Symptoms 222 Treatment 223 Etiology 224 Presenting Symptoms 225 Assessment of Intracranial Aneurysms 226 Venous Angiomas Developmental Venous Anomaly 227 Capillary Angiomas and Telangiectasia 228 Presenting Symptoms 229 Outcomes 230 Moyamoya Syndrome [books.google.com]

A 9-year-old previously healthy girl presented with 3 weeks of intermittent emesis and headache to a community emergency department, where she had rapid decompensation due to increased intracranial pressure. [scholars.northwestern.edu]

Wherever possible, references were attributed- but unfortunately a lot of this stuff is found in various neurosurgical presentation slides and "learning packages" from universities, rather than peer reviewed material. [derangedphysiology.com]

Subfalcine herniation, midline shift, effacement of the ipsilateral lateral ventricle, and enlargement of the contralateral occipital horn are present. [emedicine.medscape.com]

• Rhinorrhea

  The former may be recognized by leakage of CSF through the nose (rhinorrhea) and the latter by leakage from the ear (otorrhea). This leakage is a potential direct passage for bacteria to travel from the exterior to the subarachnoid space. [dartmouth.edu]

• Vomiting

  A 36 year old man began to suffer garbled speech, vomiting, and left-sided weakness. His wife, who was a nurse, recognized the symptoms as a potential stroke and called an ambulance. The man was taken to the nearest emergency department. [altizerlaw.com]

  […] this part major parts of the brain stem Medulla parts medulla pyramids functions medulla nuclei functions midbrain, pons, medulla oblongata pyramids and nuclei corticospinal tracts, controls voluntary movements of the limb… cardiovascular, respiratory, vomiting [quizlet.com]

  Intracranial Aneurysms 226 Venous Angiomas Developmental Venous Anomaly 227 Capillary Angiomas and Telangiectasia 228 Presenting Symptoms 229 Outcomes 230 Moyamoya Syndrome 231 Outcomes 232 Nursing Care for Vascular Brain Lesions 233 Management of Nausea and Vomiting [books.google.com]

  Symptoms of raised ICP are generally nonspecific (e.g., impaired consciousness, headache, vomiting). However, more specific symptoms may be present depending on the affected structures (e.g., Cushing triad if the brainstem is compressed). [amboss.com]

  Unconcsious people need a lot of care in order to avoid pneumonia (from aspirating their own secretions, vomiting, etc.) and if they are unconscious for a long time, the mode of death can be pneumonia. [virtualtrials.com]

• Nausea

  […] of Intracranial Aneurysms 226 Venous Angiomas Developmental Venous Anomaly 227 Capillary Angiomas and Telangiectasia 228 Presenting Symptoms 229 Outcomes 230 Moyamoya Syndrome 231 Outcomes 232 Nursing Care for Vascular Brain Lesions 233 Management of Nausea [books.google.com]

  As pressure increases near the medulla, the patient may experience projectile vomiting with no associated nausea, and cardiac arrhythmias can range from supraventricular tachycardia to severe bradycardia. [emsworld.com]

• Hypertension

  Craniopharyngiomas and emergency management of intracranial hypertension are reviewed. [scholars.northwestern.edu]

  When intracranial hypertension is suspected, an immediate CT scan should be obtained to assess the degree of ICP increase and to identify the cause of the this. [hawaii.edu]

  Cardiovascular dysfunction in phase 1 is a hyperdynamic and hypertensive state characterized by elevated systemic vascular resistance and cardiac contractility. [ncbi.nlm.nih.gov]

  On the basis of our observations we believe that arterial hypertension and advanced age are risk factors for the development of Duret hemorrhage. [link.springer.com]

  Intracerebellar Hemorrhage 162 Pediatric TBI 163 Diffuse Axonal Injury 169 Penetrating Craniocerebral Injury 170 Inflicted TBI 171 Concepts of Cerebral Physiology 174 Cerebral Blood Flow 175 Cerebral Edema 176 Collaborative Management of Intracranial Hypertension [books.google.com]

