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Ischemic stroke patients usually need to remain flat on their back for the first 24 hours to maximize perfusion to their brain.

Hemorrhagic strokes need to have the head of bed elevated to maximize venous drainage.

CSF: Cerebrospinal fluid- fluid that acts to protect, cushion and regulate the brain.

DAI: Diffuse axonal injury- tearing or shearing of diffuse areas of white matter usually seen in traumatic brain injury from acceleration/deceleration injuries like auto accidents. Usually the prognosis is poor but depends on the severity of the injury.

Epidural hematoma: space between the skull and the dura.

Initial loss of consciousness followed by an awake phase and then an extremely rapid decline if the patient is not treated.

RANDOM TIDBITS Hematoma vs Hemorrhage: Hematoma is a collection of blood while a hemorrhage is actual blood loss (internal or external) Ischemia: restriction in blood supply Infarct: damage or death Penumbra: area of the brain that may still be viable after an ischemic event.

The penumbra surrounds the infarcted area and can be saved if early diagnosis and restoration of perfusion occurs.

An AVM is when your arteries connect to your veins without the capillary bed in between- which means there is no gradual decline of pressure in the blood vessels.Many AVM’s are present at birth and aren’t discovered until the patient’s later teen years. EVD: External ventricular drain (aka “ventric” in RN slang)- is inserted during a procedure called a ventriculostomy- the doctor literally bores out a piece of the patient’s skull and inserts a drain into the ventricle. The EVD drains CSF to help reduce ICP and also allows the RN to measure ICP (see below).ICP: Intracranial pressure- measured by the external ventricular drain or an ICP monitor, ICP is the pressure inside the ventricle.Normal ICP is less than 15 mm Hg and usually in the ICU, an ICP over 20 needs treatment.It is very dangerous for a patient to have an increased ICP for an extended length of time- therefore- it is essential you know what nursing actions raise ICP so that you avoid them (suctioning, stimulation, & positioning of the patient). Mannitol, Lasix), EVD placement and can be as extreme as a frontal lobectomy.

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Hydrocephalus: literally means “water on the brain” but its actually a CSF problem- either there is an obstruction and the CSF cannot flow properly, or CSF isn’t being reabsorbed or your body is producing too much CSF.

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