X Neuro: Trauma/SCI/BrainAbcess (Ms Si) Flashcards
(119 cards)
1
Q
2nd most common cause of neuro injury
A
Craniocerebral Trauma:
head injury, falls, motor cycle/car acc, assault, sports
2
Q
Craniocerebral Trauma
A
- involves scalp, skull, brain tissue
- minor - severe
- obvious damage NOT EQUAL to severity
- Blood NOT EAUAL to severity
3
Q
Head Injury classifications
A
- open (penetration, object thru skull into brain)
- closed (no penetration)
- direct trauma (bat to head)
- indirect trauma
4
Q
Closed Head injuries
A
- coup-contrecoup phenomenon (acceleration/deceleration, direct/indirect, head hit in front and whiplash back hits back of brain)
- concussion
- contusion
5
Q
Concussion
A
-brain injury fro head impact
-mild - severe
SS: confusion, dazed, amnesia, possible unconsciousness
-NO bleeding
6
Q
Contusion
A
- brain bruise
- CAUSE: damaged/broken bv d/t blunt force
- SS: confused, tired, agitted, mem loss, attention probs, motor coor probs
7
Q
Other Skull Injuries
A
- skull fx
- scalp lacerations
- hematomas (a solid swelling of clotted blood within the tissues)
8
Q
Skull Fx
A
- linear (fracture in shape of line, parallel to bones’ long axis)
- comminuted
- depressed (crushed/caved inwards)
- compound/open (penetrate skull/brain)
- basilar (base of skull)
9
Q
Basilar Skull Fx
A
- at base of skull
- fx line can extend into sinus’ (bacteria access to brain)
- -> leakage of CSF or blood from nose/ears
SS: Battle’s sign, periorbital ecchymosis, CSF rhinorrhoea (mucous filled nose, runny nose) /otorrhoea (ear infection middle ear)
10
Q
CSF Halo
A
- put CSF on filter paper
- blood draws to center
- then yellow outer ring (CSF)
11
Q
Beta-2 Transferrine test
A
looks @ specific protein only found in CSF
12
Q
Battle’s Sign
A
bruising or ecchymosis over mastoid process
13
Q
Periorbital Ecchymosis
A
- w nose break or after Sx
- basilar skull fracture
- Raccoon eye/eyes or periorbital ecchymosis is a sign of basal skull fracture or subgaleal hematoma, a craniotomy that ruptured the meninges,
14
Q
Laceration
A
Cut
15
Q
Hematoma
A
accumulation of blood
16
Q
Type of Hematomas
A
- Epidural: btwn skull/dura mater
- Subdural: btwn dura mater/arachnoid
- Subarachnoid: subarachnoid space
17
Q
3 components of the Cranium
A
blood, CSF, brain
when 1 component not in balance, alters pressure –> IICP
18
Q
Subdural Hematoma
A
btwn dura mater/arachnoid
CAUSE: head trauma, anticoagulant therapy
TYPES: acute, subacute, chronic
RISK: elderly on warfarin
19
Q
SS of Craniocerebral Trauma
A
- HA, N, V
- bleeding from any orifice (ears/nose)
- loss of consciousness
- Chang in size and reactivity of pupils
- change in orientation
- change in motor
- battle sign (bruise behind ear)
- abnormal speech
20
Q
Craniocerebral Trauma: Dx Tests
A
- Med Hx, what injury sustained
- head CT, MRI
- PET
- EEG (brain activity)
21
Q
Craniocerebral Trauma: Rx
A
- airway mgmt
- LO cerebral edema (Mannitol, osmotic diuretic)
- MED: Analgesics (pain, narcotics should e avoided because pt needs to be conscious an oriented. won’t be able to monitor LOC. are changes due to narcotic or IICP?
- MED: Anticonvulsants (seizures)
- Craniotomy/Burr Holes
22
Q
Complications of Head Injury
A
- IICP
- Cerebral Edema
- Diffuse Axonal Injury (DAI, tearing of axons)
23
Q
Normal ICP
A
5 - 15 mmg
24
Q
How many vertebrates?
A
26 Vertebrates
Cervical - 7 Thoracic - 12 Lumbar - 5 Sacral - 1 Coccyx - 1
25
How many spinal nerves?
