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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]
Anorexia
  • 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]
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
  • 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]
  • 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]
  • Clinical signs and symptoms of acute increased intracranial pressure include, headache, vomiting, vision distortion, diminished sensorium, pupillary dysfunction, hypertension, bradycardia, flexor/extensor posturing, etc.[hawaii.edu]
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]
  • 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]
  • 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]
Palpitations
  • This edition's highlights include new chapters on palpitations, cystic fibrosis, travel related emergencies, and ultrasound and a new appendix on practice pathways.[books.google.com]
Muscle Spasm
  • She and my doctors thought it had been a muscle spasm or something, not true movement. In a future post I will share how my determined mother learned how to get me to move. It took over two years to regain movement in my left arm and hand.[thequadspot.com]
Macula
  • Downward transtentorial (central) herniation - course Uncal herniation - manifestations and mechanism 1. compress ipsilateral CN III (blown pupil, down-and-out gaze) 2. compress ispilateral PCA (contralateral homonymous hemianopia with macula sparing)[brainscape.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]
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]
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]
Hypomimia
  • Facial Expression: 0 — Normal. 1 — Minimal hypomimia, could be normal "poker face. ‏[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]
  • 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]
  • 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]
  • ., 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]
  • 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
  • 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]
  • 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]
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]
  • Marshman et al 25 have shown that the dilated and fixed pupil can rarely be contralateral to the mass lesion and thus “false-localizing,” possibly due to stretching of the contralateral oculomotor nerve from hemispheric mass effect and midline shift of[neupsykey.com]

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]
  • 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]
  • 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]
  • 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]

Prognosis

  • There are four types of Chiari malformation, and they represent very different disease processes with different symptoms and prognosis.[en.wikipedia.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]
  • 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]
  • Prognosis is particularly poor among those who show posturing or flaccidity of the muscles (Nikas, 1987a) Mortality: General Complications.[brainmind.com]

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]
  • 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]
  • […] 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]
  • 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]
  • Brain herniation represents mechanical displacement of normal brain relative to another anatomic region secondary to mass effect from traumatic, neoplastic, ischemic, or infectious etiologies. See the images below.[emedicine.medscape.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

  • 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]
  • 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]
  • ., 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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