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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
Single most important cause of persistent disability after traumatic brain damage
DAI
25
Diffuse or local
Cerebral swelling
25
If axon was to rupture, the proximal stub would become a mass of axoplasm called
retraction balls
26
A protease that degrades microtubule proteins
Calpain
27
MOI for cerebral swelling
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
28
Focal parenchymal hemorrhages that result from “scraping” and “bruising” of the brain as it moves across the inner surface of the skull
Cerebral contusions
29
Bruised and bloodied brain
Cerebral contusions
30
On the surface of the brain beneath the point of impact
Coup
31
Opposite pole as brain impacts on the inner table of the surface
Countrecoup
32
Cerebral contusions are most common in
inferior frontal and temporal lobes
33
Tearing of small and medium sized vessels within the brain parenchyma
Intracerebral hematoma
34
Source of SDH
venous
35
Located at potential space between dura and arachnoid
SDH
36
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
SDH
37
Crescent shaped density on CT
SDH
38
Symptomatic within 72 hrs after injury. More common after falls or assaults
Acute SDH
39
Symptomatic after 21 days More common in 50 y/o
Chronic SDH
40
After 2 weeks, there is encapsulation of the clot and eventually liquefies into a ___________
hygroma
41
Rare complication of head injury. Occurs in <1% of all cases but is found in 5-15% of autopsies
Epidural Hematoma
42
Bleeding into the epidural space and source is artery
Epidural hematoma
43
Epidural hematoma is d/t tearing of
middle meningeal artery
44
Convex shaped on NCCT
epidural hematoma
45
"Talk and die"
Serious cerebral damage following a lucid interval
46
Late deterioration because of expansion of subdural and epidural hematoma, worsening edema around a contusion or delayed appearance of epidural clot
Serious cerebral damage following a lucid interval
47
Blood is distributed over the convexities
Traumatic SAH
48
SAH secondary to aneurysmal rupture - over the ______________
basal cisterns
49
Mortality from GSW to head is
95%
50
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
penetrating injury
51
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
blast injury
52
Damage to BBB and to gray-white matter junction with deafferentiations of the cortical columnar structure
blast injury
53
Violent shaking of the body or head of an infant, resulting in rapid acceleration and deceleration of the cranium
Shaken baby syndrome
54
Combination of subdural and retinal hemorrhages
Shaken baby syndrome
55
Tearing of dura and arachnoid membranes
CSF fistula
56
(+) CSF (-) mucus
CSF fistula
57
Treatment for CSF fistula
Head elevation; lumbar drain
58
Collection of air in the cranial cavity
Aerocele
59
Other name for aerocele
pneumatocele or pnemocephalus
60
Result from traumatic laceration of the ICA within the cavernous sinus
Carotid-cavernous fistula
61
Distended orbital and periorbital veins and paralysis of the __________ as they pass through or within the walls of the cavernous sinus
CN III-VI
62
4 types of infections
1. extradural 2. subdural 3. subarachnoid 4. intracerebral
63
Cranial pain, dizziness, fatigue, insomnia, irritability, restlessness and inability to concentrate. Overlap with depression and anxiety
Post concussion syndrome
64
May be immediate, early (within first week) or late
Seizures and post traumatic epilepsy
65
Rare, action tremor
Post traumatic movement disorder
66
Dementia pugilistica or punch drunk syndrome
Chronic traumatic encephalopathy
67
CTE is caused by enlargement of the ___________, thinning of the _________, glial scarring over the inferior cerebellar cortex
lat ventricles; corpus callosum
68
Intervention for low risk category
observation for 24 hrs; discharge without CT
69
Intervention for moderate risk
admitted to ICU; CT after 24 hrs
70
Intervention for moderate risk
Admitted to ICU w/ early neurosurgical consultation
71
Treatment of choice for massive acute and chronic subdural, epidural, or parenchymal hematoma with mass effect
Craniotomy
72
Liquified chronic subdural hematomas
Burr hole or twist drill
73
Surgical intervention for GSW
Surgical exploration and repair
74
Surgical intervention for Cerebral edema and intracranial hypertension
Decompressive hemicraniectom
75
Normal ICP
<15 mmHg
76
CPP =
MAP - ICP
77
Mx for increased ICP
Mannitol
78
Reduction in cerebral metabolism, blood flow, and blood volume followed by reduction in edema formation
Thiopental

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

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