2 - trauma and neoplasm Flashcards
overarching principles
- brain function is site specific
- the CNS is filled with and surrounded by fluid
- The brain has few lymphatic channels
- the brain is encased in bone and has little room to swell or move
- neurons are exquisitely sensitive to oxygen and glucose deprivation
- large molecules cannot diffuse easily into the brain from the blood
- cerebral blood vessels are frequently affected by atherosclerosis
trauma - mechanism of injury
- blunt
- penetrating
trauma - types
- focal
- diffuse
trauma brain injury - definition
- scalp
- skull
- brain
trauma brain injury - causes
- falls
- collisions
- concussions
trauma brain injury - groups at risk
- elderly
- todlers
- young males (motor injury)
possible outcomes to trauma to the brain
- full recovery
- recovery with disability
- long-term changes in LOC
- brain death
long-term changes in LOC
- persistent vegetative state
- permeant/irreversible coma
- locked in syndrome
Persistent vegetative state
wake up but don’t have awareness
permeant/irreversible coma
don’t wake up and not aware
locked in syndrome
wakefulness and awareness but cannot respond
brain death
- death of cerebellum, brain stem and cortex
- require ventilator to stay alive
penetrating injury
- open injury
- skull is not intact
- brain is exposed
blunt injury
- closed injury
- no external damage evident
- skull remains intact
- brain not exposed
focal
- generally associated with a direct impact to the head
- specific, localized injuries to the brain
diffuse
- not limited to a localized area
- difficult to detect and treat
focal brain injuries examples
- skull fractures
- contusions
- hematomas
hematomas
- epidural
- subdural
- intracranial
skull fractures
- linear
- depressed
- basilar (basal)
basilar
- base of skull
- CSF leak from nose or ear
- periorbital brusing
- battle’s signs
periorbital brushing
raccoon eyes
battle’s sign
bruising behind ear
contusions
- brushing of brain tissue
- frequently located on frontal and temporal lobes
- often are “coup-contrecoup” injuries
coup-contrecoup
- 2 contusions
- if you hit the back of your head, your head will push forward and injure the front of your head
- sometimes countercoup can be worse
hematomas
accumulation of clotted blood within the tissue
subdural
- tear venous blood
- worst fast
epidural
tear artierial blood
3 meninges layer
- pia matter
- dura matter
- arachnid
intracerebral hematoma
blood clot with brain tissue inside
diffuse brain injury
- widespread areas of the brain
- can be difficult to detect and treat
diffuse brain injury - types
- concussion
- diffuse axonal injury
concussion - types
- mild concussion
- classic cerebral concussion
concussion
- transient neurological dysfunction due to a traumatic impact
concussion - manifestation
- headache
- confusion
- disorientation
- dizziness
- visual distrubances
- possible loss of consciousness
- memory deficits
memory deficits
- retrograde amnesia
- anterograde amnesia
retrograde amnesia
anything that happened prior to
anterograde amnesia
unable to form new memories
mild concussion
- no loss of consciousness
- grades I, II, or III
classic cerebral concussion
- loss of consciousness (up to 6 hours)
- grade IV concussion
postconcussive syndrome
- headache
- anxiety
- irritability
- insomnia
- difficulty concentrating
- can happen to both types of concussion
chronic traumatic encephalopathy
- progressive degeneration of brain tissue
- accumulation of abnormal protein (tau)
chronic traumatic encephalopathy - long term can cause
- dementia
- severe depression
- confusion
diffuse axonal injury (DAI)
- diffuse damage to axons
- stretching or shearing of neuronal axons
- can’t see on CT or MRI
DAI - mechanism of injury
- acceleration
- deceleration
- rotation
DAI - results in
- outcomes unpredictable
- high morbidity and mortality
DAI - types
shaken baby syndrome
shaken baby syndrome
- because they have big heads and smaller brains within their skulls
- weak neck
spinal cord injury - groups at risks
all ages however high in the elderly and young adults due to motor accidents and sport injuries
flexion injury
- hitting the head from the back
- motor vehicle injury from the front
extension injury
motor vehicle injury from getting hit from the back
compression injury
- something falls on your head
flexion-rotation injury
- motor vehicle injury
classification of SCI
- level of injury
- complete or incomplete
level of injury
- cervical
- thoracic
- lumbar
- sacral
- quadriplegia
- paraplegia
complete or incomplete
all vs part of sensory and motor function affected
quadriplegia
anything C7 or higher
paraplegia
paralysis of the lower limbs
spinal shock
- flaccid paralysis below the injury
- loss of reflexes below the injury
- last 48 hours - 6 weeks
spinal shock - manifestations
- respiratory impairment
- immobility
flaccid
limply
complications of SCI
- depend on the level of injury and whether complete or incomplete SCI
types of complications of SCI
- neurogenic shock
- respiratory failure
- autonomic dysreflexia
- bowel/bladder/sexual dysfunction
- pressure ulcers
neurogenic shock
C6 or higher
respiratory failure
C4 or higher (loss never innervation of the respiratory system)
autonomic dysreflexia
- a complication of spinal cord injury with injury above T6
- associated with disconnect between the SNS and PNS
- always starts with the lower extremities
autonomic dysreflexia - pathway
- noxious stimulus - major SNS response: vasoconstriction
- vasoconstriction below the injury causes injury causes increased blood volume above the injury
- hypertension about the injury - triggers: parasympathetic response - bradycardia and vasodilatation
summary of autonomic dysflexia
- SCI T6 or above
- severe hypertension above the injury
- bradycardia
autonomic dysflexia - treatment
- get rid of the cause
- use gravity, bring their head up
neoplasm brain - cause
no proven causative agents
neoplasm brain - metastatic
- 10-15% of people with other cancers will develop metastasis to the brain
- lung, melanoma, breast or kidney
neoplasm brain - primary
- intracerebral tumors
- extracerebral tumors
intracerebral tumors
- astrocytoma (40%)
- oligodendroglioma (4%)
- ependymoma (3%)
extracerebral tumors
- outside of the brain
- meningioma (30%)
neoplasm brain - adults
- incidence increases up to age 70 then decreases
- most are (on top) supratentorial
neoplasm brain - children
- brain tumors are the most common solid tutors in children
- most are (below) infratentorial
neoplasm brain - adults vs children (way to remember)
adults are taller than children
brain tumours
- benign vs. malignant
- microscopically small benign tutors can cause severe debility or death
- difficult to remove
- some tumors cannot be accessed
- primary malignant brain tumour rarely metastasize (because bbb)
brain tumour - manifestations
- local
- generalized
brain tumour - local
may be malignant by location
brain tumour - generalized
- due to intracrainal pressure
- LOC
- headache
- pupils
- vital signs
- seizures
- nausea and vomitting
brain tumour - treatment
- radiation
- surgery
why is chemotherapy not effective with brain tumours?
because of the bbb
spinal tumors
- as with brain tumors can be primary or metazoic
- much less common than brain tumours
spinal tumour - locations
- intramedullary
- extramedullary
- extradural
intramedullary
- in the spinal cord
- astrocytomas
- ependymomas
extramedullary
- outside spinal cord
- meningiomas
extradural
- in the bones of the vertebrae
- often metastatic
spinal tumor - manifestations
- due to compression on the spine
- pain
- numbness, tingling, weakness
- trouble walking
spinal tumor - treatment
- surgery
- radiation