```
31 - spinal nerves
8 pair - Cervical Spinal Nerves
12 pail - Thoracic
5 pair - Lumbar
5 pair - Sacral
1 pair - Coccyx
```
26
parts of the Vertebrae, Opening
Vertebral Body, Vertebral Arch, Vertebral Foramen
27
Spinal Cord
- connected to brain stem (medulla oblongata)
- diameter of a thumb
- 17" long
- extends from Foramen Magnum to L1
28
Spinal Cord makeup
- Grey matter surrounding white (myelinated) matter
| - ascending and descending tracts
29
Grey Matter
- cell bodies, axons, dedrites
| - signals generated and processed
30
White Matter
- myelinated axons
| - transmits signals
31
Location of Cervical, Thoracic, Lumbar/Sacral nerves
neck, upper back, lower back
32
Spinal Cord Injury (SCI)
- damage to any part of the spinal cord or to the nerves and end of spinal canal.
- often causes perm changes in strength, mvmt, sensation and other body fx BELOW site of injury
- 16-30
- Males 81.2%, 89.8% sports related
33
SCI: Causes
Trauma (car accident, falls, assault, sports), CA, Disease (osteoporosis, compression, fractures, cerebral column collapse)
- more common MALES
- ETOH involve in 25% SCIs
- MotorVeh 46%, Falls 22%, Violence 16%, Sports 12%
34
Leading Cause of SCI's
- Both Genders, car acc/falls/gunshots
- Males, driving acc, Motorcycle
- Females, med/surg complications, Driving Acc
- MVA, 65 and younger
- Falls, 65 and older
- Sports/Rec, under 29yrs
35
SCI Classification
- Complete Cord Injury, no fx below level of injury
| - Incomplete Cord Injury, some fx below level of injury
36
SCI Classification...more
- Class A, Complete Injury
- Class B, Incomplete w preserved sensation only
- Class C, Incomplete w non useful motor fx
- Class D, Incomplete w useful motor fx
- Class E, Complete recovery
37
Level of Injury Fx
- C1-C3: no resp fx, usually fatal
- C4: tetraplegia, loss of diaphragm mvmt (quad, ventilator)
- C6-C8: paraplegia
- T11 and below: lose bowel, bladder and sex fx
38
High Cervical Nerves (C1-C4)
- most SEVERE
- paralysis in arms, hands, trunk, legs
- may not be able to breath, cough or control bowel/bladder
- ability to speak maybe impaired
- all 4 limbs affected (Quad)
- require assistance w ADLs
- may be able to use powered wheelchair
- CAN NOT drive car on own
- 24hrs personal care
39
Low Cervical Nerves (C5-C8)
- corresponding nerves control arms and hands
- may be able to breath and speak on own/normally
C5 Injury
- Peron can raise arms/legs, bend elbows
- partial or total paralysis of wrists, hands, trunk, legs
- can speak and use diaphragm, weak breathing
- will need assistance w most ADLs, but can move w power WC.
40
C6 Injury
- nerves affect wrist extension
- paralysis in hands, trunk, legs typically
- should be able to bend wrists back
- can speak and use diaphragm, weak breathing
- can move in and out of WC and bed w asstv equip
- may be able to drive adapted vehicle
- little or no voluntary control of bowel/bladder, but able to manage w special equip
41
C7 injury
- nerves control elbow extension, some finger extension
- can straighten arm, normal mvmt of shoulder
- can do most ADLs, may need asst for diff tasks
- maybe drive
- -little or no voluntary control of bowel/bladder, but able to manage w special equip
42
C8 injury
- nerves control some hand mvmt
- should be able to grasp/release objects
- most ADLs, asst for more diff tasks
- maybe drive
- little or no voluntary control of bowel/bladder, but able to manage w special equip
43
Thoracic (T1-T5)
- affect muscles, upper chest, mid back, abd muscles
- arms/hand normal fx
- affect legs (paraplegic)
- manual wc
- can drive modified car
- stand in frame, walk w brace
44
Thoracic (T6-T12)
- affect trunk muscles (abd, back)
- normal upper body mvmt
- paraplegia
- fair/good control/balance trunk in seated position
- cough productively (if abd muscles intact)
- little/no bowel/bladder, manage w equip
- manual wc
- drive modified car
- stand in frame, walk w brace
45
Lumbar (L1-L5)
- loss of hip/leg fx
- little/no bowel/bladder, manage w equip
- wc or braces
46
Sacral (S1-S5)
- loss of hip/leg fx
- little/no bowel/bladder, manage w equip
