Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Junior - Neuro 2 > 5 - Head Trauma, Coma And Brain Death > Flashcards

5 - Head Trauma, Coma And Brain Death Flashcards

1
Q

Types of head traumas?

A
  • Epidural hematoma
  • subdural hematoma
  • concussion
  • diffuse axonal injury
  • post-concussion syndrome
  • post traumatic seizures and epilepsy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Types of herniation syndromes?

A
  • general
  • central (ranstentorial) herniation
  • uncal herniation
  • subfalcine herniation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

epidural and subdural hematomas occur in relation to? (Big list)

A
  • Trauma
  • Tumor
  • Anticoagulation
  • ASA
  • Thrombocytopenia
  • Coagulopathy
  • Epidural catheters
  • Lumbar puncture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

MC cause of epidural hematoma?

A

Trauma to the middle meningeal artery

  • Suspect in pts w temporal skull fx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Lucid intervals?

A

Epidural hematoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

CT findings for epidural hematoma?

A

Convex hyper-density in pariotemporal region

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Common cause of subdural hematoma?

A

Trauma to back or front of head cause the dura and arachnoid space to separate causing the bridging veins to rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How do subdural hematomas present?

A

Gradual signs of cerebral compression occurring hours to days or even weeks later

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

CT of subdural hematoma shows?

A

Crescent shaped hyper- intensity between brain and skull

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Definition for concussion?

A

Trauma-induced alteration in mental status (confusion, amnesia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Loss of consciousness for concussion

A

Maybe, maybe not

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Types of injuries that cause concussion?

A 
Cortical contusion
- coup countercoup 
Shear forces and tensile forces 
- torn vein
- torn artery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Why does the brain bouncing in the skull cause a concussion?

A

It causes a disruption of axonal transport leading to axonal swelling

  • release excitatory neurotransmitters
  • leads to free radical production
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Clinical features of concussion?

A

Confusion
Amnesia
Loss of consciousness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Symptoms of concussion?

A
  • HA
  • dizziness
  • vertigo
  • lack of awareness
  • N/V
  • mood changes
  • light/noise sensitivity
  • sleep disturbance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

If the concussion symptoms are getting worse it means?

A

Hemorrhage (probably not good)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Grades of concussion?

A

Grade 1: confusion <15min
Grade 2: >15 min
Grade 3: ANY loss of consciousness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When can concussion pts return to activities?

A

Grade 1: now
Grade 2: 1 week later
Grade 3: 1-2 weeks

Must be symptom free x 7 days before return to play

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Concussion sideline eval?

A

Head injury: remove from play

No Play if:

  • any loss of consciousness
  • confusion >15 min
  • post traumatic amnesia

ER if any LOC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Types of amnesia?

A

Retrograde
Amnesia of the event
Antegrade (bad)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

3 components of MACE?

A
  1. Hx of symptoms
  2. Screening neuro exam
  3. Cognitive screen w score
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Who gets MACE?

A

Anyone who is:

  • dazed
  • confused
  • “saw stars”
  • loss of consciousness
  • head injury
23
Q

MACE interpretation?

A

MACE = <25: reeval in 24hrs or evac
MACE = 26-27: manage local unless deteriorates
MACE =/>28: RTD (thats return to duty for my coasty and weekend warriors)

24
Q

What is a diffuse axonal injury?

A

Brain injury with damage in the form of extensive lesions in the white matter tracts occurs over a widespread area
- associated with severe head trauma