• Slow Pulse

  pulse Severe headache Weakness Cardiac arrest (no pulse) Loss of consciousness, coma Loss of all brainstem reflexes (blinking, gagging, and pupils reacting to light) Respiratory arrest (no breathing) Wide (dilated) pupils and no movement in one or both [medlineplus.gov]

• Anisocoria

  Patients in the conventional dosage group received 0.6 to 0.7 gm/kg mannitol, and those in the high dosage group received a total of 1.2 to 1.4 gm/kg if they did not have pupillary anisocoria, and 2.2 to 2.4 gm/kg if they had anisocoria. [neupsykey.com]

• Miosis

  […] diameter Inferior displacement of the basilar artery Coma Parinaud's syndrome: Diabetes insipidus Tonsillar Cerebellar tonsil below the foramen magnum Coma Apnea Hypertension Upward Flattened quadrigeminal cistern "Spinning top" midbrain Hydrocephalus Coma Miosis [derangedphysiology.com]

• Withdrawn

  Despite medical and surgical intervention, the patient had progression of herniation with global cerebral infarction, and care was withdrawn. [scholars.northwestern.edu]

  If it is found to be very high, no fluid is withdrawn, because withdrawal of fluid could cause herniation of the brain stem. [science.jrank.org]

• Stroke

  The problems from a stroke can be more or less anticipated by the area struck as well as, the steps needed for recovery afterwards. An infarction is a stroke that occurs in the brain stem which is the area my stroke hit. [thequadspot.com]

  His wife, who was a nurse, recognized the symptoms as a potential stroke and called an ambulance. The man was taken to the nearest emergency department. He was examined and a Code Stroke was called. A CT/CTA was done, and was reported as normal. [altizerlaw.com]

  Effects of hypertonic (10%) saline in patients with raised intracranial pressure after stroke. Stroke 2002;33:136-40 «PMID: 11779902»PubMed Toni D, Chamorro A, Kaste M ym. Acute treatment of ischaemic stroke. European Stroke Initiative. [kaypahoito.fi]

  Google Scholar strokeaha Stroke Stroke Stroke 0039-2499 1524-4628 Lippincott Williams & Wilkins Response: Canhão Patrícia, MD and Ferro José M., MD, PhD 01 02 2006 We thank Petzold et al for illustrating with this case report the results of our study, [stroke.ahajournals.org]

  This is most often the result of brain swelling or bleeding from a head injury, stroke, or brain tumor. [medlineplus.gov]

• Stupor

  […] and coma with mcc 081 Nontraumatic stupor and coma without mcc Convert G93.5 to ICD-9-CM Code History 2016 (effective 10/1/2015) : New code (first year of non-draft ICD-10-CM) 2017 (effective 10/1/2016) : No change 2018 (effective 10/1/2017) : No change [icd10data.com]

  stupor and coma without mcc [forums.acdis.org]

  That is, the patient may appear confused, stuporous, or delirious. Stupor. The patient is unresponsive and can only be aroused via intense, loud, or painful stimulation. [brainmind.com]

  Changes in consciousness begin with decreasing alertness, progressing to drowsiness, stupor and coma. ii. [kobiljak.msu.edu]

  Stage Consciousness Respiration Cranial nerves Motor examination Early diencephalic Stupor Normal Normal reactive pupils Roving eye movement Absent doll's eye Increased tone Late diencephalic Coma Cheyne-Stokes Small eactive pupils Present doll's eye [derangedphysiology.com]

• Papilledema

  Papilledema Papilledema. The edematous optic papillae protrude forward into the vitreous chamber. Normal white matter Edematous white matter Edematous white matter. The empty spaces represent interstitial fluid. [neuropathology-web.org]

  Brain imaging (e.g., showing a midline shift) and physical examination (e.g., papilledema ) can detect ICP elevation, but not necessarily rule it out. Therefore, ICP monitoring and quantification is vital in at-risk patients. [amboss.com]

  Commonly Described Neurologic Signs of Head Trauma Papilledema is evidence for increased intracranial pressure. Thirty minutes to several hours of increased pressure are required before papilledema becomes clinically apparent. [dartmouth.edu]

