ICP
because of limited space in the skull, an
increase in any one of components of the skull (brain tissue, blood,
CSF) will cause a change in the volume of the others
Monro–Kellie hypothesis
Restlessness, confusion, inc. drowsiness, inc respiratory effort. Impaired ocular movement or pupillary changes may be early signs of _______________
increased ICP
extremely severe, one-sided headaches that occur in cycles (clusters), usually lasting 15 minutes to 3 hours, often with multiple attacks per day. They are characterized by intense, stabbing pain around one eye, accompanied by autonomic symptoms like tearing or nasal congestion. Treatment involves fast-acting abortive therapies (oxygen/triptans) and preventative medication
cluster headache
a life-threatening collection of blood between the brain surface and the dura mater, usually caused by torn bridging veins from head trauma. It often appears on CT scans as a crescent-shaped bleed. Acute cases show immediate severe symptoms, while chronic cases (common in the elderly) develop slowly over weeks.
subdural hematoma
What must be done prior to giving pt food or medication?
3 ounce swallow evaluation
This term refers to the brain’s ability to change the diameter
of blood vessels to maintain cerebral blood flow
Autoregulation
increased systolic blood pressure (widened pulse pressure), bradycardia (slow heart rate), and irregular respiration
intense, recurring neurological events, often causing throbbing pain on one side of the head, accompanied by nausea, vomiting, and extreme sensitivity to light and sound. Lasting 4–72 hours, they may be preceded by sensory warnings (aura) and triggered by stress, hormonal changes, or food. Effective management includes lifestyle adjustments and medications
migraine headache
a life-threatening type of stroke caused by bleeding into the space surrounding the brain, usually from a ruptured aneurysm. It presents as a sudden, severe "thunderclap" headache, often accompanied by vomiting, stiff neck, and consciousness loss. Immediate emergency care is crucial, with treatment focusing on stopping the bleeding via surgery or endovascular coiling
subarachnoid hemorrhage (SAH)
a life-threatening medical emergency caused by high pressure inside the skull, leading to severe headache, decreased consciousness (coma), dilated/non-reactive pupils, and Cushing’s triad (high blood pressure, low pulse, irregular breathing). Immediate care is required to prevent irreversible brainstem damage or death
Brain herniation. Warning signs of impending herniation: Sudden drop in Glasgow Coma Scale (GCS) by 2; Rapidly worsening unilateral or bilateral pupil dilation. Onset of ataxic (irregular) breathing or apnea
Vasodilation
CPP less than ___________leads to irreversible neurologic damage
50 mmHG
Sumatriptan is used for acute HA. What are contraindications to using triptans?
Do not administer to patients with ischemic heart disease, coronary artery spasm (including Prinzmetal angina), stroke, uncontrolled hypertension, or peripheral vascular disease.
serious, often life-threatening brain bleed occurring between the skull and the dura mater, usually caused by trauma (e.g., falls, accidents) leading to skull fractures. It is characterized by a "lens-shaped" accumulation of blood that typically arises from either an arterial tear (most common, faster bleeding) or a venous tear
Epidural hematoma
Strokes on this side of the brain result in neglect of the contralateral side of the body and the environment, impulsive behaviors, emotional lability, high risk of falls and dysphagia
RIGHT SIDE CVA. use bed alarms, keep the bed in the lowest position, and provide close supervision. Place personal items, call lights, and approach the patient from the right side (unaffected side) initially, then gradually encourage interaction with the left side.Arrange the room to ensure important objects are in the patient's field of vision.Prevent shoulder subluxation on the left side using pillows for support.
ICP is closely related to cerebral perfusion pressure. What is a normal ICP
5-15 mm Hg
Loss of gag, swallowing, corneal reflexes, and fixed pupils are indicative of loss of what type of reflexes
Brainstem
Triptans are a selective 5-HT agonist. What must you monitor for when a patient is taking these and antidepressant meds, like SSRI and SNRI?
seratonin syndrome
What will cause increased intrathoracic pressure (and should be avoided with bleed)
Valsava maneuver, straining to defecate, coughing, and SUCTIONING
severe speech/language deficits (aphasia), and slow, cautious behavioral changes, dysphaghia, memory loss related to verbal
LEFT SIDE CVA.
A normal CPP is 50-80 mmHg. How is CPP calculated?
MAP-ICP=CPP
Medication used for ICP
Hypertonic solutions like mannitorl or 3% NS
Why must triptans and ergots not be taken together for an acute migraine?
Risk of severe hypertension
involves temporarily removing a bone flap to access the brain, then replacing it immediately after the procedure
CRANIOTOMY. A craniectomy removes the bone flap but does not replace it immediately, allowing space for severe brain swelling. Craniotomies are common for tumor removal, while craniectomies are often used to treat severe traumatic brain injuries
This type of medby binds to fibrin within the clot, converting plasminogen to plasmin, which breaks down the blockage and restores circulation.
tPA (tissue plasminogen activator) Ex: alteplase, reteplase and tenecteplase