25
How well do people with diffuse axonal injury do?
No so good
26
CT for diffuse axonal injury?
Punctate hemorrhage in deep white matter or corpus callosum
27
What is post-concussion syndrome?
Complex disorder in which various symptoms such as HA and dizziness last for weeks/months after injury The risk doesnt seem to be associated with the severity of the initial injury Sometimes seen with - litigation - workers comp - depression
28
What are post-traumatic seizures and epilepsy?
2% of head injury pts develop seizures or epilepsy - 25% of acute sever head injury
29
What is brain herniation
Simply put a displacement of the brain tissue into a compartment that it doesnt belong in LIFE THREATENING CONDITON
30
Types of cerebral herniation?
Uncal Central Transfalcial Foraminal Pics on slide 125
31
Stages of central (transtentorial) herniation?
``` First: decreased alertness Second: small, reactive pupils Third: decorticate posturing 4th: midposition pupils, decerbate posturing Final: pt becomes motionless ``` Death
32
1st sign of uncal herniation?
3rd CN palsy
33
Kernohan’s phenomenon?
Continued impaction of uncal herniation leading to ipsilateral hemiplegia
34
Tx for uncal transtentorial herniation?
Decompressive trephination “burr holes”
35
Which side should i drill my “burr holes”
Usually its on the side that you see 3rd CN problems but... 20% of cases have pupillary changes on the contralateral with ipsilateral motor changes so... If you drill a hole and it doesnt get better drill one on the other side
36
What does expansile frontal lobe mass cause?
Transfalcial herniation
37
Where does transfalcial herniation herniate to?
Herniation of the cingulate guyrs beneath the falx and across the midline - leg weakness
38
Differences between stupor and coma?
Both are impaired responsiveness to external stimulation Coma: unarousable unresponsiveness Stupor: midway between alertness and coma
39
With a coma or stupor the injury is probably?
To the reticular activating system (neurons originating in the pons and midbrain, projecting to the thalamus and cerebral hemispheres) Or significant damage to the cerebral hemispheres
40
Cause of stupor and coma (list)
* Trauma * Brainstem lesion * Cerebrovascular disease (SAH) * Meningeal irritation (meningitis, encephalitis) * Intoxications (sedative-hypnotics, alcohol, opioids) * Metabolic encephalopathy * Prolonged post-ictal state * Transtentorial herniation – with expanding mass lesion, subdural/ epidural hematoma
41
Coma is a transitional state, what does that mean?
It us usually only a few weeks They get better or it evolves into: - persistent vegetative state - brain death
42
Glasgow coma scale?
Eye opening response: 4 pts Verbal response: 5 pts Motor response: 6 pts If you’re dead you score at least 3
43
Results of glasgow coma scale?
Minor brain injury: 13-15 pts Moderate brain injury: 9-12 pts Sever brain injury: 3-8 pts
44
Decorticate posturing vs decerebrate posturing
Slide 137 but the big change is the hands Decorticate: hands and elbows in flexion, central Decerebrate: elbows extension, hands in flexion and out (angel wings)
45
Neurologic exam of stupor/coma pt?
``` Glasglow coma scale Cranial nerves Pupils Eye movements - oculocephalic maneuver (dolls eyes) - caloric testing Corneal reflex ```
46
Oculocephalic and caloric testing?
Slide 140 Oculocephalic (doll’s eyes) - eyes follow you when head moves Cold caloric response - cold water in ear and eyes move toward the cold
47
Lab studies for stupor or coma?
``` Chem 7 LFT PT PTT CBC ABG ``` Lumbar puncture
48
Preferred imaging for stupor/coma?
Neuroimaging: CT of head
49
What GCS level gets a tube?
GCS = 8
50
What is brain death?
Irreversible loss of function of the brain including the brainstem - trauma - hypoxic/ischemic insult
51
What must be there to be considered brain death?
Evidence of acute CNS event compatible w brain death Not reversible medical cause Not drug/poisoning Core temp >/= 32C (90F)
52
3 cardinal features of brain death?
Coma/unresponsiveness (no pain response) Absence of brainstem reflexes (pupils, oculocephalic, gag, grimacing) Apnea
53
Medical record must include:
- Etiology and irreversibility of condition - absence of brainstem reflexes - absence of motor response to pain - absence of respiration w PCO2 >/= 60mmHg - confirmatory testing (as indicated) - repeated neurological exams (usually need 2)

Junior - Neuro 2 (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions