WEEK: LECTURE: 7 NEUROLOGICAL DISORDERS THE BRAIN . An enclosed system due to the skull · Limited room For swelling to move · Increase in volume = increase in pressure 4 Intracranial pressure (ICP) " A rapid increase can lead to herniation 4 Any damage to brain stem can lead instantaneous death Compression of the opposite cerebral peduncle against the unyielding tenforium Herniation of cingulate gyrus under falx cerebri Herniation of temporal lobe into tentorial notch Downward displacement of brain stem through tentorial notch . To prevent increase the pressure the brain will reduce CSF, blood, brain tissue as compensation For the increased volume. This is not long term SOL - SPACE OCCUPYING LESSION Anything that causes an increase in pressure inside the brain Tumour, oedema Fluid Increased volume of intracranial content or an abnormal accumulation of Fluid and cerebral tissue Increased cerebral spinal Fluid due to hydrocephalus Focal lesion (accumulation of blood) Abscess, tumour, haematoma HYDROCEPHALUS Infants born with hydrocephalus have a enlarged head as the skull hasn't Fused Only effective up to a certain point IF no intervention, it will start to affect the brain tissue If hydrocephalus develop slowly an adult, ventricles expand and atrophy of brain tissue will occur lateral ventricles foramen of Monro third ventricle aqueduct of Sylvius fourth ventricle central canal subarachnoid space 3 cisterna magna HERNIATION
7 NEUROLOGICAL DISORDERS WEEK: LECTURE: INCREASE INTERCRANIAL PRESSURE C nI l fE uR T aT nT Stages of compensation: Removal of a portion of the skull Craniotomy/craniectomy Relieves the pressure Headaches, confusion and lethargy Due to pressure on pain receptors around intracranial blood vessels and dura mater Preventing events that may permanently damage brain tissue Blurred vision - papilloedema Due to swelling and compression of optic nerve Hypertonic saline solution Draws out the water to itself relieving intracranial pressure Nausea, vomiting Due to pressure on vomiting centres in brainstem Should be careful when using as not to dehydrate the brain or cells, causing necrosis if pressure is not decreased, decompensation occurs · Stages of decompensation: Irregular pattern of breathing A eS eN Papillary changes The Glasgow coma scale allows us to assess the level of severity Changes in blood pressure and pulse Abnormal Flexor and extensor responses Bilateral dilation and Fixation of pupils are a sign of end of life Coma " Herniation and death
NEUROLOGICAL DISORDERS WorkShop: 1. What neurological changes occur with ageing? How do the changes alter function/behaviour? Physical Changes : - Brain Atrophy ( loss of mass) - Impaired memory recall - Loss of white matter (myelin shealths) - Cortical Atrophy (reduced cortical density) - Reduced attentiveness Reduction in neurotransmitter production - Impaired ability for multitasking Most affected areas: Frontal lobe $ hippocampus Functional Changes : - Impaired cognitive function - Altered personality/ mood 2. What condition could explain Mr Tien's actions of urinating in the sink, as well as his restlessness and pulling out his nasal prongs? Condition: Delirium Reasons : confused acute onset could be infection ( e. UTI) restlessness Cognition