Question

1. Describe how an infant may compensate for increased intracranial pressure
2. Describe the six levels of consciousness
3. Describe a coup and contra coup head injury
4. Differentiate between a generalized seizure and a partial (focal) seizure. How can one guess about the area of focus regarding a partial seizure based on the characteristics of a seizure?
5. What is hydrocephalus and how is it managed?

Answer 1

Increased intracranial pressure (ICP) is associated with worse outcome after traumatic brain injury (TBI). The current guidelines and management strategies are aimed at maintaining adequate cerebral perfusion pressure and treating elevated ICP. Despite controversies, ICP monitoring is important particularly after severe TBI to guide treatment and in developed countries is accepted as a standard of care. We provide a narrative review of the recent evidence for the use of ICP monitoring and management of ICP in pediatric TBI.

Six Levels of Consciousness

Life happens to you.

Life happens by you.

Life happens in you.

Life happens for you.

Life happens through you.

Life is you.

In head injury, a coup injury occurs under the site of impact with an object, and a contrecoup injury occurs on the side opposite the area that was hit. Coup and contrecoup injuries are associated with cerebral contusions, a type of traumatic brain injury in which the brain is bruised

Focal seizures: These start in a particular part of your brain, and their names are based on the part where they happen. They can cause both physical and emotional effects and make you feel, see, or hear things that aren’t there. About 60% of people with epilepsy have this type of seizure, which is sometimes called a partial seizure. Sometimes, the symptoms of a focal seizure can be mistaken for signs of mental illness or another kind of nerve disorder.

Generalized seizures: These happen when nerve cells on both sides of your brain misfire. They can make you have muscle spasms, black out, or fall.

Treatment

One of two surgical treatments may be used to treat hydrocephalus.

Shunt

The most common treatment for hydrocephalus is the surgical insertion of a drainage system, called a shunt. It consists of a long, flexible tube with a valve that keeps fluid from the brain flowing in the right direction and at the proper rate.

One end of the tubing is usually placed in one of the brain's ventricles. The tubing is then tunneled under the skin to another part of the body where the excess cerebrospinal fluid can be more easily absorbed — such as the abdomen or a chamber in the heart.

People who have hydrocephalus usually need a shunt system for the rest of their lives, and regular monitoring is required.

Endoscopic third ventriculostomy

Endoscopic third ventriculostomy is a surgical procedure that can be used for some people. In the procedure, your surgeon uses a small video camera to have direct vision inside the brain. Your surgeon makes a hole in the bottom of one of the ventricles or between the ventricles to enable cerebrospinal fluid to flow out of the brain.

Complications of surgery

Both surgical procedures can result in complications. Shunt systems can stop draining cerebrospinal fluid or poorly regulate drainage because of mechanical malfunctions, blockage or infections. Complications of ventriculostomy include bleeding and infections.

Any failure requires prompt attention, surgical revisions or other interventions. Signs and symptoms of problems may include:

Fever

Irritability

Drowsiness

Nausea or vomiting

Headache

Vision problems

Redness, pain or tenderness of the skin along the path of the shunt tube

# build-up of fluid in the cavities deep within the brain.

The extra fluid puts pressure on the brain and can cause brain damage. It's most common in infants and older adults.defined as hydrocephalus.