Acquired Brain Injury - Stoke and TBI Flashcards

1
Q

Cerebral Vascular Accident (Stroke) - Definition

A

Clinical syndrome consisting of rapidly developing clinical signs of focal disturbance of cerebral function lasting more than 24h or leading to death with no apparent cause other than a vascular origin.

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2
Q

How long can a acute state, caused by a cerebrovascular injury, last? and what happens after this period.

A

Between 6-8 weeks.
After this period, signs of UMN related to spasticity can be seen in the contra-lateral body hemisphere, impairing functionality (ADLs).

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3
Q

Transient Ischemic Attack - Definition

A

Minor stroke. Temporary interruption of blood flow, producing symptoms that usually do not last over 72h. Considered a warning sign, leading to stroke in most cases.
No loss of consciousness. No long lasting damage.

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4
Q

Cryptogenic Stroke - Definition and Possible Causes (3)

A

All strokes that cannot be traced to a specific cause, but interruption of blood flow in a specific cerebral artery causes permanent neural damage, leading to sensorimotor or cognitive symptoms.
- Cardiovascular events
- Anatomical changes (cancer)
- Metabolic changes affecting permeability of vessels or composition of blood.

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5
Q

Modifiable Risk Factors (3) - Stroke

A

Physical inactivity (intensity influences risk for women)
Obesity (abdominal fat and BMI for women, only BMI for males)
Hypertension

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6
Q

Nonmodifiable Risk Factors (5) - Stroke

A

<45-85> years old.
Ethnicity (can be related to poor access to health care)
Arterial fibrillation
Type 1 diabetes
Genetic factor: gene in chromosome 9p21.

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7
Q

Which Arteries are most commonly damaged in a stroke (3)?

A

Anterior cerebral artery
Middle cerebral artery
Internal carotid artery

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8
Q

Traumatic Brain Injury - Contusion

A

Damage due to direct external forces (trauma) on the skull developing a hematoma.

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9
Q

Traumatic Brain Injury - Concussion - Cause, Sports, Recovery.

A

Most common traumatic encephalic diffuse lesion reported in different sports.
Caused by forces of inertia! Can lead to loss of consciousness and pos-traumatic amnesia, resolving spontaneously with time.
2-3 week recovery time.

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10
Q

Most Common Types of Hemorrhage (5)

A

Epidural Hemorrhage (EDH)
Subarachnoid Hemorrhage (SAH)
Subdural Hemorrhage (SDH)
Intraventricular Hemorrhage (IVH)
Intracranial Hemorrhage (ICH)

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11
Q

Epidural Hemorrhage (4) vs Subdural Hemorrhage (4)

A

Epidural: Convex - Convex, arterial blood, a lot of intracranial pressure, smaller area affected.
Subdural: Convex - concave, venous blood, less intracranial pressure, occupies more space.

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12
Q

Epidural Hemorrhage - Characteristics (5) Range in severity

A

Intracranial pressure (non-depressive fracture)
Deviation of the midline (we try to move all processes to the contralateral hemisphere)
Compression of subcortical structures
Compression of brainstem
Loss of consciousness

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13
Q

Subdural Hemorrhage - Possible Causes and Time Window

A

Lesion occurs inside a greater time window (venous bleeding), developing mostly to an acute phase in 3-7 days.
Often seen in patients on anticoagulants. Some genetic, integrity of blood vessels compromised.

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14
Q

Subarachnoid Hemorrhage - Most common people affected and most common etiologies

A

Most common in newborns, elderly or people with disorders affecting thickness, elasticity of arterial or venous walls.
Trauma and rupture of an aneurysm.

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15
Q

Intraventricular and Intracerebral Hemorrhage - Death of Neurons and Predictor sites (5)

A

From Trauma, death of neurons will happen due to pH differences, within 8 hours.
- Basal nuclei: 40-50%
- Cortical areas: 20-50%
- Thalamus/3rd ventricle: 10-15%
- Cerebellum: 5-10%
- Brainstem: 1-5%

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16
Q

Emergency Measures (3) - Hemorrhage

A

Lowering Intracranial pressure - craniotomy or insertion of a shunt.
Monitoring changes - decortication, decerebration patterns. Systolic blood pressure <90mmHg.
Diminishing Brain Damage - Cooling (hypothermia)

17
Q

Can you have both a concussion and a contusion at the same time?

