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Sophomore | 2nd Sem - 2nd Shifting > 2.1 | Altered Level of Consciousness > Flashcards

2.1 | Altered Level of Consciousness Flashcards

1
Q

Major cause of disability and death

A

TBI

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2
Q

Major causes of TBI

A

MVA and falls in elder

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3
Q

Violent shaking or jarring of the brain and resultant transient functional impairment

A

Concussion

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3
Q

Mild TBI defined by transient appearance of neurologic signs and symptoms following either a direct or indirect rapid movement in the brain causing extreme rotational or translational brain acceleration or deceleration injury

A

Concussion

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4
Q

Loss of consciousness at impact is not required for
diagnosis

A

Concussion

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5
Q

No evidence of structural brain injury using conventional neuroimaging. Physiologic injury to brain

A

Concussion

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6
Q

MOI of concussion

A
  1. Intracranial Brain Deformation
  2. Transient functional disruption of ARAS caused by rotational forces to the upper brainstem
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7
Q

May occur immediately after LOC and confer an increased risk of later seizures

A

Concussive convulsions

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8
Q

Present with retrograde and anterograde amnesia

A

Concussion

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9
Q

Neurological symptoms without significant focal neurologic findings

A

Concussion

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10
Q

T OR F: Concussion of 80-90% of persons with single uncomplicated concussions fully recover within 1 week

A

F - 2 wks

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11
Q

More prolonged recovery with decreasing threshold to injury

A

Recurrent concussions

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12
Q

Give 3 major neuropsychiatric disorder associated with aging

A
  1. Depression
  2. Dementia
  3. ASL
  4. PD
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13
Q

Skull fracture that is most common at the temporoparietal region

A

Linear

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14
Q

One or more bony fragments are displaced inward, compressing the underlying brain, 85% are open and prone to infection and CSF leakage

A

Depressed

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15
Q

Multiple, shattered bony fragments

A

Comminuted

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16
Q

Scalp over fracture is
lacerated

A

Open and compound

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17
Q

These types of fractures require surgical management for debridement, elevation of bone fragments and repair of dural lacerations

A

Depressed and comminuted

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18
Q

May be missed by skull X-ray

A

Basal skull fracture

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19
Q

Basal skull fracture is best identified by

A

NCCT bone window

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20
Q

Hemotympanum or tympanic perforation, hearing loss, CSF otorrhea, PFP, Battle sign

A

Petrous portion of temporal bone

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21
Q

Anosmia, bilateral periorbital ecchymosis, CSF rhinorrhea

A

Sphenoid, ethmoid, and frontal bones

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22
Q

Traumatic coma lasting >6 hrs caused by multiple small lesions in the white matter tracts

A

Diffuse axonal injury

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23
Q

Widespread micro and macroscopic axonal-shearing injury

A

DAI

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24
Q

Single most important cause of persistent disability after traumatic brain damage

A

DAI

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25
Q

Diffuse or local

A

Cerebral swelling

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25
Q

If axon was to rupture, the proximal stub would become a mass of axoplasm called

A

retraction balls

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26
Q

A protease that degrades microtubule proteins

A

Calpain

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27
Q

MOI for cerebral swelling

A
  1. Mass
  2. Cerebral edema
  3. Increased cerebral blood volume d/t abnormal vasodilation
    Delayed inflamm response or dysfunction of cerebral vasomotor regulatory centers in brainstem
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28
Q

Focal parenchymal hemorrhages that result from “scraping” and “bruising” of the brain as it moves across the inner surface of the skull

A

Cerebral contusions

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29
Q

Bruised and bloodied brain

A

Cerebral contusions

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30
Q

On the surface of the brain beneath the point of impact

A

Coup

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31
Q

Opposite pole as brain impacts on the inner table of the surface

A

Countrecoup

32
Q

Cerebral contusions are most common in

A

inferior frontal and temporal lobes

33
Q

Tearing of small and medium sized vessels within the brain parenchyma

A

Intracerebral hematoma

34
Q

Source of SDH

A

venous

35
Q

Located at potential space between dura and arachnoid

A

SDH

36
Q

Movements of the brain within the skull that leads to stretching and tearing of bridging veins that drain the surface of brain to dural sinuses

