from destructive lesions or trauma to brain tissue that causes tissue hypoxia
78
cytotoxic : define what happens when the cells begin to dysfunction ( due to hypoxia )
When cells begin to dysfunction (due to hypoxia), the sodium/potassium pump fails (causes cellular retention of sodium) leading to water moving into cells
79
true or false. Cytotoxic : this causes the cells to swell : the cells lose their K + and gain a lot of sodium
true
80
cytotoxic : Fluid shifts from extracellular space into cells causing swelling and loss of cellular function. True or false
true
81
recall that when cytotoxic edema happens : it develops from destructive lesions or trauma to brain tissue that causes tissue hypoxia. What does it directly affect ?
directly affect the cellular elements of the brain, parenchyma , and that causes failure of the active transport systems
82
true or false. Interstial edema : the brain fluid vl increases around the ventricles and that increases hydrostatic pressure
true
83
define the movement during interstitial edema
movement of the cerebral spinal fluid from the ventricles into the extracellular spaces of the brain tissues
84
where does interstial occurs ?
occurs in hydrocephalus when there is no obstruction preventing the outflow of cerebrospinal fluid within the ventricles
85
what does interstial edema create?
creates an increase in intraventricular pressure, elading to CSF leaking into the extracellular spcae
86
true or false. Interstial edema : the increased in fluid the brainn tissue is going to cause that high ICP and that’s going to affect your
oxygenation and blood flow to the brain tissue
true
87
true or false. cerebral edema results in an increase in tissue volume that carries the potential for increased icp
cerebral edema is classified as vasogenic, cytotoxic, or interstitial
true
88
name some causes of cerebral edema ( there is a lot ) so u can name 5
* Brain abscess
* Brain tumour or brain metastases
* Hematoma (intracerebral, subdural, epidural) * Hemorrhage (intracerebral, cerebellar, brainstem)
* Head injuries
89
select all that applies : causes of cerebral edema can be from the following
* Brain abscess
* Brain tumour or brain metastases
* Hematoma (intracerebral, subdural, epidural) * Hemorrhage (intracerebral, cerebellar, brainstem)
* Head injuries
* Hemorrhage
* Post-traumatic brain swelling
* Brain surgery
* Cerebral infections
* Meningitis
* Encephalitis
* Vascular insult
* Anoxic and ischemic episodes
* Cerebral infarction (thrombotic or embolic)
* Toxic or metabolic encephalopathic conditions
* Hepatic encephalopathy
true
90
cerebral edema is excess fluid in the brain which can only be caused by neurolgical cause
false, cerebral edema is excess fluid in the brain which can be both from neurological cause and a non neurolgical cause
91
brain hemorrhage , what are the different types?
* Epidural hemorrhage
* Subdural hematoma
* Subarachnoid hemorrhage
* Intracerebral hemorrhage
92
true or false. brain hemorrhage could also happen in someone who had a traumatic brain from accident , would be considered traumatic brain injury
true
93
high icp leads to what in the cerebral vessels ? and what about the blood flow
compressed vessels
decreased cerebral blood flow
94
the first stage of the response when we have brain hemorrhage is what ?
The first stage of the response involves the activation of the
sympathetic nervous system in response to this low flow. When we have low blood flow, our body tries to raise blood pressure
95
how does our body manage raise in blood pressure when we have brain hemmorhage : recall on what she said in the lecture
To manage that this causes
vasoconstriction and causes an elevation in blood pressure
96
when we have a raise in blood pressure due to brain hemorrhage : go ahead and explain the raise in blood pressure and what the attempt is behind this process
when the sympathetic nervous system kicks in, at this point you get
vasoconstriction in your whole body and that causes elevation in blood pressure.This is the body's attempts to restore the blood flow to the brain. This leads to a high cardiac output and a high blood pressure. You're going to see very high
systolic blood pressure. Once this occurs, we enter the second stage of Cushing's
triad.
97
do not answer the question*** just read through it to get the full picture of brain hemorrhage and the raise in blood pressure and the lowering of it in the process :
We know that high ICP leads to a compressed cerebral vessels and decreased
cerebral blood flow. The first stage of the response involves the activation of the
sympathetic nervous system in response to this low flow. When we have low blood
flow, our body tries to raise blood pressure. To manage that this causes
vasoconstriction and causes an elevation in blood pressure. Now at this point, I
should say that we talked about autoregulation already and that happens earlier on.
That's just something that happens normally in our body that we're auto regulating.
