Neurosurgical emergencies课件.ppt

* * * * * * * * * * * * Management of Elevated ICP: Interventions Airway/ventilator support Maintain adequate CPP Osmotic diuresis Hypertonic saline Sedation/analgesia Hypothermia Neuromuscular blockade Barbiturate coma Glycemic control CSF drainage Craniectomy Therapeutic Modalities for Reduction of ICP CNS Infections Meningitis Abcess Brain Spinal cord Subdural Epidural Encephalitis CNS Infections: Signs and Symptoms Meningismus Nuchal rigidity Headache Photophobia Fever Lethargy CNS Infections: Cause Bacterial Viral Fungal Parasites Prions CNS Infections: Pathophysiology Hematogenous Originate from infection elsewhere in the body Respiratory Endocarditis Direct extension Sinus infections Osteomyelitis Trauma or surgery Meningitis Viral meningitis causes milder symptoms, requires no specific treatment, and resolves without complications Bacterial meningitis is a very serious disease and may result in a learning disability, hearing loss, permanent brain damage, and even death Viral infections are 2-3 times more common. Meningitis Overall incidence of bacterial meningitis in US is estimated to be more than 400 per 100,000 newborn babies, and 1-10 cases per 100,000 adults per year, or 25,000 cases yearly Approximately two-thirds of all cases are in children Usually occurs in isolated cases without epidemics More common in males than females More likely in late winter and early spring Meningitis Three types of bacteria are the most common causes of meningitis in all age groups except newborns: Streptococcus pneumonia (causing pneumococcal meningitis) Neisseria meningitidis (causing meningococcal meningitis) Haemophilus influenza type b (Hib) Hib vaccine as part of routine pediatric immunization has significantly reduced the occurrence of serious Hib disease Newborns are usually infected with coliform (bacteria in the gut, contracted at birth) such as Escherichia coli or Listeria and Group B Strep Brain Abcess Types of Primary TBI Skull fracture vault or basilar h