11/12: Brain Trauma and Tumors - Thompson Flashcards
s/s brain trauma ***
- raccoon eyes
- battle signs
- CSF/blood in ear canal
- skull depression
- penetrating object
- confusion/memory loss
- neuro changes
- vital signs
- mechanism
- PERSISTENT vomiting
Key tips from Hx
- trauma
- anticoags
- change in mental status
- neuro deficits
- intoxication?
- personality changes
Glasgow scoring
3 categories - 15 max pts
Eyes (open spontaneous = 4; doesn’t open to voice or pain = 1)
Verbal (normal = 5, no verbal = 1)
Motor ( normal = 6, withdrawal from pain = 4, decerebrate =2 , no =1)
what glasgow score is dead? intubate threshold?
dead = 3 intubate = 8 (12 for long transfer) normal = 15
5 triggers for a brain CT
- s/s brain trauma
- any abnormal neuro exam
- mechanism
- anticoagulants and ANY hit to the head
- too much etoh to evaluate
imaging of choice immediately =
72 hrs later =
CT no contrast (blood looks hyperdense/white)
CT with contrast or MRI (blood looks like brain now)
raccoon eyes, csf in ears/nose, battle signs indicate…
basilar skull fx
can tear membranes of brain cause CSF leak
high infection risk
CSF – think ….
basilar skull fx
will a CT scan show a concussion?
NO
CT scan of brain looks for shear injury, bleed, stroke, tumor
if pt on coumadin with brain bleed…
give vit K
the treatment for trauma is…
SURGERY
if pt has obvious brain injury do NOT keep at small hospital to get CT - transfer to trauma center
where would you drill a burr hole if you had the chance?
not where skull depression
drill on side of dilated pupil
most common type of bleed
subdural hematoma
ages at risk for subdural hematoma
shaken baby (under 2 yo)
and old people with brain atrophy
Pathophysiology of subdural hematoma
low pressure venous bleeding of bridging veins pulls arachnoid away from dura
blood can increase intracranial pressure or direct pressure or ischemia
May cross suture line
crescent shapes…
subdural hematoma
NOT associated with skull fx
subdural hematoma risk factors
- trauma
- anticoags
- hemophiliacs
- Etoh abuse
- shaken babies
- old with brain atrophy
- recurrent ( 50% after having one)
why is alcohol an increased risk for subdural hematoma?
- poor nutrition
- falls
- liver makes clotting factors
- brain atrophy
bleeding between skull and dural layer with most likely a skull fracture
epidural hematoma
lesion is localized, looks elliptical shaped
“lucid interval” ****
epidural hematoma
20% of epidural hematomas
cause intraventricular bleed
minor head trauma
usually just watch
rapid acceleration-deceleration forces might cause…
diffuse axonal injury
poor prognosis - vegetative
not a lot seen on CT (diffuse injury)
bleeding b/w arachnoid and pia layer
subarachnoid hemorrhage
from rupture of AVM, tumor or berry aneurism
who is at increased risk for subarachnoid hemorrhage?
women more than men
black more than white
average age = 50
HTN increases risk of rupture
10-15 dont make it to hospital
40% die in 1 wk
50% in 6 mo
worst of life, sudden “thunderclap” headache with prodromal about 2 wk prior
subarachnoid hemorrhage
tx by clipping vessel or coiling it
any temporary loss of normal brain function =
concussion
4-6 x chance repeat
s/s concussion
prolonged HA visual distrubances dizzy/balance memory/amnesia/confusion nausea/ vomiting
hit again after incomplete concussion recovery
second impact
can lead to serious and permanent brain damage/death
Mets most likely to go to brain ****
Melanoma Lung Breast Colon Kidney
risk of primary brain tumor
gene mutations
MEN 1 (pit)
Neurofibromatosis
Retinoblastoma (malignant retinal glioma)
environmental risk brain cancer
vinyl choride (mfg of chloride and in tobacco smoke)
having chicken pox or shingle in hx…
decreased risk of primary brain cancer
first degree relative with disease increases risk
do cell phones fry your brain?
maybe
acoustic 2.4x risk with cell phone ear
Glio 2.0x risk
s/s of brain tumor
- parietal
- frontal
- brain stem
- pituitary ***
speech, writing, spatial, seizure
movement problems, personality changes
irritability, speech/swallowing problems, headache, hearing loss, gait, vomiting
sexual issues, BP, sodium
number one type of brain cancer in kids
astrocytoma
- originates in astrocytes
- become undifferentiated in adults –> glioblastoma multiform (most common type in adults)
5 yr survival grade 1 - plocytic astrocytomas grade 2 - diffuse astrocytomas grade 3 - anaplastic astrocytoma grade 4 - gliioblastoma
- 4%
- 4%
- 9%
- 4% **
tx glio
surgery
radiation (gamma knife, cyber knife)
chemo
increases in life span by months are considered huge successes - NO CURE
originates in 4th ventricle from primitive neural cells
medulloblastoma (2nd most common in kids)
2nd most common brain tumor type
meningioma
slow growing
hormone disruption (sex hormones most sensitive, then thyroid and growth hormone)
pituitary adenoma
3rd most common adult type that causes issues
might also have HA and visual disturbances
tumor myelin sheath =
common in HIV =
tumor of vestibularcochlear n. =
schwannoma
lymphoma
acoustic neuroma
