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BMB Test 3 > B7.055 Prework: Traumatic Brain Injury > Flashcards

B7.055 Prework: Traumatic Brain Injury Flashcards

1
Q

types of TBI

A

penetrating: gunshots and severe blunt trauma, severe damage and a high incidence of infection
nonpenetrating: blunt trauma

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2
Q

primary injury

A

at the time of trauma

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3
Q

secondary injury

A

complications subsequent to trauma (why patients get worse)

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4
Q

types of primary brain injury

A 
concussion
CNS axonal injury
cranial nerve injury
contusion
laceration
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5
Q

causes of concussion

A

freely moving head struck
OR
rapid acceleration of head without impact

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6
Q

damage done in concussion

A

partly tethered brain rotates
rotational motion > shearing stresses
worst in high brainstem
shear may also affect gray white junction
torque to RAS causes loss of consciousness

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7
Q

severity of shearing lesions

A
  1. torque causes transient stretching without transection with rapid recovery of consciousness (concussion)
  2. torque tears axons with slow recovery and permanent disability (diffuse axonal injury)
  3. torque lacerates upper brainstem with no recovery
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8
Q

concussion definition

A 
reversible traumatic paralysis of nervous function
defined by:
-LOC
-amnesia
OR
-other brain dysfunction (headache)
effects immediate
can have long term sequelae
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9
Q

clinical manifestations of concussion

A 
unconsciousness
loss of body tone (fall)
transient arrest of resp
bradycardia and hypotension
sometimes convulsions
anterograde amnesia
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10
Q

post concussion syndrome

A

recovery from concussion may be followed by recurrent headache, impaired ability to concentrate, and other minor neurologic symptoms
symptoms are usually transient but in some cases may persist for months or years

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11
Q

diffuse axonal injury

A 
predominant abnormalities in severe head injury
occur in:
-midbrain/ diencephalon
-corona radiata
-gray white junction
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12
Q

cranial nerve injury in head trauma

A

often associated with basilar skull fractures
any nerve can be affected
CN I, VII, and VIII most susceptible

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13
Q

olfactory nerve injury

A

anterior skull

common without a fracture

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14
Q

CN 7 injury

A

transverse petrous

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15
Q

CN 8 injury

A

petrous pyramid

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16
Q

CN 12 injury

A

hypoglossal canal

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17
Q

CN 4 injury

A

most common extraocular muscle nerve damaged

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18
Q

cerebral contusion

A

more severe trauma
loss of consciousness longer than with concussion
may lead to death or severe residual neurologic deficit

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19
Q

findings associated with cerebral contusion

A

edema
hemorrhage
necrosis
subarachnoid bleeding

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20
Q

mechanism of contusion

A

blunt trauma to specific portions of the brain

underlying brain tissue crushed

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21
Q

coup-contrecoup

A

coup injury- under the site of impact with an object contrecoup injury- on the side opposite the area that was hit

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22
Q

what portions of the brain are selectively vulnerable to contusions

A 
areas near rough, bony prominences
-anterior temporal
-subfrontal
-corpus callosum
falx
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23
Q

cognitive symptoms of contusion

A

apathy and short term memory deficits

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24
Q

laceration

A

grossly visible tear in brain
blunt or penetrating trauma
brainstem avulsion

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25
Q

types of secondary injuries

A 
edema
bleeding
herniation
CSF derangements
seizures
infection
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26
Q

mechanism of edema

A

vasogenic and cytotoxic
cytotoxic cascade
increases during the first 24-72 hrs
may be massive and lead to herniation

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27
Q

types of brain bleeds

A

epidural
subdural
intracerebral
subarachnoid

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28
Q

cause of acute epidural hemorrhage

A

tear in meningeal artery, vein, or dural sinus

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29
Q

symptoms and signs of epidural hemorrhage

A

headache, confusion, somnolence, seizures, and focal deficits
can lead to coma, resp depression, and death unless evacuated

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30
Q

location of epidural hematoma

A

lateral cerebral convexities

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31
Q

presentation of epidural hematoma

A

classically lucid interval then coma

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32
Q

age at risk of epidural hematoma

A

children

young adults

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33
Q

radiologic features of epidural hematoma

A

acute bulging epidural clot
bounded by cranial sutures
lenticular in shape

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34
Q

treatment of epidural hematoma

A

urgent evacuation

35
Q

cause of acute subdural hemorrhage

A

tearing of bridging pial veins and arteries

36
Q

location of acute subdural hemorrhage

A

lateral cerebral convexities

37
Q

evolution of acute subdural hemorrhage

A

many hours

38
Q

symptoms of acute subdural hematoma

A

similar to epidural

interval before onset of symptoms is longer

39
Q

age at risk of acute subdural hematoma

A

all

40
Q

radiologic findings of acute subdural hematoma

A

acute blood rimming broad region of cerebral convexity

41
Q

treatment of acute subdural hematoma

A

urgent evacuation if large enough to cause symptoms

42
Q

cause of chronic subdural hematoma

A

trauma

can expand over time as large proteins in blood break down into smaller ones, increase osmolality and draw more fluid

