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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
Q

bleeding between the dura and the pia

A

subdural

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26
Q

blood within the CSF space

A

subarachnoid

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27
Q

caused by a tear in the meningeal artery, vein, or dural sinus

A

epidural hemorrhage

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28
Q

caused by tear of the bridging pial veins and arteries

A

subdural hemorrhage

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29
Q

the interval between onset of symptoms is longer in […] hemorrhage

A

subdural (takes hours to come on)

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30
Q

risk factors for chronic subdural hemorrhage [2]

A

coagulopathy
severe brain atrophy

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31
Q

develops immediately after the injury and evolves from contusion

clinically resembles hypertensive hemorrhage

A

intracerebral hemorrhage

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32
Q

is surgical evacuation helpful for intracerebral hemorrhage?

A

not usually

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33
Q

caused by shearing of the parenchymal vessels

A

intracerebral hemorrhage

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34
Q

risk factors for intracerebral hemorrhage [2]

A

coagulopathy
amyloid vasculopathy

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35
Q

treatment for traumatic subarachnoid hemorrhage

A

generally supportive

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36
Q

typically occurs in the basilar cisterns

A

traumatic subarachnoid hemorrhage

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37
Q

can onset with headache and meningismus

A

traumatic subarachnoid hemorrhage

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38
Q

unilateral dilated
non-reactive pupil

what type of herniation?

A

lateral

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39
Q

midsize bilateral
non-reactive pupils

what type of herniation?

A

central

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40
Q

flow of CSF disrupted by subarachnoid and intraventricular blood

A

hydrocephalus

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41
Q

if the CSF obstruction is outside of the brain it is called

A

communicating

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42
Q

if the CSF obstruction is within the brain it is called

A

non-communicating

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43
Q

tear of the dura and arachnoid can result in […] leakage

A

CSF

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44
Q

a CSF leak can result in [3]

A

CSF hypotension
increased risk of infection
tension pneumocephalus

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45
Q

long term use of anti-seizure medication [does/does not] prevent post traumatic seizure

A

does not

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46
Q

a [higher/lower] number on the glascow coma scale is better

A

higher

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47
Q

[…] is the lowest the GCS goes

A

3

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48
Q

lens shaped hematoma

A

epidural

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49
Q

equation for cerebral perfusion pressure

A

CCP= MAP -ICP

50
Q

ways to decrease blood volume to lower ICP

A

evacuate hematomas
hyperventilation (lowers CPP, only used temporarily)

51
Q

ways to decrease CSF volume to lower ICP

A

external ventricular drainage

(also allows for monitoring of ICP)

52
Q

ways to decrease brain volume to lower ICP

A

mannitol
steroids
decrease fluids

(dehydrates the normal brain and can get rebound increase ICP- temporary)

53
Q

surgical procedure to give the swollen brain more room

A

craniectomy

54
Q

which imaging modality is best in an acute setting?

A

CT head

55
Q

which imaging modality is used as a quick screening tool for hydrocephalus, herniation, or intracranial hemorrhage

A

CT head

56
Q

which imaging modality is best in a subacute or non-traumatic setting?

A

MRI

57
Q

which imaging modality is would be used for acute hemorrhage?

A

CT head

58
Q

which imaging modality is would be used for fracture?

A

CT head

59
Q

which imaging modality is would be used for diffuse axonal injury?

A

MRI head

60
Q

which imaging modality is would be used for chronic injury?

A

MRI head

61
Q

which imaging modality is would be used for late stage hematoma?

A

MRI head

62
Q

most common site for contusions following head injury [2]

A

orbital frontal cortex
anterior temporal lobe

(due to rough surface of sphenoid bone)

63
Q

CN most likely to be affected by TBI

A

CN 1

64
Q

interventions to prevent herniation prior to surgery

A

burr holes
hyperventilation
IV mannitol
ventricular shunt

65
Q

convex hyperdensity on CT scan

A

epidural hematoma

66
Q

period of lucency followed by a relatively rapid progression of neurologic symptoms

A

epidural hematoma

67
Q

concave hyperdensity on CT

A

subdural hematoma

68
Q

hyperdense findings on CT within the sulci or cisterns

A

subarachnoid hematoma

69
Q

maintaining the head of the bed at […] degrees can help reduce cerebral edema

A

30

70
Q

reduces cerebral edema by lowering PaCO2

A

hyperventilation

(causes arterial vasoconstriction)

71
Q

reduce the cerebral metabolic rate, therefore reducing CSF flow

A

barbituates

72
Q

late central descending herniation is characterized by

A

bilateral mid-range unreactive pupils

73
Q

lateral (uncal) herniation is characterized by

A

unilateral dilated pupil

74
Q

[…] herniation compresses the medulla and leads to respiratory arrest

A

tonsillar

75
Q

[…] herniation can cause anterior cerebral artery infarct

A

subfalcine

76
Q

what area of the brain is most likely to suffer from contusion following head trauma? [2]

A

anterior temporal pole
inferior frontal lobe

77
Q

cause white matter tract injury in a widespread area

A

diffuse axonal injury

78
Q

areas of the brain most affected by diffuse axonal injury [3]

A

brain stem
corpus callosum
cerebral hemispheres

79
Q

does diffuse axonal injury show up on CT?

