Caring for Patients with Acute Neurological Disorders

Central Nervous System

Comprises brain and spinal cord; processes impulses.

Brain

Largest and most complex part of CNS.

Skull

Protective structure; smooth superior, rough basilar surfaces.

Meninges

Three protective layers surrounding the CNS.

Dura Mater

Outermost layer; supplies blood via middle meningeal artery.

Epidural Space

Space between skull and dura mater.

Subdural Space

Space between dura mater and arachnoid.

Subarachnoid Space

Space between arachnoid and pia mater; contains CSF.

Arachnoid Mater

Second layer; delicate structure with subarachnoid space.

Cerebrospinal Fluid (CSF)

Clear fluid; protects brain and circulates nutrients.

Choroid Plexus

Produces CSF within the ventricles.

Lateral Ventricles

Two largest ventricles; extend into frontal lobes.

Non-communicating Hydrocephalus

Fluid build-up due to CSF blockage.

Communicating Hydrocephalus

CSF accumulation caused by arachnoid villi blockage.

Arachnoid Villi

Protrusions that absorb CSF for removal.

Pia Mater

Innermost layer; adheres to brain and supplies blood.

Cerebral Vasculature

Receives 20% of cardiac output; supplies brain.

Circle of Willis

Circular network allowing blood flow between hemispheres.

Internal Carotid Arteries

Bifurcate to supply cerebrum and face.

Vertebral Arteries

Form basilar artery; supply cerebellum and brain stem.

Subarachnoid Hemorrhage

Arterial rupture causing blood in CSF.

Epidural Hematoma

Arterial rupture leading to rapid blood accumulation.

Intracranial Pressure (ICP)

Pressure within the cranial vault, non-expandable.

Normal ICP

Normal ICP measurements are less than 15 mmHg.

Increased ICP

ICP measurements greater than 15 mmHg.

Monro-Kellie Doctrine

Brain self-regulates volume of intracranial components.

Cerebral Blood Flow (CBF)

Blood flow to the brain, maintained despite changes.

Autoregulation

Ability to maintain CBF despite metabolic changes.

Cerebral Perfusion Pressure (CPP)

Indicates adequacy of oxygen delivery to the brain.

Normal CPP Range

Normal CPP values are 60-100 mmHg.

CPP Calculation Formula

CPP = MAP - ICP.

Compensatory Mechanisms

BP and CO2 significantly affect CBF.

Pressure Autoregulation

MAP 50-150 mmHg critical for brain health.

Metabolic Autoregulation

CO2 levels affect cerebral blood flow.

Cerebral Edema

Swelling in the brain leading to increased ICP.

Causes of Cerebral Edema

Includes trauma, infections, tumors, and strokes.

Vasogenic Edema

Fluid leakage into extracellular space, increased permeability.

Cytotoxic Edema

Swelling of neurons after hypoxic injury.

Central Herniation

Displacement of brain tissue due to increased ICP.

Ischemia

Insufficient blood flow to brain tissue.

Anoxic Injury

Damage due to lack of oxygen.

Cerebral Blood Flow Impact

CBF affected by systemic blood pressure changes.

Cerebral Hypoxia

Oxygen deficiency in brain tissue.

Cushing's Triad

Signs indicating imminent death: widened pulse pressure, bradycardia, irregular respirations.

Widened Pulse Pressure

Increased difference between systolic and diastolic blood pressure.

Bradycardia

Heart rate slower than normal, below 60 bpm.

Irregular Respirations

Abnormal breathing patterns indicating brainstem involvement.

Intracranial Pressure Monitoring

Guides therapy for severe brain injuries.

GCS 3-8

Indicates severe brain injury; ICP monitoring indicated.

Intraventricular Catheter

Device for monitoring ICP; can cause infections.

Intraparenchymal Monitor

Device placed within brain tissue for ICP measurement.

Lumbar/Subarachnoid Monitor

Monitors ICP from lower spinal regions.

Subdural Monitor

Used for ICP monitoring; placed under the dura mater.

Epidural Monitor

Lower risk of infection compared to other devices.

ICP Monitoring Complications

Includes infection, obstruction, hemorrhage, and misplacement.

Space-Occupying Lesions

Tumors, abscesses, and bleeds that increase ICP.

Subarachnoid Hemorrhage (SAH)

Bleeding between arachnoid and pia mater layers.

Cerebral Aneurysm

Outpouching of a blood vessel wall.

Subdural Hematoma

Bleeding between the dura mater and brain.

Antibiotic Prophylaxis

Preventive antibiotics to reduce infection risk.

Transducer Leveling

Aligning with the tragus for accurate ICP readings.

Aneurysm

Abnormal blood vessel dilation, 2-7mm diameter.

Rupture

Break in blood vessel, causing bleeding.

CSF

Cerebrospinal fluid, protects brain and spinal cord.

Oculomotor nerve

Controls eye movement and pupil response.

Ipsilateral pupil dilation

Same side pupil enlarges due to pressure.

Clinical manifestations

Signs and symptoms indicating a medical condition.

Worst headache of my life

Common description after aneurysm rupture.

Nuchal rigidity

Stiff neck indicating meningeal irritation.

Photophobia

Sensitivity to light, often with meningitis.

Kernig's sign

Pain on knee extension when hip flexed.

Brudzinski's sign

Knee flexion when neck is flexed.

CT scan

Imaging technique for diagnosing brain conditions.

Lumbar puncture

Procedure to collect CSF for analysis.

Cloudy CSF

Indicates infection, not subarachnoid hemorrhage.

Cerebral angiography

Imaging to visualize cerebral blood vessels.

Surgical clipping

Gold standard procedure to treat aneurysms.

Guglielmi detachable coils

Endovascular treatment to occlude aneurysms.

Vasospasm

Narrowing of blood vessels post-hemorrhage.

Nimodipine

Calcium channel blocker for vasospasm management.

Triple H therapy

Management strategy: Hypervolemia, Hemodilution, Hypertension.

Neuro patients

Avoid giving certain medications to these patients.

Pulmonary edema

Fluid accumulation in lungs, monitor for signs.

Hemodilution

Dilution of blood components with IV fluids.

Hypertension

Blood pressure exceeding normal range, > 120 mm Hg.

Vasopressors

Medications used to increase blood pressure.

Sweet spot BP

Optimal BP range 150-160 mm Hg.

Epinephrine

Used to maintain blood pressure in emergencies.

Hydrocephalus

Fluid buildup in the brain, often CSF.

VP shunt

Catheter from ventricle to peritoneum for drainage.

Seizures

Neurological events due to blood irritants.

Anticonvulsants

Medications to prevent or control seizures.

Rebleeding risk

Increased chance of bleeding within 24 hours.

Minimal stimulation

Reduce environmental stimuli for patient comfort.

Antihypertensives

Medications to lower high blood pressure.

Ventriculostomy

Procedure to control intracranial pressure (ICP).

Baseline neurological assessment

Initial evaluation to monitor neurological status.

Primary brain injury

Immediate damage from trauma at injury time.

Secondary brain injury

Worsening injury due to body's response mechanisms.

Calm Environment

Quiet setting to reduce stimulation for patients.