By the time the sympathetic nervous system kicks in for cushions, the person has
severe low flow to their brain is different. This is different than your
autoregulation. When the sympathetic nervous system kicks in, at this point you get
vasoconstriction in your whole body and that causes elevation in blood pressure.
This is the body's attempts to restore the blood flow to the brain. This leads to a
high cardiac output and a high blood pressure. You're going to see very high
systolic blood pressure. Once this occurs, we enter the second stage of Cushing's
triad. Baroreceptors.
Remember Man that was back in 2,500 Those are in our aortic arch. And they sense
the increase in blood pressure and this initiates the parasympathetic nervous
system to kick in and lower our heart rate because our body is going, man, we have
a good cardiac output. We have good blood pressure, we're fine. Why are we running
our blood pressure so high? Why is our heart rate so high? We need to slow down.
This is too much work. The result of the parasympathetic nervous system triggering
is bradycardia, so we get a low heart rate. That's the second part of the triad.
And then as ICP worsens, the pressure on the brainstem increases. And this is where
the third stage or the third part of the triad comes in. We know that brainstem
controls breathing, and this leads to an irregular respiratory pattern and periods
of apnea. Apnea, that means not breathing. This is the third and final stage of
cushings. Person may have changes in body temperature as well as a result of the
compression of the hypothalamus
THANK YEW
98
consequences of an increased icp
cerebral edema
compression of brain vessels, tissues, ventricles
decreased blood flow
tissue hypoxia
death of brain cells
acidosis
impaired autoregulation
brain stem compression
brain herniation
99
give the pathophysiology map of insult to the brain ( brain damage ): ** do not need to actually answer, just get the understanding **:
insult in the brain
tissue edema
increase in ICP
compression of ventricles
compression of blood vessels
decrease blood flow
decrease 02 with death of brain cells
edema around necrotic tissue
increase ICP with compression of brain stem and respiratory centre
accumulation of C02
vasodilation
increased icp resulting from increased Blood Volume
death
100
what is a tonic or clonic seizures?
one or the other, Tonic Seizure - abrupt increase in muscle tone or rigidity, loss of consciousness,
and autonomic changes lasting from 30 seconds to several minutes
Clonic Seizure - last several minutes and cause muscle contraction and relaxation
101
what is this describing? last several minutes and cause muscle contraction and relaxation
clonic seizure
102
what is this describing: abrupt increase in muscle tone or rigidity, loss of consciousness,
and autonomic changes lasting from 30 seconds to several minutes
tonic seizures
103
absence seizures, what is it?
Person is blank and unresponsive for 5-10 seconds
* Can occur up to hundreds of times per day
* Cause sudden staring with impaired consciousness
104
what is this: appears like they are staring into space, stop talking in a middle of sentence, may show fluttering eyelids, walk around aimlessly
absence seizures
105
often right after waking up or right after going to bed, drop things due to jerking or stiffening of extremities
myoclonic seizures
106
Brief jerking or stiffening of extremities ?
myoclonic seizures
107
what are some seizure triggers?
stress, lack of sleep
* Strong emotions
* Intense exercise
* Loud music
* Flashing lights
* Fever
* Menstrual period
* Lack of sleep
* Pregnancy
* Alcohol intoxication or withdrawal
108
akinetic seizures, drop seizures - sudden loss of muscle tone (lasting for seconds), followed by postical confusion
atonic seizures
109
what often leads to falls?
atonic seizures
110
what is this describing: Caused by electrical activity in a focal part of the brain * Manifestations will be unilateral, affecting the area of the brain with abnormal excitation * They may begin as focal seizures and eventually convert into the entire brain being involved
focal onset seizure, partial seizures
111
what are the motor, sensory, autonomic and emotional psychic aspect of focal aware seizure
* Motor! affect muscles (rhythmic movements, twitching, jerking)
* Sensory! affect sense (tingling, numbness, sounds, smells, tastes, visual distortions)
* Autonomic! affect autonomically controlled functions (abdominal discomfort, stomach pain, belching, vomiting, flushing, change in heart rate, epigastric discomfort, pallor, sweating, pupil dilation, urination, sexual arousal in some cases)
* Emotional and Psychic! affect feelings or thoughts (hallucinations, deja vu, fear, anxiety, sadness, anger, joy)
112
aka simple partial seizures, does not cause LOC, person is aware and can talk, * Can also be considered “auras”before a more serious seizure
* Usually lasts less than a minute
Focal Aware Seizures
113
what are some consequences of seizures?
* Aspiration
*Impaired gas exchange
* Injury
*Quality of life
*Mental health! depression, anxiety
114
what is status epilepticus?
