11/12: Brain Trauma and Tumors - Thompson

Question 1

s/s brain trauma ***

Answer 1

• raccoon eyes
• battle signs
• CSF/blood in ear canal
• skull depression
• penetrating object
• confusion/memory loss
• neuro changes
• vital signs
• mechanism
• PERSISTENT vomiting

Question 2

Key tips from Hx

Answer 2

• trauma
• anticoags
• change in mental status
• neuro deficits
• intoxication?
• personality changes

Question 3

Glasgow scoring

Answer 3

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)

Question 4

what glasgow score is dead? intubate threshold?

Answer 4

dead = 3
intubate = 8 (12 for long transfer) 
normal = 15

Question 5

5 triggers for a brain CT

Answer 5

• s/s brain trauma
• any abnormal neuro exam
• mechanism
• anticoagulants and ANY hit to the head
• too much etoh to evaluate

Question 6

imaging of choice immediately =

72 hrs later =

Answer 6

CT no contrast (blood looks hyperdense/white)

CT with contrast or MRI (blood looks like brain now)

Question 7

raccoon eyes, csf in ears/nose, battle signs indicate…

Answer 7

basilar skull fx

can tear membranes of brain cause CSF leak

high infection risk

Question 8

CSF – think ….

Answer 8

basilar skull fx

Question 9

will a CT scan show a concussion?

Answer 9

NO

CT scan of brain looks for shear injury, bleed, stroke, tumor

Question 10

if pt on coumadin with brain bleed…

Answer 10

give vit K

Question 11

the treatment for trauma is…

Answer 11

SURGERY

if pt has obvious brain injury do NOT keep at small hospital to get CT - transfer to trauma center

Question 12

where would you drill a burr hole if you had the chance?

Answer 12

not where skull depression

drill on side of dilated pupil

Question 13

most common type of bleed

Answer 13

subdural hematoma

Question 14

ages at risk for subdural hematoma

Answer 14

shaken baby (under 2 yo)

and old people with brain atrophy

Question 15

Pathophysiology of subdural hematoma

Answer 15

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

Question 16

crescent shapes…

Answer 16

subdural hematoma

NOT associated with skull fx

Question 17

subdural hematoma risk factors

Answer 17

• trauma
• anticoags
• hemophiliacs
• Etoh abuse
• shaken babies
• old with brain atrophy
• recurrent ( 50% after having one)

Question 18

why is alcohol an increased risk for subdural hematoma?

Answer 18

• poor nutrition
• falls
• liver makes clotting factors
• brain atrophy

Question 19

bleeding between skull and dural layer with most likely a skull fracture

Answer 19

epidural hematoma

lesion is localized, looks elliptical shaped

Question 20

“lucid interval” ****

Answer 20

epidural hematoma

20% of epidural hematomas

Question 21

cause intraventricular bleed

Answer 21

minor head trauma

usually just watch

Question 22

rapid acceleration-deceleration forces might cause…

Answer 22

diffuse axonal injury

poor prognosis - vegetative
not a lot seen on CT (diffuse injury)

Question 23

bleeding b/w arachnoid and pia layer

Answer 23

subarachnoid hemorrhage

from rupture of AVM, tumor or berry aneurism

Question 24

who is at increased risk for subarachnoid hemorrhage?

Answer 24

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

Question 25

worst of life, sudden “thunderclap” headache with prodromal about 2 wk prior

Answer 25

subarachnoid hemorrhage

tx by clipping vessel or coiling it

Question 26

any temporary loss of normal brain function =

Answer 26

concussion

4-6 x chance repeat

Question 27

s/s concussion

Answer 27

prolonged HA
visual distrubances
dizzy/balance
memory/amnesia/confusion
nausea/ vomiting

Question 28

hit again after incomplete concussion recovery

Answer 28

second impact

can lead to serious and permanent brain damage/death

Question 29

Mets most likely to go to brain ****

Answer 29

Melanoma
Lung
Breast
Colon
Kidney

Question 30

risk of primary brain tumor

Answer 30

gene mutations
MEN 1 (pit)
Neurofibromatosis
Retinoblastoma (malignant retinal glioma)

Question 31

environmental risk brain cancer

Answer 31

vinyl choride (mfg of chloride and in tobacco smoke)

Question 32

having chicken pox or shingle in hx…

Answer 32

decreased risk of primary brain cancer

first degree relative with disease increases risk

Question 33

do cell phones fry your brain?

Answer 33

maybe

acoustic 2.4x risk with cell phone ear

Glio 2.0x risk

Question 34

s/s of brain tumor

• parietal
• frontal
• brain stem
• pituitary ***

Answer 34

speech, writing, spatial, seizure

movement problems, personality changes

irritability, speech/swallowing problems, headache, hearing loss, gait, vomiting

sexual issues, BP, sodium

Question 35

number one type of brain cancer in kids

Answer 35

astrocytoma

• originates in astrocytes
• become undifferentiated in adults –> glioblastoma multiform (most common type in adults)

Question 36

5 yr survival
grade 1 - plocytic astrocytomas
grade 2 - diffuse astrocytomas
grade 3 - anaplastic astrocytoma
grade 4 - gliioblastoma

Answer 36

77. 4%
78. 4%
79. 9%
80. 4% **

Question 37

tx glio

Answer 37

surgery
radiation (gamma knife, cyber knife)
chemo

increases in life span by months are considered huge successes - NO CURE

Question 38

originates in 4th ventricle from primitive neural cells

Answer 38

medulloblastoma (2nd most common in kids)

Question 39

2nd most common brain tumor type

Answer 39

meningioma

slow growing

Question 40

hormone disruption (sex hormones most sensitive, then thyroid and growth hormone)

Answer 40

pituitary adenoma

3rd most common adult type that causes issues

might also have HA and visual disturbances

Question 41

tumor myelin sheath =
common in HIV =
tumor of vestibularcochlear n. =

Answer 41

schwannoma
lymphoma
acoustic neuroma