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Brain Stem Herniation

Medullary Cone


Presentation

  • 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]
  • Results: Descending transtentorial and subfalcine herniations were present in all cases. Three patients were admitted with acute subdural hematoma and one with intraparenchymal hemorrhage.[link.springer.com]
  • الصفحة 297 - Not present 1 Periods of sadness or guilt greater than normal, never sustained for days or weeks. 2 Sustained depression ( 1 week or more). 3 — Sustained depression with vegetative symptoms (insomnia, anorexia, weight loss, loss of interest[books.google.com]
  • Subfalcine herniation, midline shift, effacement of the ipsilateral lateral ventricle, and enlargement of the contralateral occipital horn are present.[emedicine.medscape.com]
Weight Loss
  • الصفحة 297 - Not present 1 Periods of sadness or guilt greater than normal, never sustained for days or weeks. 2 Sustained depression ( 1 week or more). 3 — Sustained depression with vegetative symptoms (insomnia, anorexia, weight loss, loss of interest[books.google.com]
Vomiting
  • 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]
  • […] 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]
  • ., 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]
  • It also contains the respiratory, vasomotor and cardiac centers, as well as many mechanisms for controlling reflex activities such as coughing, gagging, swallowing and vomiting.[waiting.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]
Drooling
  • Salivation 0 Normal. 1 Slight but definite excess of saliva in mouth; may have nighttime drooling. 2 Moderately excessive saliva; may have minimal drooling. 3 Marked excess of saliva with some drooling. 4 Marked drooling, requires constant tissue... ‏[books.google.com]
Hypertension
  • Craniopharyngiomas and emergency management of intracranial hypertension are reviewed.[scholars.northwestern.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]
  • 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]
  • 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]
  • 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]
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]
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]
Loss of Initiative
  • Motivation/Initiative 0 — Normal 1 —Less assertive than usual: more passive. 2 Loss of initiative or disinterest in elective (non-routine) activities. 3 — Loss... ‏[books.google.com]
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]
  • 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]
  • Spontaneous intracranial hypotension resulting in stupor caused by diencephalic compression. Neurology 1998 ; 50 : 1854 –7. Schievink WI , Meyer FB, Atkinson JSD, et al . Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension.[jnnp.bmj.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]
  • ., papilledema ) can detect ICP elevation, but not necessarily rule it out. Therefore, ICP monitoring and quantification is vital in at-risk patients. Management usually involves osmotic diuretics such as mannitol or hypertonic saline.[amboss.com]
  • 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]
  • Papilledema may not be present if ICP increases acutely. 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]
Decerebrate Posturing
  • posturing, or nothing Lower pons and medilla Both pupils fixed and unreactive Apnoea Absent (eyes fixed) Unresponsive, flaccid Central (downward) transtentorial herniation This happens when there is downward pressure on the diencephalon.[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]
  • ., cerebellar tonsils, medulla) herniate at the foramen magnum impaired consciousness, decerebrate posturing, apnea, impaired circulation, death References: [8] [12] [13] [14] [15] [16] [17] Diagnostics Imaging Clinical examination and imaging may indicate[amboss.com]
  • Intervention at the stage of unilateral pupillary dysfunction is likely to have a better prognosis than intervention at the stage of bilateral pupillary dysfunction, decerebrate posturing and bradycardia.[hawaii.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]
Fixed Pupils
  • The result is usually fatal. [9] Other symptoms of this type of herniation include small, fixed pupils with [10] paralysis of upward eye movement giving the characteristic appearance of "sunset eyes".[en.wikipedia.org]

Workup

Ischemic Changes
  • Rapid changes along the continuum of hyperperfusion versus hypoperfusion increase risk of end-organ damage, specifically pulmonary dysfunction from hemodynamic stress and high-flow states as well as ischemic changes consequent to low-flow states.[ncbi.nlm.nih.gov]

Treatment

  • 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]
  • Please contact a medical professional for treatment and explanation, because I AM NOT A MEDICAL PROFESSIONAL far from it.) Is Anyone in There? The Glasgow Coma Scale is a scoring system used to evaluate someone’s level of consciousness.[thequadspot.com]
  • Dan Heffez, the team at The Wisconsin Chiari Center will create a treatment plan geared to your specific situation.[columbia-stmarys.org]
  • 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]
  • 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]

Prognosis

  • […] 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]
  • 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]
  • There are four types of Chiari malformation, and they represent very different disease processes with different symptoms and prognosis.[en.wikipedia.org]
  • Intervention at the stage of unilateral pupillary dysfunction is likely to have a better prognosis than intervention at the stage of bilateral pupillary dysfunction, decerebrate posturing and bradycardia.[hawaii.edu]

Etiology

  • 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]

Epidemiology

  • Woven throughout the content is new and updated material that reflects key practice differences in Canada, ranging from the healthcare system, to cultural considerations, epidemiology, pharmacology, Web resources, and more.[books.google.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]
Sex distribution
Age distribution

Pathophysiology

  • 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]
  • 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]
  • 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]
  • ., hyponatremia, hepatic encephalopathy ) Epilepsy and seizures References: [1] [2] [3] [4] [5] [6] [7] Pathophysiology Physiology Physiological ICP is 15 mm Hg in adults (in supine position ), children generally have a lower ICP ICP varies with the relative[amboss.com]
  • 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]

Prevention

  • 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]
  • .: Prevention of hip fracture in elderly people with use of a hip protector. ‏[books.google.com]
  • 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]
  • To help reverse or prevent a brain herniation, the medical team will treat increased swelling and pressure in the brain.[mountsinai.org]
  • 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]

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