Neuro Exam

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  1. Intracranial Pressure
    • Pressure exerted within the intact skull
    • Nl < 15 mm Hg
  2. Cerebral Perfusion Pressure
    • Estimation of cerebral blood flow; the pressure it takes to get blood from the heart to the brain
    • Nl 70-100mm Hg
    • The difference b/w mean arterial pressure (MAP) and intracranial pressure (ICP)
  3. If ICP is excessive, so what?
    • Intracranial HTN : >20 mmHg
    • Brain matter shifts
    • Herniation
    • -Supratentorial
    • -Infratentorial
    • Shift/herniation can put pressure on brainstem
    • Primary indicators: LOC & change in resp pattern
  4. Factors that Increase ICP
    -Factors that increase cerebral mass...
    • 1. Cerebral edema r/t irritation, increased permeability, hydrocephalus
    • 2. Space occupying mass
  5. Factors that Increase ICP
    -Factors that increase CSF volume...
    • 1. Excess CSF fluid production
    • 2. Decreased or obstructed fluid drainage/absorption
  6. Factors that Increase ICP
    -Factors that increase blood volume…
    • 1. Activities that increase intrathoracic pressure...sneezing, coughing, straining (Valsalva), and bending forward.
    • 2. HTN ... (MAP > 130)
    • 3. Elevation of CO2 (even slight increases), severe decrease in PO2, and excess H+ions (acidosis)
    • 4. Vasodilating agents...anesthesia, morphine, nipride
    • 5. Conditions that increase metabolism ...seizure activity or fever.
    • 6. Working against gravity...Trendelenburg position
    • 7. Tightness around the neck, twisting of head
  7. Brain Death
    • Results from any process that directly destroys brain matter or compresses brain structure
    • If on ventilator, may need to assess brain stem fx to determine brain death
    • Remember, clinical death is the absence of VS; brain death is absence of Cerebral fx &Brainstem fx
  8. Brain Death Criteria
    • Cerebral or cortical fx absent if
    • -Unresponsive coma w/ absent motor fx given amt of time (30 min)
    • -Flat EEG
    • Absence of brain stem reflexes
    • -No spontaneous respirations –will do apnea test if on vent
    • -Pupils dilated and fixed
    • -No oculocephalic reflex -doll’s eyes
    • -No oculvestibular reflex
  9. Stroke
    Definition: Neurodeficits d/t sudden decrease in blood flow to a localized area of the brain.
  10. General Stroke
    • Contralateralmotor loss –remember motor pathways cross (deucssate) at medulla/spinal cord juncture
    • -Facial droop (affected side)
    • -Arm drift (affected arm)
    • -Slurred speech
    • -Leg
  11. Hemorrhagic Stroke
    • Most fatal
    • Cause:HTN
    • Ruptured aneurysms –often berry-type
    • Arterial –Venous Malformations –congenital
    • Other causes: trauma, erosion of vessels from tumor, etc
    • ◦Headache
    • ◦Vomiting
    • ◦Seizures
    • ◦Progressive neurological deficit
  12. Ischemic Stroke
    • •Most common –80%
    • •Narrowed Vessels &/or
    • •Clots
    • -Thrombotic –most common at night
    • -Embolic
  13. TransischemicAttacks (TIAs)
    • Often a prelude to stroke by days or months.
    • Amaurosis fugax–fleeting blindness of one eye, like shade being pulled down
  14. Intracerebral Hemorrhage
    • Most common cause: HTN
    • In this type of stroke, a blood vessel in the brain bursts and spills into the surrounding brain tissue, damaging cells.
    • Brain cells beyond the leak are deprived of blood and are also damaged.
    • Over time, high blood pressure can cause small arteries inside the brain to become brittleLocation: Intracerebral Hemorrhage
  15. Subarachnoid Hemorrhage
    • Blood spills into the space between the arachnoidlayer and the piamatter.
    • The bleeding is often signaled by a sudden, severe "thunderclap" headache.
    • This type of stroke is commonly caused by the rupture of an aneurysm, which can develop with age or be present from birth.
    • After the hemorrhage, the blood vessels in the brain may widen and narrow erratically (vasospasm), causing brain cell damage by further limiting blood flow to parts of your brain.
  16. TBI or Craniocerebral Trauma
    Any injury of the scalp, skull, or brain
  17. Head injury
    –classified as open or closed
    • ◦Open –penetrating –d/t bullet, baseball bat, etc
    • ◦Closed –blunt injury that does not result in an open skull fracture
  18. Types of TBI
    • Injury to the skull –skull fracture
    • Injury to the brain◦Focal or Diffuse
    • Intracranial hemorrhage
  19. Skull Fracture: Linear
    most common, simple and clean
  20. Skull Fracture: Comminuted
    small fragments
  21. Skull Fracture: Depressed
    inward depression
  22. Skull Fracture: Basilar
    may be linear, comminuted, or depressed but is located at the base of the skull
  23. Signs of a basal skull fracture:
    • Monitor for otorrhea or rhinorrhea
    • Leakage of CSF from nose or ears –contains glucose
    • Check Halo sign if bloody drainage –CSF will form rings
    • Battle’s sign –mastoid ecchymosis
    • Racoon’s eyes –periorbital ecchymosis
    • Cranial nerve deficits
  24. Focal Brain Injuries
    • Specific, confined to one area of the brain
    • Include contusions, lacerations, & intracranial hemorrhage
    • Contusion –sm, diffuse venous bleed
    • Intracranial hemorrhage
    • -Epidural
    • -Subdural
    • -Intracerebral Injuries
  25. Diffused Brain Injuries
    • Affects entire brain
    • ◦Mild concussion
    • ◦Classic concussion
    • ◦Diffuse Axonal Injury
  26. Mild concussion–
    temporary axonal disturbance w/ or w/o loss of consciousness of < 5 minutes
  27. ◦Classic concussion
    head injury w/ brief loss of consciousness of < 6 hrs
  28. ◦Diffuse Axonal Injury
    widespread axon injury w/ immediate loss of consciousness and other neuro deficits –poor prognosis
Card Set:
Neuro Exam
2012-04-29 04:03:13

N432 Neuro Exam
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