State of continuous seizure activity for more than 5 minutes or repeated seizures over 30 minutes
* Seizures occur in rapid succession
* Medical Emergency!!!
* Brain is in a hypermetabolic state – demand is greater than supply which can lead to hypoxemia, acidosis, hyperthermia, respiratory failure, and cardiac arrest
* Can also cause muscle to break down causing myoglobin accumulation in kidneys, leading to renal failure (rhabdomyolysis)
115
brain herniation : true or false. This is essentially the shifting of the brain tissue from one space in the space in the brain to another various openings.
true
116
what is brain herniation basically ?
this is essentially the shifting of brain tissue from one space in the space in the brain to another various openings.
117
what would brain herniation be ?
emerg
118
what are the clinical manifestations of increased icp
change in level of conciousness , ocular signs, changes in vital signs, decrease in motor function
headache, vomitting, seizures
119
what would u look for in terms of level of conciousness? when they have increased in ICP
look for behvioural changes such as restlessness, irritability, disorientation as early inidicators of change
120
Level of Consciousness
what are u looking for ?
* Early sign of increased ICP
* Related to decrease in cerebral blood flow
* Affects brain stem→specifically RAS
* Can lead to coma state if unrelieved
121
define if the following is true in terms of level of conciousness, and the things u will look for ? :
how alert someone is
decreasing cerebral blood flow
ras must be intanct
deepest state of unciousness
this is the first sign of the neurological status- changes in LOC
true
122
Lasts 1-3 minutes
* Does not involve convulsions
* Automatism behaviors
* Impairs awareness or consciousness ! person may not be able to speak
* After the seizure may have amnesia (loss of memory)
* Often originate in the temporal lobe
* Person will stop, have a blank stare, and will appear dazed
what is this?
Focal Impaired Awareness Seizures
123
Also called “complex partial seizures,” “focal dyscognitive seizures” or “psychomotor seizures”
Focal Impaired Awareness Seizures
124
wat is this describing: The individual may do the following behaviors:
* Chewing movements
* Uncoordinated activity
* Random, clumsy actions
* Walking aimlessly
* Picking things up
* Mumbling
* Picking at their clothes
Focal Impaired Awareness Seizures
125
what are automatisms ?
semi coordinated, repetitive motor activities that are associated with impaired awareness and occur in both focal and generalized seizures
126
first stage of seizures?
The first stage is called the Prodrome phase, and this can occur days to hours before a seizure. Not everyone will have this warning or this stage. But it's generally characterized by changes in mood, anxiety, difficulty sleeping, difficulty focusing, behavioral changes, and sometimes feeling lightheaded or dizzy.
127
This is the recovery after the seizure. People might feel confused, exhausted, extremely tired. They sometimes have headaches, experience fear and anxiety, and experience sore muscles and weakness throughout their body. They may also experience shame and be left with injuries from the seizure. Some people will remember their seizures and others do not.
poetictal phase
128
what stage is this: wide range of clinical manifestations for this, depending on the type of seizure, loss of awareness, confusion, difficulty hearing odd smells, tastes and sounds, Difficulty speaking or saying words, twitching, loss of muscle control, Repeated movements like lip smacking or chewing body convulsions, increased heart rate, and difficulty breathing.
Ictal Phase
129
early part, symptoms are warnign signs, nausea headache, smell weird things, dizzy panic and fear
Aura Phase, second phase
130
what are some ocular signs u could look out for when suspecting abnormal ICP
compression of oculomotor nerve cranial nerve 3 )
sluggish or no pupil constriction to light
unilateral or bilateral
ptosis
131
how do cranial nerves exit ? and how does this affect the brain stem when it has high icp
cranial nerves exist at the top of the brain stem - it becomes compressed when someone has a high icp
132
occulumotor has sensory and motor therefore what is it responsible for ?
responsible for light ( wanna test if it's reactive )
133
what is the latest sign of high icp when it comes to ocular signs ?
sluggish or no pupil constriction to light
134
true or false. When suspecting to a high ICP and ur vital signs have changed tremendously, it is not a good sign this mean u are reaching herniation.
true
135
vital signs ; name the characteristics that undergoes this section when talking abt high ICP
* Late sign of intracranial pressure
* Cushing's Triad
* Increased blood pressure (wide pulse pressure)
* Decreased heart rate
* Irregular respiratory rate, periods of
apnea→Cheyne Stokes
*Changes in temperature
136
true or false, cushings triad is a protective mechanism ?
