SUBMITTED BY: Rachel M.

Raynog BSNIIIBSNIII-A8

EARLY
DETERIORATION IN THE LEVEL OF CONSCIOUSNESS
Early signs are confusion, restlessness, lethargy, and disorientation first to time, then to place, and then to person

PUPILLARY DYSFUNCTION RELATIVE TO SIZE, SHAPE, AND REACTION TO LIGHT:

Early signs are a gradual dilation, a slightly ovoid shape, and a sluggish response to light ipsilateral to the lesion

MOTOR WEAKNESS AND SENSORY DEFICITS

Early signs are monoparesis, hemiparesis, and decreased visual acuity, such as blurred vision, diplopia, and field

EARLY
HEADACHE -Early signs are slight or vague headache which

is the worst upon arising in the morning

BLOOD PRESSURE

-Relatively stable in early stages

PULSE

-Relatively stable in early stages

TEMPERATURE

- Within normal ranges during compensatory stage

LATE
DETERIORATION IN THE LEVEL OF CONSCIOUSNESS
Later signs are stupor and coma

PUPILLARY DYSFUNCTION RELATIVE TO SIZE, SHAPE, AND REACTION TO LIGHT:

Later signs are dilation of the ipsilateral pupil and a non-reactivity to light Final stage signs are bilateral dilation and fixation

MOTOR WEAKNESS AND SENSORY DEFICITS

Later signs are hemiplegia, decortication, or decerebration (either unilateral or bilateral) and triple

LATE
CRANIAL NERVE PARALYSIS POSSIBLE SEIZURES, POSSIBLE VOMITING (INCLUDING PROJECTIVE VOMITING), AND POSSIBLE PAPILLEDEMA RESPIRATIONS

-acute neurogenic pulmonary edema, adult respiratory distress syndrome, and disseminated intravascular coagulopathy can result from an acute increase in ICP.

LATE
BLOOD PRESSURE -Increased blood pressure and a widening pulse in later

stages which signal cerebral dysfunction that may be irreversible

o Cushing's response (a compensatory response that attempts to provide adequate CPP in the presence of rising ICP) presents as a rising systolic pressure, a widening pulse pressure, and bradycardia and is a late presentation of brain stem dysfunction o Cushing's triad (a very late presentation of brain stem dysfunction) presents as hypertension, usually with a widening pulse pressure, bradycardia, and abnormal respiratory patterns

LATE
PULSE
oIrregular, rapid, and thready in the decompensatory stage

TEMPERATURE
oHigh temperatures can occur during decompensatory stage

IMPAIRED BRAIN STEM REFLEXES, SUCH AS CORNEAL AND GAG REFLEXES