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pathophysiology > 2 - trauma and neoplasm > Flashcards

2 - trauma and neoplasm Flashcards

1
Q

overarching principles

A
  1. brain function is site specific
  2. the CNS is filled with and surrounded by fluid
  3. The brain has few lymphatic channels
  4. the brain is encased in bone and has little room to swell or move
  5. neurons are exquisitely sensitive to oxygen and glucose deprivation
  6. large molecules cannot diffuse easily into the brain from the blood
  7. cerebral blood vessels are frequently affected by atherosclerosis
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2
Q

trauma - mechanism of injury

A
  • blunt

- penetrating

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3
Q

trauma - types

A
  • focal

- diffuse

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4
Q

trauma brain injury - definition

A
  • scalp
  • skull
  • brain
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5
Q

trauma brain injury - causes

A
  • falls
  • collisions
  • concussions
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6
Q

trauma brain injury - groups at risk

A
  • elderly
  • todlers
  • young males (motor injury)
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7
Q

possible outcomes to trauma to the brain

A
  • full recovery
  • recovery with disability
  • long-term changes in LOC
  • brain death
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8
Q

long-term changes in LOC

A
  • persistent vegetative state
  • permeant/irreversible coma
  • locked in syndrome
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9
Q

Persistent vegetative state

A

wake up but don’t have awareness

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10
Q

permeant/irreversible coma

A

don’t wake up and not aware

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11
Q

locked in syndrome

A

wakefulness and awareness but cannot respond

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12
Q

brain death

A
  • death of cerebellum, brain stem and cortex

- require ventilator to stay alive

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13
Q

penetrating injury

A
  • open injury
  • skull is not intact
  • brain is exposed
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14
Q

blunt injury

A
  • closed injury
  • no external damage evident
  • skull remains intact
  • brain not exposed
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15
Q

focal

A
  • generally associated with a direct impact to the head

- specific, localized injuries to the brain

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16
Q

diffuse

A
  • not limited to a localized area

- difficult to detect and treat

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17
Q

focal brain injuries examples

A
  • skull fractures
  • contusions
  • hematomas
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18
Q

hematomas

A
  • epidural
  • subdural
  • intracranial
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19
Q

skull fractures

A
  • linear
  • depressed
  • basilar (basal)
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20
Q

basilar

A
  • base of skull
  • CSF leak from nose or ear
  • periorbital brusing
  • battle’s signs
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21
Q

periorbital brushing

A

raccoon eyes

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22
Q

battle’s sign

A

bruising behind ear

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23
Q

contusions

A
  • brushing of brain tissue
  • frequently located on frontal and temporal lobes
  • often are “coup-contrecoup” injuries
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24
Q

coup-contrecoup

A
  • 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
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25
Q

hematomas

A

accumulation of clotted blood within the tissue

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26
Q

subdural

A
  • tear venous blood

- worst fast

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27
Q

epidural

A

tear artierial blood

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28
Q

3 meninges layer

A
  • pia matter
  • dura matter
  • arachnid
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29
Q

intracerebral hematoma

A

blood clot with brain tissue inside

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30
Q

diffuse brain injury

A
  • widespread areas of the brain

- can be difficult to detect and treat

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31
Q

diffuse brain injury - types

A
  • concussion

- diffuse axonal injury

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32
Q

concussion - types

A
  • mild concussion

- classic cerebral concussion

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33
Q

concussion

A
  • transient neurological dysfunction due to a traumatic impact
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34
Q

concussion - manifestation

A
  • headache
  • confusion
  • disorientation
  • dizziness
  • visual distrubances
  • possible loss of consciousness
  • memory deficits
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35
Q

memory deficits

A
  • retrograde amnesia

- anterograde amnesia

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36
Q

retrograde amnesia

A

anything that happened prior to

37
Q

anterograde amnesia

A

unable to form new memories

38
Q

mild concussion

A
  • no loss of consciousness

- grades I, II, or III

39
Q

classic cerebral concussion

A
  • loss of consciousness (up to 6 hours)

- grade IV concussion

40
Q

postconcussive syndrome

A
  • headache
  • anxiety
  • irritability
  • insomnia
  • difficulty concentrating
  • can happen to both types of concussion
41
Q

chronic traumatic encephalopathy

A
  • progressive degeneration of brain tissue

- accumulation of abnormal protein (tau)

42
Q

chronic traumatic encephalopathy - long term can cause

A
  • dementia
  • severe depression
  • confusion
43
Q

diffuse axonal injury (DAI)

A
  • diffuse damage to axons
  • stretching or shearing of neuronal axons
  • can’t see on CT or MRI
44
Q

