Objectives

1
Objectives

• At the end of this session, plus the patho.
  Lectures and your readings, you should be able
  to
• Relate the clinical features of meningitis to its
  pathophysiology.
• Recognise the clinical features of raised
  intracranial pressure.
• Summarise the management of raised intracranial
  pressure
• Predict the collaborative and nursing management
  of meningitis
• Summarise the management of cerebral aneurysm

2
Intracranial Infection1. Meningitis

• Definition
• inflammation of meninges
• Aetiology
• Viral
• Fungal
• BACTERIAL
• - Neisseria meningitides
• - Streptococcus pneumoniae
• - Haemophilus influenzae

3
Pathophysiology

• Nasopharyngeal infection
• Septicaemia (or direct spread)
• Inflamed meninges
• Thrombosis lt cerebral blood flow
• Meningeal exudate
• Profound alterations in IC physiology

4
Clinical Manifestations

• Infection
• Increased Intracranial Pressure
• Headache
• Fever/rash
• LOC changes
• Meningeal irritability
• - nuchal rigidity
• - Kernigs sign
• - Brudzinskis sign
• - Photophobia

5
Intracranial Pressure Determinants

• Monro-Kellie Hypothesis
• Brain Tissue 1,400g
• Blood 75mls
• CSF 75mls
• Intracranial Pressure (10-20mmHg)

6
Cerebral Response to Increased Intracranial
Pressure

• Autoregulation
• Functions up to systolic BP 60-160mmHg
• ICP lt 40mmHg
• Cushings response
• Cushings triad
• 1. Bradycardia
• 2. Hypertension
• 3. Bradypnoea
• Herniation and brain death

7
Clinical Manifestations of Increasing ICP

• EARLIEST
• - Change in LOC
• - Reslessness/drowsiness/confusion
• - Stuporous
• - Comatose

8
Assessment of Intracranial
PressureGCSPupilsVitalsCerebral
angiographyCTMRIPET
9
Management of Increased ICP

• Invasive monitoring of ICP
• Decreasing cerebral oedema
• Lowering the volume of CSF
• Decreasing blood volume
• - osmotic diuretics
• - corticosteroids
• - restricting fluids
• - draining CSF
• - hyperventilation
• - controlling fever-reducing met. demands

10
Management of Meningitis

• Assessment
• CSF Blood
• Prevention
• antimicrobial prophylaxis
• meningococcal vaccines
• Treatment
• - IV antibiotic
• - - Dexamethasone
• - Management of complications and ICP

11
Nursing Management

• Possible patient problems
• Fever
• Dehydration
• Cerebral oedema
• Seizures
• Airwary obstruction
• Resp/cardiac arrest

12
Intracranial Aneurysm

• Definition
• dilation of arterial wall due to weakness
• Pathophysiology
• symptoms when aneurysm presses cranial nerves or
  brain tissue, or when rupture causes subarachnoid
  haemorrhage
• Assessment
• CT, Lumbar puncture
• Hunt-Hess grades (table 59-1)

13
Aneurysm (cont.d)

• Management
• Goals
• - allow brain to recover
• - minimise risk for re-bleeding
• - prevent and treat other complications
• Bed rest, sedation, - surgical intervention