yes this is true
137
what is another term we use to call " cushing triad" * she may use this in the exam
cushing reflex
138
What does HBB stand for ** hint we are talking abt cushing triad
hypertension ( contrict of that vessels )
bradycardia
bradyapnea
139
true or false. cushing triad is a set of a three primary signs that often indcate increase in intracranial pressure
true
140
true or false. Cushings tirad is an important, but early signs of raised ICP, therefore early intervention is a must.
false. it is a late sign of ICP, we must look for patients who recently had brain injury/damage if they have altered LOC
141
if the high icp is related to an injury or a lesion on one side of the brain
for ex: big hetoma or a pooling of blood on one side of the brain- this would manifest as motor changes on the opposite side of the body contralateral ( the opp. side of where the brain insult was ). true or false
true
142
decreased motor function is seen when high icp is ocuring, name what could occur?
* Contralateral hemiparesis or hemiplegia
* Decorticate Posturing
*Decerebrate Posturing
143
what is contralateral hemiparesis or hemiplegia
weakness on one side of the body - opposite side of the injury - hemiparesis
paralysis on one side of the body- opposite side of injury- hemiplegia
144
which one is worst ?* Decorticate Posturing * Decerebrate Posturing
decerebrate
145
what does decorticate indicate that there is a damage of ?
sign that damage has occured to the cerebral hemispheres, the thalamus and the mid brai
less severe compared to decebrate
146
what does decerebrate indicate a damage of ?
brain stem damage
pressure is compressing and reaching herniation ( pushing it down )
147
why does headache occur when there is an increase of ICP
*Caused by compression of vessels and nerves in the brain
* Described as continuous
* Aggravatedbymovingand
straining
148
how does pt usually describe headache as when there is an increase of ICP? how does it get aggravated
Described as continuous
*Aggravated by moving and
straining
149
why does vomiting occur when there is an increase of ICP
* Usually occurs without nausea
* Related to direct pressure on vomiting
center (Medulla)
* Projectile
150
true or false, High ICps usually causes vomiting without nausea
true
151
bacterial meningitis is what ?
acute inflammation of the meninges ( pia mater, arachnoid mater, and dura mater )
152
who is most affected ( typically what age do we see this ) bacterial meningitis occur ?
occurs in infants, adults, and high risk populations
153
when is bacterial meningitis usually prevalent
more prevalent in winter or spring - secondary to viral respiratory diseases
154
what are the most common meningitis
Pneumococcus meningitis and meningococcal meningitis are the most common
155
massive inflammatory responds leads to what during bacterial meningitis ?
cerebral edema
156
clinical manifestations of bacterial meningitis
* Fever
* Severe headache
* Nausea
* Vomiting
* Nuchal Rigidity
* Positive Kernig Sign
* Photophobia
* Decreased LOC
* Cranial Nerve Dysfunction
* Hemiplegia, Hemiparesis, aphasia
* Signs of Increased ICP
157
what type of streptoccocci that can cause bacterial meningitis for infants
Group B streptococci
158
true or false. Influenza vaccine has significanty reduced meningitis linked to the organisms that causes most bacterial mengitis Group A streptoccocci
false, it is group B
159
pneumococci are inhaled and attached to the epithelial cells in the nasopharynx, and then they cross mucosal barriers in which enter the blood stream, and travel to the cerebral blood vessels and cross the BBB- the bacteria will then infect the meninges. true or false
true
160
what happens when the bacteria enter the CNs ?
there's a massive cascade of events neutrophils are subachnoid space, the release of cytotoxic inflammatory agents change the permeability - causes cerebral edema
161
how does bacteria reach these meninges , knowing the fact it has 3 protective layers
bacteria can enter the CNs through the upper respiratory tract and blood stream, they can also directly enter the brain through skull fractures, or penetrating wounds
162
true or false. bacterial meningitis can be caused by infection, bacteria, or other mechanisms.
true
163
CSF becomes thick with exudate
exudate is rich in protein and cells , it will be increased in the areas of inflammation and infection
the thickness of the exudate interferes with the normal CSF flow around the brain and spinal cord = lead to csf obstruction and hydrocephalus
this is true
164
is fever, tachy, and chills apart of clini mani of meningitis ?
yes it is
165
what is nuchal ridigity ?
Resistance of the extensor muscles of the neck to being bent forwards (i.e., impaired neck flexion) a
166
what is positive kernig sign ?
The appearance of resistance or pain during extension of the patient's knees beyond 135 degrees
167
what is brudzinki's sign ?
Reflex flexion of the patient's hips and knees after passive flexion of the neck