DAI - mechanism of injury

A
  • acceleration
  • deceleration
  • rotation
45
Q

DAI - results in

A
  • outcomes unpredictable

- high morbidity and mortality

46
Q

DAI - types

A

shaken baby syndrome

47
Q

shaken baby syndrome

A
  • because they have big heads and smaller brains within their skulls
  • weak neck
48
Q

spinal cord injury - groups at risks

A

all ages however high in the elderly and young adults due to motor accidents and sport injuries

49
Q

flexion injury

A
  • hitting the head from the back

- motor vehicle injury from the front

50
Q

extension injury

A

motor vehicle injury from getting hit from the back

51
Q

compression injury

A
  • something falls on your head
52
Q

flexion-rotation injury

A
  • motor vehicle injury
53
Q

classification of SCI

A
  • level of injury

- complete or incomplete

54
Q

level of injury

A
  • cervical
  • thoracic
  • lumbar
  • sacral
  • quadriplegia
  • paraplegia
55
Q

complete or incomplete

A

all vs part of sensory and motor function affected

56
Q

quadriplegia

A

anything C7 or higher

57
Q

paraplegia

A

paralysis of the lower limbs

58
Q

spinal shock

A
  • flaccid paralysis below the injury
  • loss of reflexes below the injury
  • last 48 hours - 6 weeks
59
Q

spinal shock - manifestations

A
  • respiratory impairment

- immobility

60
Q

flaccid

A

limply

61
Q

complications of SCI

A
  • depend on the level of injury and whether complete or incomplete SCI
62
Q

types of complications of SCI

A
  • neurogenic shock
  • respiratory failure
  • autonomic dysreflexia
  • bowel/bladder/sexual dysfunction
  • pressure ulcers
63
Q

neurogenic shock

A

C6 or higher

64
Q

respiratory failure

A

C4 or higher (loss never innervation of the respiratory system)

65
Q

autonomic dysreflexia

A
  • a complication of spinal cord injury with injury above T6
  • associated with disconnect between the SNS and PNS
  • always starts with the lower extremities
66
Q

autonomic dysreflexia - pathway

A
  1. noxious stimulus - major SNS response: vasoconstriction
  2. vasoconstriction below the injury causes injury causes increased blood volume above the injury
  3. hypertension about the injury - triggers: parasympathetic response - bradycardia and vasodilatation
67
Q

summary of autonomic dysflexia

A
  • SCI T6 or above
  • severe hypertension above the injury
  • bradycardia
68
Q

autonomic dysflexia - treatment

A
  • get rid of the cause

- use gravity, bring their head up

69
Q

neoplasm brain - cause

A

no proven causative agents

70
Q

neoplasm brain - metastatic

A
  • 10-15% of people with other cancers will develop metastasis to the brain
  • lung, melanoma, breast or kidney
71
Q

neoplasm brain - primary

A
  • intracerebral tumors

- extracerebral tumors

72
Q

intracerebral tumors

A
  • astrocytoma (40%)
  • oligodendroglioma (4%)
  • ependymoma (3%)
73
Q

extracerebral tumors

A
  • outside of the brain

- meningioma (30%)

74
Q

neoplasm brain - adults

A
  • incidence increases up to age 70 then decreases

- most are (on top) supratentorial

75
Q

neoplasm brain - children

A
  • brain tumors are the most common solid tutors in children

- most are (below) infratentorial

76
Q

neoplasm brain - adults vs children (way to remember)

A

adults are taller than children

77
Q

brain tumours

A
  • 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)
78
Q

brain tumour - manifestations

A
  • local

- generalized

79
Q

brain tumour - local

A

may be malignant by location

80
Q

brain tumour - generalized

A
  • due to intracrainal pressure
  • LOC
  • headache
  • pupils
  • vital signs
  • seizures
  • nausea and vomitting
81
Q

brain tumour - treatment

A
  • radiation

- surgery

82
Q

why is chemotherapy not effective with brain tumours?

A

because of the bbb

83
Q

spinal tumors

A
  • as with brain tumors can be primary or metazoic

- much less common than brain tumours

84
Q

spinal tumour - locations

A
  • intramedullary
  • extramedullary
  • extradural
85
Q

intramedullary

A
  • in the spinal cord
  • astrocytomas
  • ependymomas
86
Q

extramedullary

A
  • outside spinal cord

- meningiomas

87
Q

extradural

A
  • in the bones of the vertebrae

- often metastatic

88
Q

spinal tumor - manifestations

A
  • due to compression on the spine
  • pain
  • numbness, tingling, weakness
  • trouble walking
89
Q

spinal tumor - treatment

A
  • surgery

- radiation

pathophysiology (16 decks)

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