Term
| How is movement minimized in the CNS? |
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Definition
-separation b/n cerebral hemispheres via Falx cerebri
-separation b/n the cerebrum & cerebellum: tentorium cerebelli |
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Term
| How is the CNS protective? |
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Definition
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Term
| The CNS relies on ______ & ______, |
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Definition
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Term
| What is the point of CNS pressure autoregulation? |
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Definition
| -local blood flow remains constate despite changes in MAO from 50-160 mmHg |
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Term
| If trauma occurs and intracranial P inc, what happens to local blood flow in CNS? |
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Definition
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Term
| How is the CNS metabolically autoregulated? |
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Definition
| -cells will closely relate to blood flow |
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Term
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Definition
-sensitiv eot changes in arterial partial pressure of CO2 (PaCO2)
-inc CO2 => vasodilation |
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Term
| What are the more common causes of CNS contusion? |
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Definition
-spinal isntability: fx, luxation
-disc hernation
-blunt trauma |
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Term
| What are the more common causes of CNS compression? |
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Definition
-disc herniation
-disc protrusion
-spinal instability: fx, luxation
-blunt trauma
-localized hemorrhage |
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Term
| What is the most common location for trauma in CNS? |
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Definition
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Term
| What is the primary damage due to trauma in CNS? |
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Definition
-mechanical trauma
-axonal injury
-hemorrhage
-edema |
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Term
| What are the secondary biochemical effects due to trauma in the CNS? |
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Definition
-demyelination
-neuronal and glial cell necrosis
-inflamm response: IL, TNF, NO |
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Term
| Severity of CNS trauma depends on...? |
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Definition
-cause
-speed of onset
-duration
-location
-amount |
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Term
| Does vascular insult more commonly occur in the gray or white matter? |
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Definition
-gray
-commonly secondary to contusion/compression |
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Term
| What are some examples of vascular insult in CNS? |
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Definition
-fibrocartilagenous embolism
-feline ischemic myelopathy
-thrombosis |
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Term
| Why would you only perform a partial neuro exam w/ CNS trauma case? |
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Definition
| -DO NOT MANIPULATE SPINAL TRUAMA |
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Term
| What are the goals of exam of CNS trauma cases? |
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Definition
-determine most likely cause
-determine prognosis |
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Term
| OUtline CNS trauma triage. |
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Definition
-treat shock: fluids, eCG, oxygen, maintainairway, monitor vitals
-decide if spinal shock is present
-decide if head trauma is present
-Cushing response |
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Term
| What do we look at during triage to determine if head trauma is present? |
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Definition
-anisocoria
-pupil size
-nystagmus
-mentation/level of consciousness
-bleeding: nose, ear, eye
-less responsive PLRs |
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Term
| -What is a Cushing response due to CNS trauma? |
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Definition
-nervous system response to inc ICP
-severe cases of head injury/brain herniation
-inc BP, irregular breathing, bradycardia |
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Term
| What are the components of spinal shock? |
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Definition
-acute, swollen spinal cord
-temporary hyporeflexia/areflexia
-edema and/or hemorrhage
-focal or diffuse
-caution w/ location: resp difficulty w/ caudal cervical |
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Term
| How do we treat spinal shock? |
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Definition
-fluids: do not overhydrate!
-pain control: opioids
-steroids: methylpred sodium succinate ACUTE INJURY ONLY
-mannitol: oxygen free-radical scavenger |
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Term
| Why do we give MPSS for acute CNS injury(<8h)? |
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Definition
| -reduces edema and secondary biochemical trauma |
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Term
| In general, how do we treat head trauma? |
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Definition
-serial neuro exams
-keep head elevated
-fluids
-oxigen
-vent support if needed
-monitor ECG
-pain meds: opioids
-mannitol (osmotic diuretic)
-dex (Dec vasogenic edema) |
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Term
| Why would we surgically intervene w/ head trauma cases? |
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Definition
-subdural hematoma
-dep skull fracture
-debride contaminated/necrotic tissue
-stabilize intracranial P |
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Term
| What does a craniectomy do for head trauma? |
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Definition
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Term
| What does a durotomy do for head trauma? |
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Definition
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Term
| When do we use diagnostics for head trauma cases? What are they? |
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Definition
-when the patient is stable
-spinal rads, MRI, CT scan |
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Term
| What is the best way to perform spinal stabilization? Alternate options? |
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Definition
-best treatment: surgical stabilization
-others: maintain on a stable surface, provide sedation if necessary |
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Term
| What is a key prognostic indicator? |
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Definition
| -presence of deep pain nociception caudal to the lesion |
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Term
| What are some negative prognostic indicators for CNS trauma? |
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Definition
-mentation does not improve
-spinal shock
-schiff-sherrington |
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