A

no, need MRI

80
Q

head trauma followed by a slow progression of neurologic symptoms

A

subdural hematoma

81
Q

located within brain parenchyma and has a rapid onset of symptoms

A

intracerebral hemorrhage

82
Q

a subdural hematoma is caused by a ruptured […]

A

dural bridging vein

83
Q

an epidural hematoma is caused by rupture of the […]

A

middle meningeal artery

84
Q

intraparenchymal hemorrhage can be caused by rupture of the […] arteries

A

lenticulostriate

85
Q

risk factors for subdural hemorrhage [3]

A

extremes of age (old and young)
alcoholism
anticoagulation use

86
Q

hyperdensity within the tissue of the brain on CT with acute onset of symptoms

A

intraparachymal hemorrhage

87
Q

[…] hemorrhages are located in the midbrain and pons and are a result of downward herniation of the brain

A

Duret

88
Q

[…] herniation will typically cause progressive findings that begin with anisocoria

A

uncal

89
Q

[…] herniation may cause changes in mentation or focal motor findings, but will typically not cause pupillary findings

A

subfalcine

90
Q

[…] herniation results in the compression of the medulla or upper spinal cord

A

cerebellar tonsillar

91
Q

[…] herniation may cause respiratory symptoms, lethargy, or paralysis but not pupillary findings

A

cerebellar tonsillar

92
Q

herniation of the brain through a skull defect

A

transcalvarial

93
Q

sudden onset of worst headache of their life and meningismus

A

subarachnoid hemorrhage

94
Q

most common etiology of subarachnoid hemorrhage

A

ruptured anuerysm

95
Q

typical causes of secondary brain injury [5]

A

acidosis
cerebral edema
free radical formation
ischemia
neurotransmitter release

96
Q

what elements are required for diagnosis of concussion [2]

A

force
altered neurologic status

97
Q

is aphasia a symptom of concussion?

A

no

98
Q

common symptoms of concussion

A

blurred vision
difficulty with balance
loss of consciousness
post-traumatic amnesia

99
Q

prolonged symptoms related to concussion

A

post-concussion syndrome

100
Q

most common risk factor of intraparenchymal hemorrhage

A

hypertension

101
Q

what type of hydrocephalus can subarachnoid hemorrhage, meningitis, and leptomeningeal carcinomatosis cause?

A

communicatings

102
Q

often secondary to skull fracture involving the pterion

A

epidural hematoma

103
Q

might present with transient loss of consciousness, followed by recovery, then rapid deterioration

A

epidural hematoma

104
Q

does not cross suture lines

A

epidural hematoma

105
Q

can cause transtentorial herniation and CN III palsy

A

epidural hematoma

106
Q

rupture of bridging veins

A

subdural hematoma

107
Q

type of hematoma in shaken baby syndrome

A

subdural hematoma

108
Q

crosses suture lines

A

subdural hematoma

109
Q

bleeding due to trauma, rupture of aneurysm, or AV malformation

A

subarachnoid hemorrhage

110
Q

rapid time course
“worst headache of my life”
bloody/yellow LP

A

subarachnoid hemorrhage

111
Q

increases the risk of developing hydrocephalus

A

subarachnoid hemorrhage

112
Q

most commonly caused by systemic hypertension

A

intraparenchymal hemorrhage

113
Q

seen with amyloid angiopathy, such as in AD

A

intraparenchymal hemorrhage

114
Q

most often occur in the lenticulostriate vessels

A

intraparenchymal hemorrhage

115
Q

traumatic shearing of the white matter tracts during rapid acceleration of the brain

A

diffuse axonal injury

116
Q

shear injury often resulting in coma or vegetative state

A

diffuse axonal injury

117
Q

MRI show multiple lesions involving white matter tracts

A

diffuse axonal injury

118
Q

fluid accumulation in the brain parenchyma causing increased ICP

A

cerebral edema

119
Q

cerebral edema is caused by osmotic shift

A

cytotoxic

120
Q

common causes of cytotoxic cerebral edema [3]

A

early ischemia
hyperammonemia
SIADH

121
Q

cerebral edema caused by extracellular fluid accumulation due to disruption of BBB

A

vasogenic edema

BMB Test 3 (18 decks)

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