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Cerebral Spinal Fluid(CSF)
A clear fluid that surrounds the brain and spinal cord.
- Layers of tissue protecting the brain. They include the dura mater, arachnoid, and the pia materThe arachnoid membrane and the pia mater are sepeated by a lattice of fibrous, spongy tissue called the subarachnoid spaceBleeding between the dura mater and the skull is called epidural.
- Bleeding beneath the dura is called subdural.
- Bleeding between the arachnoid and the surface of the brain is called subarachnoid hemorrhage.
Part of the brain controlling conscious and sensory functions, emotions, and personality.
Part of the brain controlling equilibrium and muscle coordination.
Part of the brain that controls most automatic functions of the body.
- Mild injury that causes temporary loss of brain function.
- Signs and symptoms:
- Momentary confusion
- Inability to recall the incident and sometimes the period just before it(retrograde amnesia) and just after it(anterograde amnesia)
- Repeating questions of what happened
- Mild or moderate irritability and resistance to treatment
- Inability to answer questions or obey commands appropriately
- Nausea and vomiting
- Injury that causes bruising or swelling of the brain.
- Decreasing mental status or unresponsiveness
- Unequal pupils
- Alteration of vital signs
- Profound personality changes
- Bleeding between the brain and the dura mater
- Acute: signs and symptoms begin immediately after the injury
- Occult: Bleeding continues over the time and the signs and symptoms don't become apparent for days to weeks after the injury
- Weakness of paralysis to one side of the body
- Deterioration in level of responsiveness
- Dilation of one pupil
- Abnormal respirations or apnea
- Possible increasing systolic blood pressure
- Decreasing pulse rate
- Personality change
- Bleeding between the dura mater and the skull.
- Loss of responsiveness followed by return of responsiveness
- Decreasing mental status
- Severe headache
- Fixed and dilated pupil
- Increasing systolic blood pressure and decreasing heart rate
- Apnea or abnormal breathing pattern
- Systolic hypertension and bradycardia(Cushing reflex)
- Posturing(withdrawal or flexion)
Penetrating brain damage
- Compression and pushing of the brain through the foramen magnum
- Can be any part of the brain, especially the brain stem.
- Dilated or sluggish pupils on one side
- Weakness or paralysis
- Severe alteration in consciousness
- Abnormal posturing
- Abnormal ventilation pattern
- Cushing reflex
Posture in which the patient arches the back and flexes the arms inward toward the chest. A sign of serious head injury. Also called decorticate posturing.
A posture in which the patient arches back and extends the arms straight out parallel to the body. A sign of serious head injury. Also called decerbrate posturing.
Glasgow Coma Scale
- Eye opening: Spontaneous(4), to verbal command(3), to pain(2), no response(1)
- Verbal response: Oriented and converses(5), Disoriented and converses(4), inappropriate words(3), incomprehensible sounds(2), no response(1)
- Motor response: Obeys verbal commands(6), Localizes pain(5), withdraws from pain-flexion (4), Abnormal flexion in response to pain-decorticate rigidity(3), Extension in response to pain-decerbrate rigidity(2), no response(1)
Same or similar reaction of the unstimulated pupil when the other pupil is stimulated, as when a light is shined into one pupil and both pupils contract.
Discoloration of tissue around the eyes suggestive of basilar skull injury.
Discoloration of the mastoid suggesting basilar skull fracture.
Physical exam for suspected head injury
- The head: palpate, check DCAPBTLS
- The eyes:
- 1. check pupils with penlight, check for consensual reflex-suggests increased pressure in brain
- 2. check eye movement
- 3. any discoloration? Raccoon signs?-intracranial injury
- The ears and nose:
- 1. Check both ears for leakage
- 2. Battle sign3. Check nose for leakage
- Motor/Sensory Assessment: PMS
Inability to remember circumstances prior to an incident
Inability to remember circumstances after an incident.
Signs and Symptoms of Head Injuries
- Irregular breathing pattern
- Cushing reflex
- Leakage of cerebral spinal fluid
- Raccoon signs
- Battle signs
- Absent motor or sensory functions
- Unequal pupil sizes
- Possible seizures
- Retrograde amnesia
- Anterograde amnesia