43
Q

risk factors for chronic subdural

A

coagulopathy

severe brain atrophy

44
Q

evolution of chronic subdural

A

days to weeks

45
Q

signs and symptoms of chronic subdural

A

headache, progressive alteration in mental status +/- focal neuro signs

46
Q

age at risk of chronic subdural

A

elderly

47
Q

radiologic findings of chronic subdural

A

hyper- or isodense

unilateral or bilateral

48
Q

treatment of chronic subdural

A

evacuation in some circumstances

49
Q

etiology of intracerebral hemorrhage

A

develops immediately after injury
often evolves from contusion
clinically resembles hypertensive hemorrhage

50
Q

cause of intracerebral hemorrhage

A

shearing of parenchymal vessels

51
Q

risk factors for intracerebral hemorrhage

A

coagulopathy

amyloid vasculopathy

52
Q

location of intracerebral hemorrhage

A

inferior frontal and temporal lobes

53
Q

evolution of intracerebral hemorrhage

A

expand over 12-48 hours

54
Q

age at risk of intracerebral hemorrhage

A

any

55
Q

radiologic findings in intracerebral hemorrhage

A

multiple, confluent regions of edema intermixed with focal, acute blood

56
Q

treatment of intracerebral hemorrhage

A

evacuate if large

57
Q

cause of traumatic subarachnoid hemorrhage

A

bleeding of pial vessels

58
Q

location of subarachnoid hemorrhage

A

typical basilar cisterns

59
Q

evolution of subarachnoid hemorrhage

A

minutes to hours

60
Q

symptoms and signs of subarachnoid hemorrhage

A

headache, meningismus, delayed manifestations, vasospasm

61
Q

age at risk of subarachnoid hemorrhage

A

any

62
Q

radiologic findings in subarachnoid hemorrhage

A

acute blood lining cortex in subarachnoid space

63
Q

treatment for subarachnoid hemorrhage

A

generally supportive

64
Q

what is herniation

A

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

65
Q

syndrome of central herniation

A

bilateral midsize, nonreactive pupils
diffuse edema or midline lesion
para and sym affected

66
Q

syndrome of lateral herniation

A

unilateral dilated, nonreactive pupil

CN III affected (para)

67
Q

traumatic hydrocephalus

A

flow of CSF disrupted by subarachnoid and intraventricular blood

68
Q

communicating hydrocephalus

A

obstruction outside of brain

69
Q

non-communicating hydrocephalus

A

obstruction within brain

70
Q

CSF leak

A

tear of dura and arachnoid leads to extracranial CSF leakage and CSF hypotension (headache)

71
Q

results of CSF leak

A

increased risk of infection

tension pneumocephalus

72
Q

post traumatic seizures

A

common
do not increase risk of subsequent seizures
may increase ICP
prevent with acute prophylactic anti-seizure meds

73
Q

post traumatic infection

A

penetrating injuries and CSF leak increase risk of post traumatic infection
meningitis
abscess
empyema

74
Q

glascow coma scale

A 
3= worst
15= best
75
Q

treatment of TBI

A

ICU care
prevent infection
treat seizures
control ICP

76
Q

what is ICP

A 
intracranial pressure
proportional to volume of:
-blood
-CSF
-brain
77
Q

how to decrease ICP

A

decrease

  • blood
  • CSF
  • brain
78
Q

CPP

A

cerebral perfusion pressure
must be maintained
CPP = MAP - ICP

79
Q

ways to decrease blood volume

A 
evacuate hematoma
hyperventilation
-decreased CO2
-vasoconstriction
-decreased cerebral perfusion
80
Q

ways to decrease CSF volume

A

external ventricular drainage

81
Q

ways to decrease brain volume

A

decreased fluid
hyperosmolar therapy (mannitol, hypertonic saline)
steroids

82
Q

give swollen brain more room?

A

craniectomy

83
Q

chronic sequelae of TBI

A 
post concussion syndrome
post traumatic encephalopathy
post traumatic epilepsy
permanent vegetative state
dementia pugilistica

BMB Test 3 (21 decks)

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