- can walk
47
C4 - tetra (neck down)
C6 - tetra (chest down)
T6 - para (abdomen down)
L1 - para (legs down)
C4 - tetra (neck down)
C6 - tetra (chest down)
T6 - para (abdomen down)
L1 - para (legs down)
48
SCI: Dx tests
- Chest xray (cervical)
- CT scan
- MRI
- Myelography - contrast w xray (not used much anymore)
49
Types of Vertebral Column Injuries
- Compression Fx
- Burst Fx
- Vertebrae dislocation
50
Vertebral Column Injuries: Compression Fx
bone tissue of vertebral body collapses (osteoperosis)
51
Vertebral Column Injuries: Burst Fx
vertebra crushed in all directions (shattered)
52
Vertebral Column Injuries: Dislocation
- ligaments torn or stretched from injury
| - vertebrae lock over eachother
53
Complications of SCI
- spinal shock
- autonomic dysreflexia
- muscle spasms
- orthostatic hypotension
- DVT
- infection
- skin breakdown (ulcers)
- renal complications (UTI, stones)
54
Comp of SCI: Spinal Shock
- 30-60min after SCI, lasts 4-6wks
- no transmission of signals
- loss of motor and autonomic fx (sympathetic, para, VS, resp, BP, HR)
SS:
.Bradycardia
.Hypotension
.Labile VS
GOAL: to maintain BP, HR
55
CNS includes
- brain
| - spinal cord
56
Peripheral Nervous System
- Somatic nervous system
| - Autonomic nervous system
57
Somatic Nervous System (voluntary)
sends messages form CNS to skeletal muscles (voluntary)
(i. e. walking)
- Spinal Nerves: 31 pairs (Afferent, sensory /Efferent, motor)
- Cranial Nerves: 12 pair, (conduct impulses btwn head/neck/brn), back of brain, brain stem. (Nerve X, Vegus brings impuls to Thoracic/abdominal, unlike the rest)
58
Autonomic Nervous System
| involuntary, automatic
sends messages from CNS to smooth muscle, cardiac muscle and certain glands (involuntary, unconscious i.e. heart beat, breathing)
- Sympathetic NS
- Parasympathetic NS
59
Comp of SCI: Autonomic Dysreflexia (Hyperreflexia)
- over activity of ANS --> leads to abrupt onset of hypertensive crisis
- injuries at or higher than T6
- common cause: overfilled bladder
- stimulus sends new impulse to brain which is blocked d/t SCI
- a reflex is activated, UP Symathectic NS, UP BP
60
Comp of SCI: Autonomic Dysreflexia: Triggers
- full bladder
- constipation
- menstrual cramps
- ingrown toenails
- wrinkles in sheets
- sex activity
- insert supp/enema
61
Comp of SCI: Autonomic Dysreflexia: SS
- severe HTN (>200/100)
- dilated pupils
- bradycardia (brain counteracts UP BP by LO HR)
- flushing (above injury)
- diaphoresis
- goose bumps
- nasal congestion
this pt can not sense any stimulus, so HTN as body reacts to all stimuli
62
Comp of SCI: Autonomic Dysreflexia: Prevention (NI)
- prevent stimuli
- pressure relief
- freq skin asses
- bowel program to prevent constipation
- adequate fluid intake
- compliance w MEDS
- indwelling catheter (keep tubing patent, drain bags empty to prevent urine backflow)
63
Comp of SCI: Autonomic Dysreflexia: MM
- Immobilize head/neck (collar, backboard, halo traction)
- stabilitze breathing, BP
- Methyprednisolone: w/in 8hrs of injury. better outcome
- Halo Traction: For cervical/thoracic vertebrate fractures w/out SCI. NEVER delegate moving pt in Halo Traction to an aide. NEVER unbuckle vest unless patient is supine.
64
SCI Injury: Sx recommended for...
- removal of bone frags, foreign objects, clots, spinal tumors, anything compressing spine
- to stabilize spine and help future pain or deformity.
65
Brain Abscess
mass of immune cells (pus and other material) r/t bacterial infection/fungal
NIH - 1500-2500 cases/yr
1. Bacteria infect part of the brain
2. inflammation response
3. infected brain cells, abc, bacteria collect
4. membrane forms around cells creating mass
66
Brain Abscess: Causes
- ear, tooth, sinus infection
| - lungs, endocarditis, skull fx, trauma, non sterile neuro procedure
67
Brain Abscess: SS
-Gradual or Sudden
-HA
-Fever/Chills
-Lethargy
-UP IICP
-Vision changes
-loss of muscle fx
unRx, death is 100%,
Rx, death 10-30%
68
Brain Abscess: Dx Test
- Med Hx
- SS
- Radiology: CT, MRI --> abscess
- Blood Test: CBC (UP WBC normal 5-10k), C+S?)
