6.4 Traumatic Brain Injury

Question 1

at the time of trauma, usually injury due to angular acceleration

Answer 1

primary traumatic brain injury

Question 2

complications after the trauma, delayed (edema, bleeding, herniation, hydrocephalus)

Answer 2

secondary traumatic brain injury

Question 3

reversible, immediatie traumatic paralysis with loss of consciousness or memory

Answer 3

concussion

Question 4

recurrent headache and difficulty concentrating, transient to lasting for years

Answer 4

post concussion syndrome

Question 5

CT shows punctate hemorrhage, shearing of axons, results in coma

Answer 5

diffuse axonal injury

Question 6

more severe trauma, loss of consciousness usually longer than with concussion, may lead to death or severe neurologic deficit, get edema, hemorrhage and necrosis, may have subarachnoid bleeding

Answer 6

cerebral contusion

Question 7

• fractures commonly present
• middle meningeal artery injury
• 80% in temporal area
• rapid expansion under systemic arterial pressure
• CT: hyperdense blood collection not crossing suture lines

Answer 7

epidural hematoma

Question 8

• acceleration/deceleration injuries
• tearing of bridging veins
• one of most lethal
• can be chronic assoc’d with elderly and mild trauma

Answer 8

subdural hematoma

Question 9

-commonly due to systemic HTN, occurs in basal ganglia and internal capsule

Answer 9

intracerebral hemorrhage

Question 10

• bleeding of pial vessels, rupture of an aneurysm
• rapid time course, worst headache of my life, bloody spinal tap
• radiology: acute blood lining cortex in subarachnoid space

Answer 10

subarachnoid hemorrhage

Question 11

midsize bilateral non-reactive pupils in _______ herniation

Answer 11

central

Question 12

unilateral dilated non-reactive pupil

Answer 12

lateral herniation

Question 13

mass effect of edematous brain or hematoma, compression of diencephalon/midbrain/pons/medulla, rostral caudal detorioration of function

Answer 13

herniation

Question 14

flow of CSF disrupted by subarachnoid and intraventricular blood

Answer 14

hydrocephalus

Question 15

hydrocephalus, obstruction outside of brain, decreased CSF absorption by arachnoid granulations, increased intracranial pressure, herniation

Answer 15

communicating

Question 16

hydrocephalus, obstruction within brain, structural blockage of CSF circulation within ventricular system

Answer 16

non-communicating hydrocephalus

Question 17

ways to reduce intracranial pressure?

Answer 17

evacuate hematomas, hyperventilation (decreased CO2 –> vasoconstriction –> decreased cerebral perfusion), external ventricular drainage, hyperosmolar therapy