A

SDH

37
Q

Crescent shaped density on CT

A

SDH

38
Q

Symptomatic within 72 hrs after injury. More common after falls or assaults

A

Acute SDH

39
Q

Symptomatic after 21 days
More common in 50 y/o

A

Chronic SDH

40
Q

After 2 weeks, there is encapsulation of the clot and eventually liquefies into a ___________

A

hygroma

41
Q

Rare complication of head injury. Occurs in <1% of all cases but is found in 5-15%
of autopsies

A

Epidural Hematoma

42
Q

Bleeding into the epidural space and source is artery

A

Epidural hematoma

43
Q

Epidural hematoma is d/t tearing of

A

middle meningeal artery

44
Q

Convex shaped on NCCT

A

epidural hematoma

45
Q

“Talk and die”

A

Serious cerebral damage following a lucid interval

46
Q

Late deterioration because of expansion of subdural and epidural hematoma, worsening edema around a contusion or delayed appearance of epidural clot

A

Serious cerebral damage following a lucid interval

47
Q

Blood is distributed over the convexities

A

Traumatic SAH

48
Q

SAH secondary to aneurysmal rupture - over the ______________

A

basal cisterns

49
Q

Mortality from GSW to head is

A

95%

50
Q

Amount of tissue damage
is dependent on kinetic
energy and velocity of the
missile, angle of entrance,
number of bony fragments,
affected structures and
configuration of secondary bullet tracts d/t ricochet

A

penetrating injury

51
Q

Explosive missiles initiate overpressure waves that translate mechanical, thermal, and electromagnetic energy to the brain by spallation, implosion, and inertia directly through the cranium and indirectly through oscillating pressure in the fluid-containing large vessels

A

blast injury

52
Q

Damage to BBB and to gray-white matter junction with deafferentiations of the cortical columnar structure

A

blast injury

53
Q

Violent shaking of the body or head of an infant, resulting in rapid acceleration and deceleration of the cranium

A

Shaken baby syndrome

54
Q

Combination of subdural and retinal hemorrhages

A

Shaken baby syndrome

55
Q

Tearing of dura and arachnoid membranes

A

CSF fistula

56
Q

(+) CSF (-) mucus

A

CSF fistula

57
Q

Treatment for CSF fistula

A

Head elevation; lumbar drain

58
Q

Collection of air in the cranial cavity

A

Aerocele

59
Q

Other name for aerocele

A

pneumatocele or pnemocephalus

60
Q

Result from traumatic laceration of the ICA within the cavernous sinus

A

Carotid-cavernous fistula

61
Q

Distended orbital and periorbital veins and paralysis of the __________ as they pass through or within the walls of the cavernous sinus

A

CN III-VI

62
Q

4 types of infections

A
  1. extradural
  2. subdural
  3. subarachnoid
  4. intracerebral
63
Q

Cranial pain, dizziness, fatigue, insomnia, irritability, restlessness and inability to concentrate. Overlap with depression and anxiety

A

Post concussion syndrome

64
Q

May be immediate, early (within first week) or late

A

Seizures and post traumatic epilepsy

65
Q

Rare, action tremor

A

Post traumatic movement disorder

66
Q

Dementia pugilistica or punch drunk syndrome

A

Chronic traumatic encephalopathy

67
Q

CTE is caused by enlargement of the ___________, thinning of the _________, glial scarring over the inferior cerebellar cortex

A

lat ventricles; corpus callosum

68
Q

Intervention for low risk category

A

observation for 24 hrs; discharge without CT

69
Q

Intervention for moderate risk

A

admitted to ICU; CT after 24 hrs

70
Q

Intervention for moderate risk

A

Admitted to ICU w/ early neurosurgical consultation

71
Q

Treatment of choice for massive acute and chronic subdural, epidural, or parenchymal hematoma with mass effect

A

Craniotomy

72
Q

Liquified chronic subdural hematomas

A

Burr hole or twist drill

73
Q

Surgical intervention for GSW

A

Surgical exploration and repair

74
Q

Surgical intervention for Cerebral edema and intracranial hypertension

A

Decompressive hemicraniectom

75
Q

Normal ICP

A

<15 mmHg

76
Q

CPP =

A

MAP - ICP

77
Q

Mx for increased ICP

A

Mannitol

78
Q

Reduction in cerebral metabolism, blood flow, and blood volume followed by reduction in edema formation

A

Thiopental

Sophomore | 2nd Sem - 2nd Shifting (2 decks)

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