hydrocephalus
name the main symptom from hydrocephalus
ICP
name 5 of the complications that occur from a coup and contrecoup "strike" brain shift in the cranium & name the most severe/why?
1. change in shape from plates shifting
2. post-injury contour of the skull
3. torn subdural vessels
4. shearing (tearing) forces **
5. trauma from initial strike
what is the generic name for genetic disorders that leads to progressive muscular degeneration?
muscular dystrophy
define bacterial meningitis & what it can lead to
inflammation of the meninges, or outer lining of the brain = increasing pressure in the cranium
what is the #1 cause of unintentional death in children 1-4 years old?
submersion/drowning
name the product that is overproducing in the ventricles & how it is becoming imbalanced
CSF - it is produced, circulated, then reabsorbed
what head injury is considered the mildest but can persist for weeks? what common symptoms will occur?
concussions; headache, photophobia, N/V, & dizziness
what type of disease is GBS and what is its pathophysiology?
1. autoimmune, and 2. it is a progressive disease where the myelinization of axons are destroyed = presenting as peripheral weakness that progresses in ward/upward working up the axon.
why is it important to know what is causing the meningitis? which type is the hardest to treat?
each type is treated differently, fungal
bacterial (pyogenic), viral (aseptic), tuberculosis, fungal (hard to treat - does not cross the blood-brain barrier), or protozoal (fatal - eating the brain)
what is the lowest and highest score for the glasgow coma scale & what are you monitoring?
lowest is 3 (coma), highest is 15, you would intubate at 9 or less
this monitors PERRLA, brain stem herniation, and neuro response
name the most common type of shunt used for a CSF issue
ventricoperitoneal
name the specific effects from contusion damages in occipital, frontal, and temporal lobes
occipital (vision/balance)
frontal (higher level thoughts)
temporal lobes (speech)
give an example of what can trigger GBS & what to look for generally
1. vaccines, may trigger a body response to itself (myelin sheaths)
2. look for peripheral & progressive weakness inward/upward, find out what triggered this - it presents quickly
what vaccines have reduced the rates of meningitis? what are still the risks?
1. Hib (Haemophilus influenzae type B)
2. pneumococcal (Streptococcus pneumoniae)
3. meningococcal vaccines (Neisseria meningitis)
there’s still a risk with patients too young to be vaccinated
name of NTD (neural tube defect) where the sac ruptures (spinal cord is exposed), LE may have decreased function & may be caused by spina bifida
myelomeningocele
name 4 ways that CSF can overproduce to cause hydrocephalus
1. the body can overproduce CSF faster than it can be reabsorbed
2. have an obstruction in the flow that causes CSF backup
3. not reabsorb
4. CSF can also take more space due to an infection or intracranial bleed
name the injury in the brain that causes bleeding where it shouldn't be
hematomas
when do symptoms usually occur after a vaccination and what is the primary concern with this?
10 days, primary concern is paralysis that eventually reaches the diaphragm = acute respiratory failure
name the 2 specific assessments to identify meningitis & explain how they are used
1. KErnig: lying flat on the back with thigh flexed, other leg cannot extend completely from the pain, Knee Extension is painful
2. brudziNsKi: Neck flexion, would lead to Knee flexion from pain
this syndrome is a main reason we do not give children aspirin (viral with aspirin = bad reaction), may cause rapid inflammation to the brain and liver. what drug type are we trying to avoid, example?
1. Reye's
2. Salicylates (pepto bismal)
name 4 symptoms other than ICP that cause hydrocephalus
1. frontal bossing (prominent forehead due to constant ICP, dilated scalp veins (craniomegaly)
2. bulging fontanels/wide sutures
3. thinner cranial bones “cracked-pot sound”
4. setting-sun eyes (sclera visible above the iris)
name 3 of the treatment methods for cerebral edema, and why is one of them a contraindication?
1. craniotomy: take out a portion of skill = decrease swelling
2. external ventricular drains (tube into skull cavity, the pressure gets above a point = it will drain cerebral spinal fluid, EVDs)
3. mannitol (diuretic) or 3% NS (more NaCl in it, water will get pulled into the bloodstream & take it out) ** very hypertonic state **
how long does this last? how is it treated? and what would be a future contraindication?
1. this is temporary, body will stop attacking meyelin & reform
2. manage with ventilator, IVIG/steroids to reduce immune response, may take weeks-months
3. vaccines
what precautions are taken if this is suspected & why? name the hallmark sign for this?
1. if considered, prophylactic antibiotics are often started while waiting for culture results.
2. can cause long-term disability due to damage to the brain = stuck at early stage of development (others: seizures, lethargy, confusion, abnormal aggression, come, and death)
3. nuchal rigidity
what are VP shunts proned to? which can lead to what?
how should they be managed post-op?
1. kinking, clogs, or separating = leading to CSF recollecting or draining elsewhere (symptoms will be similar to increased ICP or a fluid-filled mass) or increased risk for infection (meningitis/encephalitis)
2. the peritoneal end is often “pigtailed” to allow lateral growth without needing to replace the VP tubing, rest is best (limit movement)