Acute Intracranial
Problems
Megan McClintock, MS, RN
11/4/11
Head Injury
Head Injury
Skull Fractures
 Basilar
 Frontal
 Temporal
 Parietal
 Posterior fossa
Head Trauma
 Diffuse Injuries
 Concussion
 Diffuse axonal injury (DAI)
 Focal Injuries
 Lacerations
 Contusions
 Hematomas
 Cranial nerve injuries
Complications
 Epidural hematoma
 Bleeding between the dura and the skull
 Arterial or venous
 Initial LOC, brief lucid interval, decrease in LOC
 Headache, nausea, vomiting
 Subdural hematoma
 Bleeding between the dura mater and the arachnoid layer
 Usually venous
 Acute, subacute, or chronic
 Symptoms similar to a stroke, TIA, or dementia
 Intracerebral hematoma
 Usually occurs in frontal or temporal lobes
Diagnostic Studies
 CT
 MRI (for smaller lesions)
 Cervical spine xrays
 Most important to diagnose timely and get them to
surgery (if needed) and keep ICP from increasing
 Craniectomy
 Craniotomy with surgical evacuation
 Hemicraniectomy
Goals
 Maintain cerebral blood flow
 Remain normothermic
 Control pain
 Prevent infection
 Attain maximum cognitive, motor, sensory function
Interventions
 Prevention
 Monitor for changes in neuro status
 Encourage family members to stay
 Lubricating eye gtts, tape eyes shut
 Do not allow fever or shivering
 Watch for otorrhea/rhinorhea
 HOB up
 Collection pad (no packed dressings)
 No NG tubes
 No sneezing or blowing nose
 No nasotracheal suction
Brain Tumors
 Can occur anywhere
 Can be primary or secondary
Brain Tumors
 Symptoms depend on location
 Dx studies – CT, MRI, no LP, biopsy
 Tx – surgical removal, VP shunt, radiation therapy,
chemotherapy
Cranial Surgery
 Burr hole
 Craniotomy
 Craniectomy
 Cranioplasty
 Stereotactic
 Shunt
Interventions
 Hair is shaved in the OR
 Usually need ICU after surgery
 Prevention of increased ICP
 Frequent neuro assessments for first 48 hrs
 Closely monitor F&E status
 Prevention of pain and nausea
 HOB at 30 degrees (except for posterior fossa, burr hole)
 Do not position patient on operative side with craniectomy
Brain Abscess
 Accumulation of pus within the brain tissue
 Sx – headache, fever, n/v, focal symptoms, s/s of  ICP
 Tx – antimicrobial therapy, may need surgical drainage or
removal (if encapsulated)
 If untreated, mortality is almost 100%
Bacterial Meningitis
 Usually Streptococcus pneumoniae, Neisseria
meningitidis, used to be Haemophilus influenzae
 Less common in summer
 MEDICAL EMERGENCY!!!!
 Sx – fever, headache, n/v, nuchal rigidity, photophobia,
decreased LOC, ICP, skin rash
 Cx – neuro deficits, chronic headache,
Waterhouse-Friderichsen syndrome
Treatment
 Dx – blood culture, CT, LP (high protein, low glucose,
purulent)
 Tx – immediate antibiotic therapy (after culture), may give
decadron
Interventions
 Prevention with immunizations
 Vigorous treatment of ear and resp infections
 Seizure precautions
 Codeine for pain
 Dark room, cool cloth, quiet, decreased stimuli
 Avoid restraints
 Family at bedside
 Control fever
 Respiratory isolation!!!!
Viral Meningitis
 Also called aseptic meningitis
 Caused by a variety of viruses , sometimes through
personal contact or by insects, most people have the
viruses but don’t develop meningitis
 Usually mild and self-limiting
 Give antibiotics until you confirm that it is viral
 Only treat symptoms
Encephalitis
 Acute inflammation of the brain
 Can be fatal
 Usually caused by a virus
 See as a complication of AIDS
 Sx – fever, headache, n/v, then CNS abnormalities
 Tx – may need ICU, antivirals,
1. Intracranial pressure monitoring is instituted for a patient
with a head injury. The patient’s arterial blood pressure is
92/50 mm Hg, and intracranial pressure is 18 mm Hg. Using
these values to calculate the patient’s cerebral perfusion
pressure (CPP), the nurse determines that
1. the CPP is adequate for normal cerebral blood flow.
2. to prevent cerebral hypoxemia, the patient’s blood pressure
should be increased.
3. the CPP is so low that ischemia and neuronal death are
imminent.
4. lowering the patient’s blood pressure will reduce the
intracranial pressure, increasing cerebral blood flow.
3. Management of the patient with bacterial meningitis includes
1. administering antibiotics immediately following collection of
specimens for culture.
2. waiting for results of a CSF culture to identify an organism before
initiating treatment.
3. providing symptomatic and supportive treatment because drug
therapy is not effective in treatment.
4. obtaining skull x-rays and CT scans to determine the extent of the
disease before treatment is started.