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BMB Test 3 > B7-055 CBCL Trauma/Subdural > Flashcards

B7-055 CBCL Trauma/Subdural Flashcards

1
Q

primary causes of TBI [5]

A

concussion
CNS axonal injury
cranial nerve injury
contusion
laceration

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2
Q

concussion is largely caused by

A

angular acceleration

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3
Q

how can angular acceleration cause loss of consciousness?

A

torque to the RAS

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4
Q

what part of the brain is selectively vulnerable to the shearing stresses that occur due to angular acceleration?

A

high brainstem (midbrain/diencephalon)

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5
Q

torque causes transient stretching of axons without transection

A

concussion

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6
Q

torque tears axons with slow recovery and permanent disability

A

diffuse axonal injury

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7
Q

any symptom after any head injury is a

A

concussion

but symptoms will start immediately after injury

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8
Q

recovery from concussion followed by recurrent headache, impaired concentration, other minor neurologic symptoms

may persist for months to years

A

post-concussion syndrome

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9
Q

a patient with diffuse axonal injury can have relatively minor scans and still never wake up. why?

A

the axons of the RAS have been sheared off

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10
Q

cranial nerve injuries are often associated with […] fractures

A

basilar skull

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11
Q

most common cranial nerve affected by head injury

A

CN 1

(VII and VIII often susceptible as well)

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12
Q

CN 7 is likely to be damaged due to […] fracture

A

transverse petrous

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13
Q

CN 8 is likely to be damaged due to […] fracture

A

petrous pyramid

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14
Q

CN 12 is likely to be damaged due to […] fracture

A

hypoglossal canal

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15
Q

most common extraocular nerve affect by head injury

A

CN 4

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16
Q

blunt trauma to specific portions of the brain

underlying brain tissue crushed

A

contusion

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17
Q

forepart of brain slams into the front, then goes back is called […] injury

A

coup-contrecoup

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18
Q

what areas of the brain are selectively vulnerable to contusion? [2]

A

near rough, bony prominences (petrous bone)
falx

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19
Q

contusions typically affect the anterior temporal, subfrontal, and corpus callosum causing what symptoms?

A

apathy
short term memory deficits

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20
Q

grossly visible tear in the brain due to blunt or penetrating trauma

A

laceration

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21
Q

secondary injuries (mostly due to bleeding/swelling of the brain) [5]

A

edema
herniation
CSF derangements
seizures
infection

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22
Q

what patient population is especially vulnerable to herniation due to edema?

