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27 Cards in this Set
- Front
- Back
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Mechanisms of Brain Injury: Hypoxia |
Deprivation of Oxygen caused by reduced atmospheric pressure, CO poisoning, CN, respiratory disease, anemia General Brain depression: symptoms vary with degree of oxygen depletion- euphoria, convulsions, unconsciousness, coma Brain uses 20% of the body's oxygen to produce ATP |
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Mechanisms of brain injury: Ischemia
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Reduced blood flow, can be focal or global Glucose and glycogen stores are depleted in 2-4 minutes, ATP storage is depleted within 4-5 min |
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Mechanisms of brain injury: Cerebral Edema
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Increased extracellular fluid volume Interstitial: CSF moves out of ventricles Vasogenic: damage to blood brain barrier cytotoxic: Fluid collects inside neurons Ischemic lysosome rupture: Destroys BBB |
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Mechanisms of brain injury: traumatic brain injury
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Injury to the surface or internal structures of the brain
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Hematoma definition
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Collection of blood in part of the brain, typically between two layers of the meninges, although it can be in the parenchymal tissue. Also called intracerebral hemorrhage
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Epidural Hematoma
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Blood collects between dura and the skull. More common in young adult males, ratio is 4:1. Middle meningeal artery in the temporal region, may seem minor with a short loss of consciousness
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Subdural Hematoma
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Blood collects between the dura and the brain, normally filled wit CSF. Usually a venous bleed, 5-25% caused by severe head trauma. accompanied by contusion, lacerations, and 50% have a skull fracture
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Subarachnoid Hemorrhage
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Blood collects in the mesh of the subarachnoid space. May be due to an aneurysm rupture or trauma. Most common is a leaky aneurysm in the circle of willis. Frequency increases with age
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Intracerebral hemorrhage
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Blood collects within the brain tissue itself, seen most often in persons with uncontrolled hypertension or people on anticoagulation therapy who have a minor head injury. Increases with increasing age
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Signs and symptoms of hematomas
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Severe HA, positive kernig sign, cognitive sensor and motor disturbances, LOC, aphasia*(expressive or receptive) symptoms worsen with increased intracranial pressure *aphasia is a speech disorder. Expressive is a verbal problem, receptive is a hearing problem |
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Hematoma Therapy
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diagnosed with MRI, angiography Surgery: Burr holes to reduce ICP and remove clot Barbituates to control seizures antihypertensives, ventilator support |
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Levels on consciousness
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oriented: arousal is spontaneous Confused: disoriented to PPT, agitation, inability to follow directions Delirium: spontaneous speech and movement w/out purpose lethargy: unable to arouse spontaneously Obtunded: sleep unless touched or spoken to loudly. one word answers Stupor: deep sleep, need continuous stimulation Coma: no response even to noxious stimuli |
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Glascow Coma Scale
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Eye open: 4-spont, 3-to speech, 2-to pain, 1-no verbal: 5-orient to PPT, 4-confused speech, 3-inappropraite, 2-incomprehensible sounds, 1-no Motor: 6-obeys commands, 5-localizes pain, 4-withdraws from stimulus, 3-abnormal flexion, 2-abnormal extension, 1-flaccidity |
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Brain injury breathing patterns
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Kusmaul: Hyperventilation Cheyne-Stokes: Waxing and waning Apneustic: long pauses without breathing Cluster: sleep apnea Ataxic: usually belly breathing in infants w/ high brain stem injuries Gasping: accessory muscles used |
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Brain Death
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Irreversible loss of brain function Loss of responsiveness to stimuli, brainstem reflexes absent, motor reflexes to pain absent |
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Persistent vegetative state
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Loss of cognitive functions and awareness of self and surroundings. Reflexes may remain intact
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Cerebrovascular disease
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Disorders that involve impairment of blood flow to the brain, either as a result of vessel occlusion of hemorrhage of a ruptured vessel Cerebrovascular accident CVA Every 45 seconds someone in the US has a CVA Every 3 minutes someone dies of a CVA |
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Two Types of CVA
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Ischemic: disorders due to thrombus or an embolus Hemorrhagic: bleed into the brain substance. Size and location of the bleed are associated with morbidity and mortality |
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Risk factors of cerebrovascular disease
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Non-modifiable: female gender, age >65, African American ethnicity history of transient ischemic attacks, MI, sickle cell disease Modifiable: cigarette smoking, cocaine abuse, diabetes mellitus, heavy alcohol use, hyperlipidemia, hypertension, physical inactivity, obesity, atrial fibrillation |
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signs, symptoms, and treatment of cardiovascular disease |
sensory and motor dysfunction, cognitive impairment, LOC. Diagnose with PET, CAT, MRI thrombolytic therapy, needs to be administered within 3 hours of onset of symptoms, |
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Transient Ischemic Attack "mini-strokes"
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Loss of consciousness may be brief or not at all Brief sensory, motor, visual disturbances usually resolve within 8-14 hours Five signs for identification of a CVA or TIA 1 smile, 2 stick out your tongue, 3 speak a coherent sentence, 4 can you see how many fingers I am holding up, 5 Can you stand and walk |
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FAST method of cardiovascular Diagnosis
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FAce, smile and speak a sentence, time to call 911 |
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STR method of cardiovascular diagnosis
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Smile, try to speak, raise both arms
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Central Nervous system infections: Meningitis
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An infection of the coverings (meninges) of the brain or spinal cord Bacterial Etiology: Affects pia & arachnoid matter. Infection w/ Neisseria meningitides, streptococcus pneumonia, haemophilus influenza Aseptic: From a bleed or abcess Viral: coxsackie, poliomyelitis, HS-1, adenovirus Fungal: Coccidiomycosis, cryptosprodium, candidiasis |
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Signs, symptoms, and treatment of CNS infections
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Cloudy CSF, elevated WBC, stiff neck, HA, photophobia, fever, malaise Antibiotics and antivirals, analgesics, osmotic diuretics if there is a change in intracranial pressure, antiemetics for nausea and vomiting |
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Central Nervous System infections: Encephalitis
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An acute infection of the CNS resulting in a rapid onset of altered states of consciousness Etiology: same agents as meningitis, most common are HS-1, and arthropod bourne viruses, from systemic viral infections, exposure to toxins, penetrating head wound, parasites |
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Signs, symptoms and treatment of encephalitis
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Headache, necrosis, edema, and ICP, fever, seizure, and or coma, paresthesia, and paresisAntibiotics, antivirals, anticonvulsants, IV support, ventilation support, PT rehab
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