A

yes

18
Q

Which physiological mechanism leads to unconsciousness in Rotational Brain Injury?

A

Disturbance in the axons of the arachnoid mater → Deregulated ion flux with potassium efflux and calcium influx → Neuronal depolarization → Immense release of GABA, shutting down the brain. → Acute neuronal functional failure.

19
Q

Second Impact Syndrome

A

Concussion while still recovering from another concussion, leading to instant death.

20
Q

Post Concussion Syndrome (PCS) -
Physical Symptoms

A

Headache
Nausea
Dizziness
Fatigue
Problems with balance/gait
Light and sound sensitivity

21
Q

Post Concussion Syndrome (PCS) -
Emotional, Cognitive and Sleep Symptoms

A

Emotional lability
Anxiety, depression

Cognitive deficits (concentration, memory, decision making)
Language Impairment
Disorientation and amnesia

Sleep-wake disturbance

22
Q

Post Concussion Syndrome (PCS) - Metabolic Theory

A

PCS related to ongoing mismatch between ATP supply and demand, exacerbated by impaired cerebral blood flow and exhausted mitochondrial function.
Most accepted theory

23
Q

Post Concussion Syndrome (PCS) - White Matter Tract Theory

A

PCS relates to axonal damage.

24
Q

Post Concussion Syndrome (PCS) - Cervicogenic Theory

A

Concussion symptoms are perpetuated by cervical strain.

25
Q

Post Concussion Syndrome (PCS) - Psychogenic Theory

A

Concussion symptoms are preserved through maladaptive coping behaviors and psychological co-morbidities.

26
Q

Chronic Traumatic Encephalopathy (CTE)

A

Result of multiple traumata to the head (microfractures). Leads to non-reversable neuropsychological and hypokinetic physical disabilities over time.
Highly observed in former athletes of contact sports, American football, boxing, ice hokey, basketball and soccer.

27
Q

Chronic Traumatic Encephalopathy - Pathophysiology Pathways

A

Dopaminergic pathways.
Nigrostriatal: SN-Striatum: movement regulation, attention.
Mesolimbic: VTA-AM: Goal directed behavior
Mesocortical: VTA-PFC,aCC: Attention, working memory.

28
Q

Recognizing a Possible Encephalic Injury (3)

A

Changes in social behavior such as aggressivity or confusion.
Movement disturbance, like abnormal gait and coordination deficits.
Memory and wakefulness disturbance.

29
Q

Symptoms of a Possible Encephalic Injury (13)

A

Nausea
Dizziness
Irritability
Worsening headache
Photo- and sound sensitivity
Sleep disturbance
Diplopia (double/multiple vision)
Fatigue
Loss of conscousness
Poor cognitive performance (finding words)
Amnesia
Convulsion (rapid, involuntary contractions, cause shaking like in seizures)
Altered pupil reflex

30
Q

Symptoms of a Severe Encephalic Injury (7)

A

Worsening headache
Photo and sound sensitivity
Diplopia
Loss of consciousness
Poor cognitive performance
Convulsions
Altered pupil reflex

31
Q

Avoiding Further Complications (8)

A

Seek medical care
Rest your mind
Rest your body
Sleep (not during day)
Avoid driving
Avoid anti-inflammatory and strong pain meds
Don’t use stimulant substances
Avoid a heavy diet

32
Q

Recovery - Time and Supporting Actions (5)

A

7-20 days.
Triggers: Avoid experiences that worsen symptoms
Nap if needed (30min)
Avoid any physical activity that increases heart rate over 10% of resting value
Expect difficulties (especially with attention) in complex mental tasks, don’t push it.
Avoid blood thinners, even without an onset bleeding.