Cerebral Edema
This kind of cerebral edema involves actual swelling of brain cells. Manifestations of this kind of edema include major changes like stupor or coma
Cytotoxic Edema
At this level of consciousness the patient is unarousable & unresponsive to external stimuli or internal needs
coma
What is the most common predisposing factor of a hemorrhagic stroke?
Hypertension
The Monroe-Kellie Hypothesis states that what two fluids are most able to compensate for changes in ICP?
Cerebrospinal Fluid (CSF) and Blood Volume (BV)
This type of cerebral edema results from water & sodium passing into peri-ventricular white matter.
Interstitial Edema
This breathing pattern is common with diffuse cortical injury. It is characterized by alternating pattern of deep and shallow breathing with periods of apnea.
Name 3 modifiable risk factors of a stroke
MODIFIABLE:
Hypertension-- **Most important & common precursor
Cigarette smoking
High cholesterol
Alcohol use
Obesity
Heart disease
Diabetes mellitus
Cocaine & other drugs
Sedentary lifestyle
The displacement of brain tissue as a result of excessive intracranial pressure is known as?
Herniation.
This kind of cerebral edema results from an increase in the ECF that surrounds brain cells. Manifestations of this edema include focal neurologic deficits, disturbances in consciousness, and severe intracranial HTN
Vasogenic Edema
This type of breathing pattern indicates damage to the medullary respiratory control center and is a chaotic respiratory effort
Ataxic Breathing
Also known as a "mini stroke", this is a brief blockage of blood flow to part of the brain characterized by focal ischemic cerebral neurologic deficits that last < 24 hrs.
Transient Ischemic Attack (TIA)
Place the following stages of intracranial hypertension in their correct order
1. herniation or loss of cerebral perfusion pressure
2. increased intracranial pressure
3. compensation
4. decompensation
Stage 1 = Compensation
increased volume in one compartment leads to a decrease in one or both of other volumes
Intracranial pressure remains near normal
Stage 2 = Increased ICP
Brain responds by constricting cerebral arteries to reduce pressure but results in hypoxia & hypercarbia and deterioration of brain function
Stage 3 = Decompensation
Cerebral arteries respond with reflex dilation
Increased blood volume leads to further increased ICP
Small changes in intracranial volume result in large changes in pressure
Stage 4 = Herniation or Loss of CPP
Swelling & pressure leads to herniation
When ICP = MABP there is no cerebral perfusion
A score of 3 implies that the person is not opening their eyes, not providing any verbal response, and not demonstrating any purposeful motor response. A GCS score of 3 suggests a profound state of unconsciousness or coma.
This type of ischemic stroke results from occlusion of smaller branches of large cerebral arteries. In the process of healing it leaves behind small cavities or “lacuna” term referring to small cavities or spaces that can form after the death of brain tissue.
A lacunar infarct
What is the BEST sign of increased ICP
A decrease in the level of consciousness is the earliest & most reliable sign of increased ICP.
Cushing's triad is a set of three classic signs associated with increased intracranial pressure (ICP), typically seen in severe brain injuries or conditions that lead to brain swelling. What are the three components of the triad?
Hypertension (High Blood Pressure): This is often characterized by an increase in systolic blood pressure.
Bradycardia
Irregular Respirations (Abnormal Respiratory Patterns): Cheyne-Stokes, Central neurogenic ventilation, Apneustic ventilation, Cluster breathing, Ataxic breathing
This is the area where blood flow is reduced but not completely stopped during a stroke. This area surrounds the central core of dead/dying cells where ischemia caused irreversible damage.
Ischemic Penumbra-- Medical interventions for evolving ischemic strokes often aim to salvage the ischemic penumbra. IV thrombolytic therapy with drugs like tissue plasminogen activator (tPA) or mechanical thrombectomy (removal of the clot using a catheter-based procedure) are common approaches. These interventions aim to restore blood flow, especially to the ischemic penumbra, and improve the chances of neurological recovery.
This CNS ischemic response triggered by ischemia of vasomotor center in brain results in increased mean arterial blood pressure, widening pulse pressure, and reflex slowing of the heart rate.
Cushing Reflex