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38 Cards in this Set
- Front
- Back
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ICP normal range |
0-20 mmHg.
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CPP = MAP - ICP
normal = 70-100 mmHg the higher the ICP the lower CPP |
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cerebral blood flow
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CBF = CPP/CVR (cerebral vein resistance)
normal 20-70 ml per 100 grams of tissue per minute |
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MAP
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MAP = DBP - 1/3 (SBP-DBP)
normal 70-110 mmHg depends heavily on DBP |
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normal autoregulation range in the brain
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MAP of 50-150 in non-hypertensives keeps CBF stable
below MAP 50 --> ischemia above MAP 150 --> edema patients with decreased intracranial compliance have a directly proportional relationship |
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ICP waveform
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first (highest) peak --> P1 --> percussion wave--> arterial pulsation
second peak --> P2 --> tidal wave --> intracranial complaince third peak --> P3 --> dicrotic wave --> aortic valve closure |
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management of high ICP
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HOB 30 degrees
head midline pain and temperature control ICP minitoring EVD hyperventilation of PCO2 30 osmotic agents surgical decompression |
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subfalcine herniation focal deficits
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ACA compression --> contralateral leg weakness
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Duret's hemorrhage |
due to shearing and stretching of the basilar perforators as results of a central herniation
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uncal herniation focal deficits |
ipsilateral CN III pupillary dilation +/- ipsi or contralateral hemiparesis
midbrain compression --> decreased consciousness PCA compression --> infarction Kernohan's notch phenomenon |
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Kernohan's notch phenomenon
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compression of the contralateral cerebral peduncle in uncal herniation --> ipsilateral hemiparesis
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concussion grading |
grade 1 --> transient confusion < 15 minutes without LOC
grade 2 --> transient confusion > 15 minutes without LOC grade 3 --> any symptoms with LOC transient confusion --> poor concentration, posttraumatic amnesia, staring, delayed response, incoordination, emotions out of proportion to event |
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return to play after concussion
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grade 1 --> single concussion --> same day if normal sideline assessment at rest and exertion
grade 1 --> multiple concussions --> 1 week grade 2 --> single concussion --> 1 week grade 2 --> multiple concussions --> 2 weeks grade 3 --> LOC of seconds --> 1 week grade 3 --> LOC of minutes --> 2 weeks grade 3 multiple concussions --> 1 month or more based on clinical judgement *** guidelines might have changed |
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cauda equina syndrome
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radicular pain
weakness and sensory deficits often asymetric absent reflexes +/- bladder and erectile dysfunction |
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conus medullaris syndrome
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uncommon radicular pain
distal weakness and saddle sensory deficits are symmetrical achilles reflex absent, patellar may be preserved bladder and erectile dysfunction very common |
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glasgow coma scale
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Eye response -->
1. No eye opening 2. Eye opening in response to pain stimulus 3. Eye opening to speec 4. Eyes opening spontaneously Verbal response --> 1. No verbal response 2. Incomprehensible sounds 3. Inappropriate words 4. Confused 5. Oriented Motor response --> 1. No motor response 2. Extension to pain (decerebrate) 3. Abnormal flexion to pain (decorticate) 4. Flexion/Withdrawal to pain 5. Localizes to pain 6. Obeys commands |
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ascending reticular activating system
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cell bodies in the upper pons and midbrain --> thalamus, hypothalamus and raphe nucleus --> projects diffusely to cortex
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persistent vegetative state |
arousal, eye tracking and sleep cycles without any awareness for more than 4 weeks
if > 4 weeks --> permanent vegetative state if some awareness --> minimally vegetative state |
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normal response of caloric testing
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eyes deviate towards cold water
sacades/nystagmus to the contralateral side implies intact MLF, CN3, CN6 and CN8 |
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abnormal response to caloric testing
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eyes deviate away from cold --> cortical lesion
no response --> brainstem lesion |
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oculocephalic reflex
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eyes move opposite to head movement
implies intact MLF and EOM innervation |
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fixed nonreactive pupils lesion
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no parasympathetics or sympathetics
midbrain lesion or drug-related |
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pinpoint pupils lesion
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sympathetic dysruption with preserved parasympathetic
pontine lesion or drug-induced |
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fixed dilated pupil lesion
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extensive medullary lesion, hypothermia or barbiturates
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anisocoria lesion
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Horner's syndrome (myosis)
CN3 lesion --> PCOM aneurysm |
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unequeally reactive pupils lesion
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afferent --> optic nerve
efferent --> oculomotor nerve |
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gaze preference to paretic side lesion
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pontine lesion with CN6 palsy
oculocephalic maneuver can't overcome the gaze preference |
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gaze preference away from paretic side
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frontal eye field lesion in the side of the gaze preference
oculocephalic maneuver overcomes the gaze preference |
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skew eye movements
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midbrain lesion
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ocular bobbing |
pons
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most sensitive areas to hypoxia in the brain |
cerebellar purkinje cells
dentate nucleus globus pallidus CA1 pyramidal cells of hippocampus cortical layers III and V |
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hypoxic ischemic encephalopathy residual deficits |
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brain death criteria |
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brain death confirmatory testing |
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types of brain edema |
cytotoxic --> failure of Na/K ATPase pump with cellular edema
interstitial or transependymal --> increased intraventricular pressures lead to edema (hydrocephalus) vasogenic --> disruption of blood-brain barrier leads to permeability of blood vessels |
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hypothermia after cardiac arrest indications
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strong evidence for out-of-hospital initially Vfib arrest
may be beneficial in asystole or PEA |
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hypothermia after cardiac arrest protocol
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target temperature 32-34 degrees celsius for 12-24 hours
lower temperatures may be harmful |
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causes of cytotoxic edema
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stroke |