69
Brain Abscess: Rx
- Abx
- Antifungal
- Diuretic (edema/ICP)
- steroids (inflam)
- Sx for ICP (drain abscess)
70
Intra Cranial Tumor
- mass in brain
- Primary (from brain cells) or Secondary (metastasis)
- Benign (not CA but still bad) or Malignant
71
Intra Cranial Tumor: Types
- Gliomas
- Menningiomas
- Pituitary Tumors
- Neuromas
72
Intra Cranial Tumor: Dx Tests
- Head CT Scan, MRI,
- EEG (brain wave activity)
- CT guided biopsy
- cerebral angiogram (assess blood flow to artery and vessels of brain)
73
Intra Cranial Tumor: Types: Gliomas
- Glial Cells Fx: support/protection for neurons
- CA starts in brain and arises fro glial cells
- Cause: Idiopathic
```
TYPES:
Ependymomas
Astrocytomas (worst = death, 50% w'in 1yr)
-Ogliodendrogliomas
-Oligoastrocytomas (mixed)
```
74
Glial Cells
- surround neurom
- supply nutrients + O2
- insulate neurons from one another
- remove dead cells, pathogens from neuron
75
Intra Cranial Tumor: Types: Meningioma
- tumor that arises for Meninges
- Benign (rarely malignant)
- slow growing
- WOMEN
76
Intra Cranial Tumor: Types: Pituitary Tumor
- abnormal cell growth develops in pituitary
- hormonal imbalance
- Benign (rarely malignant)
- SS r/t hormonal level changes and what hormone is affected (i.e. Adrenocorticotropic hormone prod tumor --> Cushings (excess cortisol) vs Growth Hormone prod tumor --> Acromegly (excess GH)
77
Intra Cranial Tumor: Types: Neuromas
- nerve tumors
- Acoustic Neuroma: acoustic nerve tumor
- Benign primary intracranial tumor of myelin forming cells
- AKA Vestibular Schwannoma
78
Intra Cranial Tumor: SS
- HA
- N/V
- Vision changes
- gradual loss of sensation/mvmt in extremities
- diff w balance
- speech diff
- confusion
- personality/behavioral changes
- Sz
- Hearing
- Hormonal Disorder
79
Intra Cranial Tumor: Rx
- Surgery (Craniotomy, Craniectomy)
| - Chemo, Rad
80
Intra Cranial Tumor: Surgical Rx
Craniotomy: bone flap removed
Craniectomy: remove skull portion, bone pieces not replaced
81
What part of brain controls personality
Frontal Lobes
the part of the brain that controls important cognitive skills in humans, such as emotional expression, problem solving, memory, language, judgment, and sexual behavior. It is, in essence, the “control panel” of our personality and our ability to communicate.
82
Intra Cranial Tumor: NI
-neuro asses (LOC, orientation, PERRLA, Mvmt, Hand grasps, Gait)
-neuro check q2hrs
-emotional support
pre-op prep
83
Creutzfeldt-Jakob Disease (CJD)
- rare, degenerative, fatar, brain disorder
- Categories: Sporadic, Hereditary, Acquired
- a spongiform encelopathy caused by infectious protein know as PRION
84
Prion
an infectious agent, composed entirely of protein, presumed to be the cause of the transmissible spongiform encephalopathies (TSEs).
85
Types of CJD
- Classic CJD (not related to mad cow)
- Variant CJD (related to mad cow)
- BSE (bovine spongiform encephalopathy) Mad Cow disease
86
Categories of CJD
- Sporadic
- Hereditary
- Acquired
87
CJD Pathos
- prion proteins occur in normal form and infectious form
- both forms have same sequence of Amino Acids, but infectious form takes a diff forded shape. it UNfolds
- Sporadic CJD may dev bc normal prions spontaneously change
- Once they appear, abnormal proteins aggregate --> neuron loss and brain damage.
88
CJD SS
- rapidly progressing dementia
- muscular coor, probs
- impaired vision
- insomnia, depression
NO Dx test
Dx on autopsy
NO Rx, palliative only
89
CJD: Transmission
- exposure to infected brain tissue,CSF (acquired)
- grafts of dura mater, transplanted corneas, implantation of inadequately sterilized electrodes in brain, injections of contaminated pituitary growth hormone
- consumption of contaminated beed (V CJD, Mad Cow)
90
CJD: Trans Prevention
-normal sterilization,cook, wash, press, don't work
- caregivers take precautions
- cover cuts and abrasions w waterproof dressings
- wear surgical gloves when handling pt tissues, fluid, dressing
- avoid sticking w contaminated objects
- face protection
- disposable clothes
- soak instruments in undiluted chlorine leach for 1 hr, then autoclave
91
Meninges
- membranes enveloping the CNS and Spinal Cord
- protects CNS
- 3 layers: Dura Mater, Arachnoid Mater, Pia Mater
92
Meninges: 3 layers
Dura Mater,
Arachnoid Mater,
Pia Mater
93
Meningitis
-inflammation of the meninges and the CSF that surrounds brain and sc.
