颅脑损伤（英文版)幻灯片.ppt

Brainstem Injury Significant mechanical disruption of axons Cerebral hemispheres and brainstem High mortality rate Signs Symptoms Prolonged unconsciousness Cushing’s reflex Decorticate or Decerebrate posturing Diffuse Brain InjurySevere Diffuse Axonal Injury Pathway of Deterioration Cranial insult Tissue edema Increasing ICP Compression of arteries Decreased cerebral blood flow Decreased O2 with cellular death Edema around necrotic tissue Con’t Increasing ICP with compression of brainstem and respiratory center Accumulation of CO2 resulting in vasodilation Increasing blood volume further increasing ICP Death Any swelling or bleeding decreases the circulating blood volume and cerebral blood flow Decreased cerebral blood flow results in hypoxia and CO2 rises Hypercarbia dilates cerebral blood vessels causing increasing BP Attempts to perfuse brain resulting in increased ICP Herniation Depression of 3rd cranial nerve results in pupillary dilation- aniscoria Lateral paresis Cushing’s triad Decorticate posturing Decerebrate posturing Decorticate Posturing Results from lesions of internal capsules, basal ganglia, thalamus or cerebral hemisphere Interrupts corticospinal pathways Presents with flexed arms and extended lower extremities Decerebrate Posturing Results from injury to midbrain and pons Indicative of brainstem dysfunction Presents with extended upper extremities and pronation Extended lower extremities Usually indicative of graver injury Cushing’s Reflex Late sign of increasing ICP Bradycardia Widening pulse pressure/ increasing BP Changes in respiratory patterns Respiratory Patterns May be indicative of injury location in the brain Cheyne - Stokes Central Neurogenic hyperventilation Apneustic Cluster breathing Ataxic breathing Cheyne- Stokes Respirations Periodic breathing in which depth of each breath increases to peak then decreases to a period of apnea Hyperpneic stage usually lasts longer than apneic phase Bilateral lesions in cerebral hemispheres Ce