Acute neuro

Cerebral Edema Definition

Increase in water and sodium in brain causing increased brain volume and ICP

Vasogenic Edema

Breakdown of blood-brain barrier causing fluid/protein leakage into brain tissue

Causes of Vasogenic Edema

Hemorrhage, brain injury, meningitis

Cytotoxic Edema

Swelling of brain cells due to increased intracellular fluid

Causes of Cytotoxic Edema

Hypo-osmotic states, water intoxication, low sodium

Brain Death Definition

Irreversible loss of all brain and brainstem function

Brain Death Reversible Causes

Drug intoxication or metabolic causes may mimic brain death

Brain Death Diagnosis Tools

EEG, angiography, transcranial Doppler, brain scans, evoked potentials

Epidural Hematoma Location

Between skull and dura mater

Epidural Hematoma Cause

Arterial bleed often from skull fracture (middle meningeal artery)

Epidural Hematoma Presentation

LOC → lucid interval → rapid deterioration

Subdural Hematoma Location

Between dura and arachnoid

Subdural Hematoma Cause

Tear of bridging veins (venous bleed)

Subdural Hematoma Symptoms

Headache, confusion, agitation, LOC

Acute Subdural Hematoma

Occurs within 24 hrs, rapid progression, high mortality

Chronic Subdural Hematoma

Delayed weeks, common in elderly/alcoholics

Why Subdural Worse than Epidural

Can expand slowly and go unnoticed

Intracerebral Hematoma Definition

Bleeding directly into brain tissue

Spinal Cord Injury Definition

Damage to spinal cord affecting motor and sensory function

Vertebrae Count

7 cervical, 12 thoracic, 5 lumbar, 5 sacral (fused), 4 coccygeal (fused)

Spinal Nerves Count

8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal

Cervical Function

Neck, shoulders, hands

Thoracic Function

Chest and abdomen

Lumbar Function

Lower extremities

Sacral Function

Bowel and bladder

Coccygeal Function

Sitting

SCI Mechanisms of Injury

Fracture, compression, rotation, stretch, shear, dislocation, contusion, penetrating injury

Spinal Cord Contusion

Swelling and loss of blood flow causing loss of function

Complete Transection

Loss of all motor, sensory, reflex, autonomic function below injury

Spinal Shock

Immediate loss of reflexes after injury

Central Cord Syndrome

Arms affected more than legs

Anterior Cord Syndrome

Loss of motor, pain, temperature; preserves position/vibration

Brown-Sequard Syndrome

Ipsilateral motor/proprioception loss; contralateral pain/temp loss

Cauda Equina Syndrome

Flaccid bowel, bladder, sexual dysfunction (emergency)

SCI Assessment Priorities

ABCs, respiratory function, LOC, level of injury

SCI Functional Assessment

Motor, sensory, vital signs, bowel/bladder

Upper Motor Neuron Syndrome

Injury T12 and above; spasticity, reflexes intact

Lower Motor Neuron Syndrome

Injury T12 or below; flaccid paralysis, no reflexes

C4 Function

Controls diaphragm

T1-T7 Function

Intercostal muscles

T6-T12 Function

Expiration and abdominal muscles

SCI Thermoregulation Problem

Loss of temperature control below injury

SCI Vasovagal Response

Bradycardia/asystole from unopposed parasympathetic activity

SCI Stabilization Meds

Vasopressors (increase BP), atropine (increase HR)

SCI Symptom Meds

Pain meds, anticoagulants

SCI Muscle Relaxants

Baclofen, diazepam, dantrolene

SCI Bladder Meds

Bethanechol, oxybutynin

Autonomic Dysreflexia Definition

Massive sympathetic response in SCI above T6

AD Triggers

Full bladder, bowel, pain

AD Symptoms

Hypertension, headache, sweating, flushing, bradycardia

AD Complications

Stroke, seizures, MI, death

AD Treatment

Remove trigger, lower BP, raise HR, elevate HOB

Stroke Definition

Sudden neurological deficit from ischemia or bleeding

TIA Definition

Temporary loss of blood flow with no permanent damage

TIA Importance

Warning sign for stroke (high risk within 90 days)

TIA Duration

Usually resolves within 1 hour

Ischemic Stroke Definition

Blockage of blood flow (80–85%)

Thrombotic Stroke

Clot forms in vessel (stationary)

Embolic Stroke

Clot travels and lodges in brain

Hemorrhagic Stroke Definition

Bleeding from vessel rupture

Aneurysm Stroke

Ruptured vessel bulge causing subarachnoid bleed

AVM Stroke

Abnormal artery-vein connection causing stroke

Stroke Risk Factors

Hypertension, diabetes, obesity, smoking, high cholesterol, age, cardiac disease

Stroke Symptoms

Hemiplegia, confusion, speech issues, vision loss, dizziness, headache

Stroke Lateralization

Opposite side of brain injury (contralateral)

Stroke Diagnosis Priority

Time of symptom onset

Stroke Imaging

CT (bleeding), MRI (ischemia), MRA/CTA (vessels)

Stroke Antiplatelets

Aspirin, ticlopidine, clopidogrel

tPA Function

Breaks down fibrin clot

tPA Time Window

Within 3 hours (180 min)

tPA Goal

Save penumbra and reduce damage

Meningitis Definition

Inflammation of meninges and CSF

Bacterial Meningitis Patho

Destroys capillaries, causes edema and inflammation

Bacterial Meningitis Organisms

Strep pneumoniae, Neisseria meningitidis

Bacterial Meningitis Symptoms

Fever, headache, stiff neck, vomiting, photophobia, altered LOC

Meningococcal Rash

Petechial rash (DIC sign)

Viral Meningitis Definition

Less severe, self-limiting meningitis

Viral Meningitis Risk Factors

Skull fracture, infections, sepsis, neurosurgery, immunocompromised