1.11 traumatic brain injury

Question 1

mild concussion gcs score and symptoms 3

Answer 1

loss of consciousness <30min

amnesia <24hrs

GCS 13-15

Question 2

moderate concussion GCS score and symptoms 3

Answer 2

30-24hrs loss of conscioussness

amnesia 1-7days

9-12 score

Question 3

severe concussion GCS score and symptoms

Answer 3

> 24hrs loss of consciousness

amnesia> 7 days

GCS score >8

Question 4

lowest GCS score you can have

Answer 4

3

Question 5

what are the three components that the glasgow coma score tests

Answer 5

eye opening
motor response
verbal response

Question 6

levels of eye opening rating on glasgow coma score 4

Answer 6

eye opening spontaneously
eye opening to sound
eye opening to pain
no response

Question 7

levels of verbal response rating on glasgow coma score 5

Answer 7

orientated
confused
inappropriate words
incomprehensible sound
no sound

Question 8

levels of motor response in glasgow coma score 6

Answer 8

obeys to command
localises to pain
withdraws to pain
flexion to pain
extension to pain
no response

Question 8

pathology of concussion 6 steps

Answer 8

1. primary injury
2. neurotransmitter release
3. widespread ionic fluxes
4. increased activity of membrane pumps to restore ion graident
5. hyperglycolysis to provide atp for channels
6. reduction in brain glucose, taking several days, hence symptoms

Question 9

current difficulties in diagnosing concussion 3

Answer 9

no abnormalities on imaging

no routine test to confirm concussion

history presentation subjective

Question 10

types of primary brain injury 4

Answer 10

focal

diffuse

penetrating

blast

Question 11

focal primary brain injury characteristics (2) and subsets (3)

Answer 11

requires direct contact
results in coup and contrecoup injuries opposite to side of impact

contusion
bleed
fracture

Question 12

diffuse primary brain injury characteristics 3

Answer 12

doesnt require contact, due to movement of brain

diffuse axonal and vascular injury

Question 13

types of haemorrhages 4

Answer 13

epidural
subdural
subarachnoid
intracerebral

Question 14

what characteristic epidural haemorrhage 3

Answer 14

meningeal artery

trauma

lens shape on imaging

Question 15

what characteristic of subdural haemorrhage 3

Answer 15

bridging vein

deceleration injuries

crescent shape on imaging

Question 16

what does concussion caused increase risk of 4

Answer 16

dementia
parkinsons
ALS
chronic traumatic encephalopathy

Question 17

indications for CT scan in TBI

Answer 17

GCS <15 2 hours after
focal neurological deficits
skull fracture
amnesia >30mins

Question 18

acute management of TBI 4

Answer 18

primary survey
c spine immboilisation
ct scan
limit secondary brain injury

Question 19

how do we limit secondary brain injury 4

Answer 19

maintain bp control
sedatives
anti-convulsants to prevent seizure
analgesics

Question 20

secondary injury in TBI def

Answer 20

delayed biochemical and physiological events in response to primary injury

Question 21

types of secondary injury in tbi 6

Answer 21

neuroinflammation
cerebral oedema
oxidative stress
excitotoxicity
ischemia
axonal injury