  If there is an unexplained history of worsening headache, intractable vomiting, seizure, focal neurologic signs, altered consciousness, or papilledema, computed tomography should be performed. [anesthesiology.pubs.asahq.org]

  When the herniation is of sufficient severity, obstruction of the aqueduct may occur leading to increased intraventricular pressure and varying degrees of hydrocephalus and papilledema (7, 8). [ajnr.org]

• Decerebrate Posturing

  Midbrain and upper pons Both pupils fixed and unreactive Hyperventilation or Cheyne-Stokes Absent (eyes fixed) Decerebrate posturing, or nothing Lower pons and medilla Both pupils fixed and unreactive Apnoea Absent (eyes fixed) Unresponsive, flaccid [derangedphysiology.com]

  Decerebrate posturing in response to noxious stimuli and hyperventilation may be seen. Secondary brainstem hemorrhages (Duret hemorrhages) may occur, probably because of compression and stretching of blood vessels, especially veins. [kobiljak.msu.edu]

  As brainstem dysfunction proceeds inferiorly, decerebrate posturing (figure bottom) occurs, recognized as rigid extension of the arms with internal rotation, and extension of the legs with internal rotation and downward pointing of the toes. [casemed.case.edu]

  posturing, apnea, impaired circulation, death References: [8] [12] [13] [14] [15] [16] [17] Diagnostics Imaging Clinical examination and imaging may indicate elevated ICP, but cannot rule it out! [amboss.com]

  Decerebrate posturing is manifested by leg extension along with arm extension and internal rotation that can occur spontaneously or following any noxious stimulation (such as tickling the nose). [dartmouth.edu]

• Decorticate Posture

  Decorticate posturing (figure top) is recognized as bilateral flexion at the elbows and wrists, shoulder adduction and extension of the lower extremities occurring with lesions above the midbrain’s red nucleus. [casemed.case.edu]

  The disrupted brainstem can lead to decorticate posture, respiratory center depression and death. [en.wikipedia.org]

  posturing Midbrain and upper pons Coma Hyperventilation Mid-size unreactive pupils Present doll's eye Restriction of upward gaze (Parinauds' syndrome) Decerebrate posturing Lower pons and medilla Coma Ataxic breathing Mid-size unreactive pupils Absent [derangedphysiology.com]

  Decorticate posturing is similar but leg extension is accompanied by arm flexion and internal rotation. To produce this type of posturing, descending cortical motor impulses must be interrupted. [dartmouth.edu]

Options 216 Family Education 217 Pathophysiology 218 Treatment 219 Outcomes 221 Presenting Symptoms 222 Treatment 223 Etiology 224 Presenting Symptoms 225 Assessment of Intracranial Aneurysms 226 Venous Angiomas Developmental Venous Anomaly 227 Capillary [books.google.com]

Treatment & Monitoring What are the treatments for the condition? This is a medical emergency, so treatment must be started right away. Treatment is aimed at reducing the brain's swelling. [medicineonline.com]

Dan Heffez, the team at The Wisconsin Chiari Center will create a treatment plan geared to your specific situation. [columbia-stmarys.org]

Without treatment, death is likely. There can be damage to parts of the brain that control breathing and blood flow. This can rapidly lead to death or brain death. [mountsinai.org]

Although the development of central brain herniation after initiation of treatment for DKA is unpredictable, it typically becomes evident 6 to 13 hours after treatment has begun (4, 6). [ajnr.org]

Such patients are not dead, and their prognosis depends in large part on the quality of the care they receive. The discussion of their management occasionally abuts onto controversies about euthanasia and the “right to die.” [britannica.com]

[…] increasing the breathing rate to reduce the levels of carbon dioxide (CO 2 ) in the blood Removing blood or blood clots if they are raising pressure inside the skull and causing herniation Removing part of the skull to give the brain more room Outlook (Prognosis [mountsinai.org]

There are four types of Chiari malformation, and they represent very different disease processes with different symptoms and prognosis. [en.wikipedia.org]

Prognosis is particularly poor among those who show posturing or flaccidity of the muscles (Nikas, 1987a) Mortality: General Complications. [brainmind.com]

