• Brain abscess s/s (infection, pus) Signs of infectious etiology, localized collection of pus -Stiff neck, headache, intracranial pressure, change in LOC, vision/speech/behavior changes • Priority assessments ABC’s (airway, breathing/respiratory, circulation/cardiovascular), level of consciousness • Glascow coma scale Used to assess LOC in acutely brain-injured patients, eye opening/arousal-directed responses/motor reactions, under 8 is severe, over 12 is mild • Mechanisms of spinal cord injuries Hyperflexion (forward), hyperextension (backward), compression • Decorticate vs decerebrate posturing Decorticate=abnormal flexor (arms/hands up on chest), decerebrate=abnormal extension (arms/hands at sides) • Meningitis (S.P. bacteria in CNS) -Bacteria usually reach the CNS via the bloodstream or extension from cranial structures like sinuses or ears. -Most common bacteria are Streptococcus pneumoniae. -Bacteria invade leptomeninges; accumulation of inflammatory exudate can result in obstructive hydrocephalus (excess fluid in head). -Classic presentations: headache, fever, stiff neck (meningismus), and signs of cerebral dysfunction (confusion, delirium) • Types of traumatic brain injuries LOCATION: Primary=focal (coup), polar (coup countercoup)(acceleration/deceleration, injury to polar sides), diffuse (widespread) MECHANISM: Concussion, contusion, intracranial hematomas=epidural, subdural, subarachnoid SEVERITY: Secondary Injury=ischemia (decreased blood flow), hypoxic events (decreased blood oxygenation), vasogenic/neurogenic edema • Focal (coup) brain injuries -Localized to site of impact -Decreased LOC, muscle weakness, cranial nerve dysfunction • Difference between hemorrhagic stroke and thrombotic/embolic stroke (ischemic) as well as diagnosis -Ischemic strokes result from sudden occlusion of a cerebral artery secondary to thrombus formation or embolization -Thrombotic strokes associated with atherosclerosis and coagulopathies- clot traveled to brain -Hemorrhage within the brain parenchyma , usually occurs secondary to severe, chronic hypertension (secondary injury, morbidity much higher) -CT, MRI, LOC • Increased intracranial pressure s/s -Headache, vomiting, and altered level of consciousness (drowsiness) -Blurry vision and edema of the optic disk (papilledema) -As ICP rises to higher levels, LOC decreases, pupil responsiveness to light becomes impaired; altered respiratory patterns and unresponsive to stimulation; unable to move, verbalize, or open the eyes • Activities that cause traumatic brain injuries Transportation-related accidents, falls, firearms, sports-related accidents • Differences between subarachnoid hemorrhage, epidural hematoma, subdural hematoma Subarachnoid: (berry aneurysm/circle of willis/thunderclap) -Collection of blood between arachnoid membrane and the pia mater -Caused by rupture of bridging veins that pass through the subarachnoid space -More commonly associated with rupture of cerebral aneurysms or arteriovenous malformations; arterial in origin -Blood spreads throughout CSF, causing meningeal irritation, hydrocephalus, headache, vasospasms, ischemia Epidural: (lens/arteries/trauma/lucid interval before rapid deterioration) -Collection of blood between dura and skull, outside brain tissue -Typically involves arterial injury thus rapid onset of symptoms -Brief period of disturbed consciousness followed by a period of normal cognition (lucid interval), then consciousness rapidly deteriorates Subdural: (crescent/veins/older/alcohol/rebleeding risk/increased ICP) -Collection of blood between dura and outer layer of arachnoid membrane -Typically involves bridging veins; symptom onset may be slower -Acute: symptoms within 24 hours of injury -Subacute: increased ICP (headache, vomiting, blurred vision) 2 to 10 days later -Chronic: prone to rebleeding • Diagnosis of seizures -Clinical symptoms -Electroencephalograms: assess electrical patterns of brain regions -Laboratory studies: identify metabolic/nutritional deficits, infections, and exposure to toxins -Lumbar puncture: for CNS infections -CT, MRI: for structural causes • Cerebral aneurysm (dilation/ballooning of an artery, circle of willis) -Lesion of an artery that results in dilation and ballooning of a segment of the vessel -High blood pressure, acute alcohol intoxication, and recreational drug use (especially cocaine) implicated -Congenital defect of the medial layer of the artery weakens, allowing dilated portion to fill with blood and eventually burst causing hemorrhage; most found in circle of Willis. -Clinical manifestations: typical presentation is severe headache with meningismus; photophobia (visual sensitivity to light), n/v • Reperfusion injury - Once blood supply is re-established, injury is caused by free radical