A

children

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23
Q

edema in the brain occurs due to […] occurring in the first 24-72 hours

A

cytotoxic cascade

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24
Q

bleeding between the periosteum and dura mater

A

epidural

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25
bleeding between the dura and the pia
subdural
26
blood within the CSF space
subarachnoid
27
caused by a tear in the meningeal artery, vein, or dural sinus
epidural hemorrhage
28
caused by tear of the bridging pial veins and arteries
subdural hemorrhage
29
the interval between onset of symptoms is longer in [...] hemorrhage
subdural (takes hours to come on)
30
risk factors for chronic subdural hemorrhage [2]
coagulopathy severe brain atrophy
31
develops immediately after the injury and evolves from contusion clinically resembles hypertensive hemorrhage
intracerebral hemorrhage
32
is surgical evacuation helpful for intracerebral hemorrhage?
not usually
33
caused by shearing of the parenchymal vessels
intracerebral hemorrhage
34
risk factors for intracerebral hemorrhage [2]
coagulopathy amyloid vasculopathy
35
treatment for traumatic subarachnoid hemorrhage
generally supportive
36
typically occurs in the basilar cisterns
traumatic subarachnoid hemorrhage
37
can onset with headache and meningismus
traumatic subarachnoid hemorrhage
38
unilateral dilated non-reactive pupil what type of herniation?
lateral
39
midsize bilateral non-reactive pupils what type of herniation?
central
40
flow of CSF disrupted by subarachnoid and intraventricular blood
hydrocephalus
41
if the CSF obstruction is outside of the brain it is called
communicating
42
if the CSF obstruction is within the brain it is called
non-communicating
43
tear of the dura and arachnoid can result in [...] leakage
CSF
44
a CSF leak can result in [3]
CSF hypotension **increased risk of infection** tension pneumocephalus
45
long term use of anti-seizure medication [does/does not] prevent post traumatic seizure
does not
46
a [higher/lower] number on the glascow coma scale is better
higher
47
[...] is the lowest the GCS goes
3
48
lens shaped hematoma
epidural
49
equation for cerebral perfusion pressure
CCP= MAP -ICP
50
ways to decrease blood volume to lower ICP
evacuate hematomas hyperventilation (lowers CPP, only used temporarily)
51
ways to decrease CSF volume to lower ICP
external ventricular drainage (also allows for monitoring of ICP)
52
ways to decrease brain volume to lower ICP
mannitol steroids decrease fluids (dehydrates the normal brain and can get rebound increase ICP- temporary)
53
surgical procedure to give the swollen brain more room
craniectomy
54
which imaging modality is best in an acute setting?
CT head
55
which imaging modality is used as a quick screening tool for hydrocephalus, herniation, or intracranial hemorrhage
CT head
56
which imaging modality is best in a subacute or non-traumatic setting?
MRI
57
which imaging modality is would be used for acute hemorrhage?
CT head
58
which imaging modality is would be used for fracture?
CT head
59
which imaging modality is would be used for diffuse axonal injury?
MRI head
60
which imaging modality is would be used for chronic injury?
MRI head
61
which imaging modality is would be used for late stage hematoma?
MRI head
62
most common site for contusions following head injury [2]
orbital frontal cortex anterior temporal lobe (due to rough surface of sphenoid bone)
63
CN most likely to be affected by TBI
CN 1
64
interventions to prevent herniation prior to surgery
burr holes hyperventilation IV mannitol ventricular shunt
65
convex hyperdensity on CT scan
epidural hematoma
66
period of lucency followed by a relatively rapid progression of neurologic symptoms
epidural hematoma
67
concave hyperdensity on CT
subdural hematoma
68
hyperdense findings on CT within the sulci or cisterns
subarachnoid hematoma
69
maintaining the head of the bed at [...] degrees can help reduce cerebral edema
30
70
reduces cerebral edema by lowering PaCO2
hyperventilation (causes arterial vasoconstriction)
71
reduce the cerebral metabolic rate, therefore reducing CSF flow
barbituates
72
late central descending herniation is characterized by
bilateral mid-range unreactive pupils
73
lateral (uncal) herniation is characterized by
unilateral dilated pupil
74
[...] herniation compresses the medulla and leads to respiratory arrest
tonsillar
75
[...] herniation can cause anterior cerebral artery infarct
subfalcine
76
what area of the brain is most likely to suffer from contusion following head trauma? [2]
anterior temporal pole inferior frontal lobe
77
cause white matter tract injury in a widespread area
diffuse axonal injury
78
areas of the brain most affected by diffuse axonal injury [3]
brain stem corpus callosum cerebral hemispheres
79
does diffuse axonal injury show up on CT?
no, need MRI
80
head trauma followed by a slow progression of neurologic symptoms
subdural hematoma
81
located within brain parenchyma and has a rapid onset of symptoms
intracerebral hemorrhage
82
a subdural hematoma is caused by a ruptured [...]
dural bridging vein
83
an epidural hematoma is caused by rupture of the [...]
middle meningeal artery
84
intraparenchymal hemorrhage can be caused by rupture of the [...] arteries
lenticulostriate
85
risk factors for subdural hemorrhage [3]
extremes of age (old and young) alcoholism anticoagulation use
86
hyperdensity within the tissue of the brain on CT with acute onset of symptoms
intraparachymal hemorrhage
87
[...] hemorrhages are located in the midbrain and pons and are a result of downward herniation of the brain
Duret
88
[...] herniation will typically cause progressive findings that begin with anisocoria
uncal
89
[...] herniation may cause changes in mentation or focal motor findings, but will typically not cause pupillary findings
subfalcine
90
[...] herniation results in the compression of the medulla or upper spinal cord
cerebellar tonsillar
91
[...] herniation may cause respiratory symptoms, lethargy, or paralysis but not pupillary findings
cerebellar tonsillar
92
herniation of the brain through a skull defect
transcalvarial
93
sudden onset of worst headache of their life and meningismus
subarachnoid hemorrhage
94
most common etiology of subarachnoid hemorrhage
ruptured anuerysm
95
typical causes of secondary brain injury [5]
acidosis cerebral edema free radical formation ischemia neurotransmitter release
96
what elements are required for diagnosis of concussion [2]
force altered neurologic status
97
is aphasia a symptom of concussion?
no
98
common symptoms of concussion
blurred vision difficulty with balance loss of consciousness post-traumatic amnesia
99
prolonged symptoms related to concussion
post-concussion syndrome
100
most common risk factor of intraparenchymal hemorrhage
hypertension
101
what type of hydrocephalus can subarachnoid hemorrhage, meningitis, and leptomeningeal carcinomatosis cause?
communicatings
102
often secondary to skull fracture involving the pterion
epidural hematoma
103
might present with transient loss of consciousness, followed by recovery, then rapid deterioration
epidural hematoma
104
does not cross suture lines
epidural hematoma
105
can cause transtentorial herniation and CN III palsy
epidural hematoma
106
rupture of bridging veins
subdural hematoma
107
type of hematoma in shaken baby syndrome
subdural hematoma
108
crosses suture lines
subdural hematoma
109
bleeding due to trauma, rupture of aneurysm, or AV malformation
subarachnoid hemorrhage
110
rapid time course "worst headache of my life" bloody/yellow LP
subarachnoid hemorrhage
111
increases the risk of developing hydrocephalus
subarachnoid hemorrhage
112
most commonly caused by systemic hypertension
intraparenchymal hemorrhage
113
seen with amyloid angiopathy, such as in AD
intraparenchymal hemorrhage
114
most often occur in the lenticulostriate vessels
intraparenchymal hemorrhage
115
traumatic shearing of the white matter tracts during rapid acceleration of the brain
diffuse axonal injury
116
shear injury often resulting in coma or vegetative state
diffuse axonal injury
117
MRI show multiple lesions involving white matter tracts
diffuse axonal injury
118
fluid accumulation in the brain parenchyma causing increased ICP
cerebral edema
119
cerebral edema is caused by osmotic shift
cytotoxic
120
common causes of cytotoxic cerebral edema [3]
early ischemia hyperammonemia SIADH
121
cerebral edema caused by extracellular fluid accumulation due to disruption of BBB
vasogenic edema

BMB Test 3 (18 decks)

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