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Acute Brain Disorder (Mechanisms of Brain Injury (primary injury. (( …

- - - -  Head trauma
      -  Cessation of blood flow - Stroke
      -  Brain tissue necrosis
      -  Cytotoxic edema
  - - - progress over days or weeks
      - preventing secondary damage have remained elusive
      - mortality and morbidity ↑
- - - - headache
      - Vomiting
      - blurry vision
        → edema of the optic disk (papilledema).
    - - he level of consciousness decreases
        
         pupil responsiveness to light becomes impaired.
        
         exhibit altered respiratory patterns ,unresponsive to stimulation , unable to move, verbalize, open the eyes.
    - - Central lowly dilating or odd-shaped pupils
        indicates compression
        the third cranial nerve
        Midbrain
        ation
- - - -  Aspirin may be administered following negative findings of hemorrhagic stroke on CT scan
        
         affects platelet aggregation and may help inhibit thrombus size.
        
         Thrombolytic therapy is most effective in limiting infarct size if it is initiated early.
        
         prevent further cerebral hypoxia or ischemia after ischemic stroke.
        
         volume depletion,hemoconcentration, hypotension, and arterial obstruction must be avoided.
- - - -  Warning leaks may occur before an aneurysm ruptures
      -  often produce severe headache
      -  the worst headache I have ever had.
      -  photophobia (visual sensitivity to light)
      -  nausea/vomiting
      -  stiff neck
      - Treatment
        
         Surgical stabilization
        
         the complications of cerebral vasospasm
        
         careful and frequent neurologic assessments
- - - - → vessels to progressively enlarge
    - - surgically removed
        gamma knife or stereotactic radiosurgery
- - - -  meningitis is bacterial in origin, but it can also be viral or fungal.
      -  The bacterium most frequently involved in causing meningitis in adults is Streptococcus pneumoniae
      -  by way of the bloodstream or by extension from cranial structures, such as the paranasal sinuses or ears.
      - Treatment
        
         Treatment includes general supportive care
         Vaccination against Neisseria meningitidis provides short-term protection (a few years).
- - - -  Supportive and symptomatic
      -  moderate to severe disease require careful and ongoing neurologic assessment
      -  Seizures are a common complication in encephalitis
      -  hypoxia, tissue destruction, toxic encephalopathy
      -  inflammatory vasculitis, hyponatremia.
      -  Steroids control edema、anticonvulsants to prevent seizures
      - analgesics to relieve headaches、antipyretics to control hyperthermia
- - - -  After cardiopulmonary stabilization, Hematomas, depressed skull fractures, and bleeding vessels require prompt surgical intervention.
      -  insertion of ICP monitors and/or CSF drainage devices.
      -  maintain ICP
      -  ICP can be managed with administration of mannitol (osmotic diuretic), sedation, hypothermia, and mild hyperventilation.
      -  Repeat radiologic examination
      -  Patients with open head injuries may be treated with prophylactic antibiotics to prevent CNS infection