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ICU Exam_ Neuro.
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Exam of 11 pages for the course SRU ELEC340 F at SRU ELEC340 F (ICU Exam_ Neuro.)
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ICU Exam: Neuroacute subdural hematoma - ANS-symptoms occur within the first hours of injury
AVM (arteriovenous malformation) - ANS-tangled mass of arterial and venous blood
vessels that shunt blood directly from the arterial side into the venous side, bypassing
capillary system
may be small, focal lesions or large, diffuse lesions
ALWAYS CONGENITAL
SAH from AVM usually occurs 20-40yo
AVM assessment - ANS-"worst HA of my life"
brief loss of consciousness, n/v, focal neurological deficits, stiff neck
warning leak
neuro deficit
AVM dx - ANS-NONCONTRAST CT is cornerstone
clinical presentation/hx
lumbar puncture
cerebral angiography
AVM pathophysiology - ANS-One or more cerebral arteries (feeders) feed the AVM ->
feeders enlarge over time -> increase the volume of blood shunted through the
malformation -> increase mass effect -> large, dilated tortuous veins develop from
increase in arterial blood flow -> veins become engorged and rupture
cerebral atrophy because of chronic ischemia because of shunting of blood through
AVM
basilar skull fracture - ANS-located at base of skull
underlying dura may be torn
infection and meningitis are major concern
blunt trauma head injury - ANS-deceleration, acceleration, both
cerebral aneurysm pathophysiology - ANS-congenital aneurysm matures, blood
pressure rises, stress is placed on poorly developed and thin vessels, ruptures, sends
arterial blood at a high pressure in subarachnoid space
berry or sac-like appearance with a stem/neck
usually small, 2-7mm
, often occurs at the base of the brain on the circle of Willis
most occur at bifurcations
cerebral aneurysms and SAH - ANS-90% aneurysms are congenital
10% caused by traumatic injuries, infection
multiple aneurysms occur 30% of cases and are often bilateral in same location
can live full life with an unruptured cerebral aneurysm
most prevalent 35-60yo
cerebral angioplasty - ANS-used when pharm tx has failed
only when CT/MRI has provided evidence that infarction has not yet occurred
cerebral contusion - ANS-bruising of the brain
often temporal or frontal lobes
coup-contrecoup mechanism
clinical manifestations depend on location: mass effect
dx: CT
cerebral contusion management - ANS-serial neuro assessments
ICP monitoring as needed
tx for increased ICP as needed
outcome depends on location and degree of damage, and can turn into a hematoma
cerebral perfusion pressure - ANS-measures perfusion of brain tissue
MAP - ICP = CPP
normal range of 50-70
cerebral vasospasm - ANS-SAH complication
onset usually 7-10d post-op of aneurysmal
70% of all pt with SAH
can result in ischemic stroke or death
cerebral vasospasm therapies - ANS-hemodynamic augmentation
nimodipine
cerebral angioplasty
chronic subdural hematoma - ANS-sx start at least 3w after head injury
common complications for SAH - ANS-rebleed, vasospasms, hyponatremia,
hydrocephalus, seizures
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