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:
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
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
Bleeding between the dura mater and the skull.
Loss of responsiveness followed by return of responsiveness
Decreasing mental status
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 ventilation pattern
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
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.