Causes: viral, bacterial, fungal
Types: bacterial or Viral
94
What type of Meningitis worse? Bacterial or Viral?
Bacterial
95
Meningitis: Bacterial Causes
****Neisseria meningitidis (worst)
Streptococcus pneumoniae
Haemophilus influenzae
96
Meningitis: Viral Causes
- Herpes Simplex/Zoster
- mumps
- Epstein Barre
- Cytomegalovirus
97
Meningitis: SS
- flu like symptoms
- F/HA
- Photophobia
- Kernig's and Brudinski's sign
- Nucal rigidity ( stiff neck, touch chin to neck)
- lethargy/irritability
- rash
98
Meningitis: Brudzinski's sign
flexion of hips and knees when neck is flexed
99
Meningitis: Kernig's sign
Inability to straighten leg when hip flexed to 90 degrees
100
Bacterial Meningitis
- most SERIOUS
- 16-21yrs
- Neisseria meningitidis, spread via resp and throat secretions.
101
Bacterial Meningitis: Dx tests
- Lumbar Puncture (LO BG, UP WBC, UP PROTEIN
- Chest Xray (source of infection, lungs inflamed?)
- Head CT
- EEG - Brain Activity
102
Bacterial Meningitis: MM
- IV
- Steroids - LO ICP
- Anticonvulsants (prevent Sz)
- Isolation (droplet, air, CDC)
103
Serogroup B menningococcal Vaccines
- 12 types of Neisseria Meningitidis called serogroups
- Serogroup A, B, C, W, Y most common
- 16-21yrs
- ST protection against most strains of serogroup B meningoccocal disease
- preferred vaccine ages 16-18
104
Vaccine Schedule
- Bexsero: 2 dose, 1 most apart
- Trumenba: 3 doses, 2nd 2 mos later, 3rd 6mos later
- same vaccine used for all doses
105
Vaccine Recommended for Adults if
- college freshman in dorm
- military
- damaged spleen
- terminal complement deficiency
- microbiologist exposed to NM
- travel or reside in countries where common
- exposure to breakout
106
Viral (Aseptic) Meningitis
- common and mild
- bacteria WONT grow in CSF
- 90% caused by Enterovirus (fecal/oral)
107
Viral (Aseptic) Meningitis: Dx Tests
- lumbar puncture
- titres CBC
- Head CT, Chest Xray
108
Viral (Aseptic) Meningitis: MM
- supportive measures (bed rest, maintain fluid balance, E balance, analgesics PRN)
- NO ABX
- usually recovers in 7-10 days
109
Encephalitis
Inflammation of Brain
CAUSE: viral* , bacterial
TYPES: Primary (started in brain), Secondary (mets from other area)
110
Viral Encephalitis
-Lymphocytic infiltration of brain tissue, Pia and arachnoid mater
--> cerebral edema, nerve cell destruction
CAUSE: virus from tick/mosquito, herpes, enterovirus, HIV, West Nile
111
Viral Encephalitis : Risk factors
- age: very young, very old (age 20-40 d/t Herpes Simplex
- weak immune system (HIV, immunosuppressant)
- geographic region (ticks, mosquitos )
- outdoor activities
- season of year (spring/summer)
112
Viral Encephalitis: SS
- classic: lethargy, photophobia, nuchal rigidity
- Change in LOC/behavior
- acute confusion
- Sz
- paralysis
113
Viral Encephalitis: Rx
Treat symptoms not virus, needs to run its course
- supportive measures
- control cerebral edema
- antiviral meds
- anticonvulsants
- safety precautions
- hydration
- antipyretic
114
Bacterial Encephalitis
RARE
SS: fever, change LOC, nuchal rigidity
Rx: Abx, analgesics (fever,pain), Sz precautions, maybe anticonvulsants
115
West Nile Virus
- birds are the carriers (vectors)
- female mosquitos feed on infected birds, infected mosquitoes feed on humans
Most vulnerable birds, crows and house sparrows
116
West Nile Virus: modes of transmission
- #1, bite from infected mosquito
| - organ transplant, blood transfusion, mother to fetus, breast feeding
117
West Nile Virus: SS
Usually NO SS
- HA, fever, back pain
- myalgia (muscle pain)
- anorexia (weight loss d/t no eating)
- encephalitis
- meningitis
118
West Nile Virus: Rx
No specific
- supportive care, treat SS
- IV fluids
- similar to Meningitis, Encephalitis
119
West Nile Virus: Prevention
- bug spray
- no standing water
- cover hands /legs
- limit outdoor activities
- report dead/dying birds