Prognosis in Cerebral Herniation Syndromes Although the overall prognosis for patients with clinical herniation syndromes is poor, it is by no means hopeless. [neupsykey.com]

181 Temperature Regulation 182 Additional Nursing Care 183 Syndrome of Inappropriate Secretion of Antidiuretic Hormone 184 Preoperative Baseline 185 Postoperative Complications 186 Outcomes 187 References 188 Spine 191 Traumatic Spinal Cord Injuries Etiology [books.google.com]

[…] herniation transalar herniation : ascending and descending transtentorial herniation downward: uncal herniation upward: ascending transtentorial herniation* tonsillar herniation* e xtracranial herniation * theoretically not cerebral but cerebellar herniation Etiology [radiopaedia.org]

For specific brain diseases see under headings relating to etiology and lesion. brain abscess common signs caused by an abscess in the brain are circling, rotation of the head, abnormal reflexes in one eye. [medical-dictionary.thefreedictionary.com]

Etiology Idiopathic intracranial hypertension CNS inflammation, infection, and/or abscess Space-occupying lesions Intracranial hemorrhage or hematoma Aneurysm Intracranial tumors Elevated venous pressure (e.g., as a result of heart failure ) Increased [amboss.com]

[…] unpredictable, conjugate fast eye movements without inner saccadic intervals. it is also referred to as saccadomania or reflexive saccade. the movements of opsoclonus may have a very small amplitude, appearing as tiny deviations from primary position. possible etiologies [allnurses.com]

Martins, F. et al. (1998): “Spinal cord injuries ą Epidemiology in Portugal’s central region”. Spinal Cord, 36 (8): 574-578. Mills, P. [cedd.net]

Traumatic brain injury: Definition, epidemiology, pathophysiology. Emedicine.com. Retrieved on January 28, 2007. ^ a b c Hudson K (2006). "Brain Herniation Syndromes - 2 Nursing CEs". Dynamic Nursing Education. [en.wikipedia.org]

The pathophysiology of Duret hemorrhage remains under debate: arterial origin (stretching and laceration of pontine perforating branches of the basilar artery), versus venous origin (thrombosis and venous infarction). [link.springer.com]

Nursing Care 200 Summary 202 KlippelFeil Syndrome 205 Outcomes 206 Summary 208 Neurovascular Disease 211 Arterial Supply 212 Venous Supply 213 Vein of Galen Aneurysmal Malformations 214 Diagnostic Tests 215 Treatment Options 216 Family Education 217 Pathophysiology [books.google.com]

Third, with progression of intracranial pathophysiology to terminal brain stem herniation, multisystem consequences occur, including dysfunction of the hypothalamic-pituitary axis, depletion of stress hormones, and decreased thyroid hormone bioavailability [ncbi.nlm.nih.gov]

Aneurysm Intracranial tumors Elevated venous pressure (e.g., as a result of heart failure ) Increased CSF ( hydrocephalus ) Metabolic disturbances ; (e.g., hyponatremia, hepatic encephalopathy ) Epilepsy and seizures References: [1] [2] [3] [4] [5] [6] [7] Pathophysiology [amboss.com]

— Vascular pathophysiology and acute and chronic oxygen deprivation. In MINCKLER, J., ed. — Pathology of the Nervous System. McGraw-Hill Book Co., New York, 1S68, vol. 1, p. 341-350. 19. HOWELL, D. [scielo.br]

Prevention & Expectations What can be done to prevent the condition? Some causes cannot be prevented. For instance, a brain tumor cannot be prevented. [medicineonline.com]

Herniation and swelling of the brainstem prevents the flow of CSF out of the skull to the spinal cord, and effaces the fourth ventricle. [anatomicaljustice.com]

To help reverse or prevent a brain herniation, the medical team will treat increased swelling and pressure in the brain. [mountsinai.org]

Prevention of hip fracture in elderly people with use of a hip protector. ‏ [books.google.com]

I usually continue Dilantin "to the end", this to prevent any seizure activity which, whether the patient is awake or not, can be disturbing to the family. [virtualtrials.com]