Brain Flashcards
___ brain injury is caused by direct impact
Focal: one area
Diffuse: more than one area
Primary brain injury
Altered brain function due to external force. Closed or open head trauma is called ___ brain injury
Traumatic
__ brain injury indirect consequence of primary injury.
Ex ischemia due to vascular interruption
Secondary brain injury
The hallmark of a severe tbi is loss of consciousness for 6 hours or more
Know
Gas glow grading
Best response is 15
Comatose client 8 or less
Total unresponsive is 3
Know
Diffuse injuries
Diffuse axonal injury
Blast
Confusion
Focal
Contusion
Penetrating
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___ brain injury fan he closed (blunt) or open (penetrating)
Closed is more common, head strikes a surface or moving object strikes head. Or by blast waves. Dura mater remains intact and tissues are not allowed exposed to environment
Causes both focal and diffuse axonal injury
Open: penetrating trauma. Break in dura mater and exposed cranial content
Focal
___ injury directly below point of impact
*closed brain injury
Coup
___ injury is when the head bounces back and you get injury on opposite side
*closed brain injury
Contrecoup injury
Closed brain injury the force of the impact on typically produces contusions. Contusions Usually in frontal and temporal
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Bleeding between dura mater and skull
Epidural hematoma
Bleeding between dura mater and arachnoid membrane of the body
Headache confusion drowsiness
10-20% of persons with TBI
Subdural hematoma
___ hematoma bleeding within brain. 2-3% of people with TBI also seen with stroke
Intracerebral hematoma
With any brain injury, monitor ICP and advanced imaging EEG, MRI, control ICP
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If someone says worst headache of their life think of subarachnoid hemorrhage
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___ brain injury breaks the dura and exposes the cranial contents to the environment
Causes both focal and diffuse injuries
Open brain injury
Something shot at head and causing injury
Missile injury
___ injury is splintering of the bone
Compound
Identified as a coma that lasts 6 or more hours after TBI
Involves widespread area of brain
Acceleration and deceleration or rotational forced cause axonial damage. Shearing, tearing, stretching or nerve fibers.
Long term neuro issues
Whiplash injury *
Trouble responding, behavior and cognitive changes
Diffuse brain injury axonal injury
___ indirect result of primary brain injury, trauma and stroke syndrome, systemic processes (hypotension, hypoxemia, Amemia) cerebral processes (inflammation, cerebral edema)
**Management is to prevent hypoxia and maintain cerebral perfusion
Secondary brain injury
Mild TBI (mild concussion) Glasgow coma 13-15, blunt trauma to head, no or short loss of consciousness, confusion for minutes and retrograde amnesia
Moderate TBI( moderate concussion)
GCS 9-12
Loss of consciousness 30 minutes to 6 hours
Confusion with amnesia longer than 24 hours
Severe TBI
GCS 3-8
Loss of consciousness longer than 6 hours
Severe cognitive system defects
Pupil changes, cardiac and respiratory systems, abnormal reflexes & posture abnormal, severe cognitive defect
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Complications of TBI
Post concussion syndrome
Lasts weeks or months post mild concussion
Symptomatic relief with observation
Post traumatic seizures
Occurs within days, lasts up to 2-5 years post injury
Seizure prevention initiated early with moderate to severe TBI
Chronic traumatic encephalopathy
Progressive cementing disease
Violent behaviors
Repeated injury
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Spinal cord injury
___ occurs with initial mechanical trauma and immediate tissue destruction
Primary
Spinal cord injury
___ pathophysiologic cascade of events that begin immediately after injury and continues for weeks
Life threatening
Secondary
Vertebral injury
•most often occur at C1-C2 c4-c7 and t10-L2
SCI most commonly occur die to vertebral injuries
Rest from acceleration, deceleration, deformation forces
Simple fracture- single break that usually affects transverse or spinus process
Compressed (wedged) fracture- vertebral body is compressed anteriorly
Comminuted( burst)fracture- shattered vertebral body
Dislocation- our of place
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All cervical spinal cord trauma except for axial compression
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Normal activity of spinal cord ceases below level of injury. Temporary and lasts 2-3 days
Spinal shock
Vasogenic shock, occurs with injury above T6, caused by absence of sympathetic activity and unopposed parasympathetic tone
Neurogenic shock
Sudden massive reflex sympathetic discharge because descending inhibition is blocked.
Stimulation of the sensory receptors * below the level of the cord lesion*
Most common cause is distended bladder or distended rectum ***
Stroke, seizures, death
Autonomic hyperreflexia (dysreflexia)
The autonomic nervous system
The sympathetic stimulates fight or flight- everything speeds up.
Parasympathetic inhibitory- slows everything down
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Any abnormality of the brain caused by a process in the blood vessels
- most frequently occurring neurologic disorder
- ischemia with or without infarction (death of brain tissue)
Cerebrovascular accident
Leading cause of disability *
Third in females and 5th in makes as leading cause of death in US. 25% are recurrent
CVA
Occurs when there is obstruction to arterial blood flow to the brain due to clot or low perfusion
*type of stroke
Ischemia stroke
___ stroke is obstruction by thrombus in arteries supplying the brain
Thrombotic
Episode of neurological dysfunction that lasts no more than one hours. Temporary destruction of brain blood flow
TIA
___ stroke is where thrombus fragments obstructing brain vessels (from heart)**
Embolic
*SYSTEMIC hypoperfusion decreases blood supply to brain
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____ infarction when a area of the brain loses blood supply due to vascular occlusion
Central core of irreversible ischemia and necrosis, surrounded by ischemia *penumbra- prompt infusion of thrombolytic agents may restore perfusion in penumbra preventing necrosis
Central infarction
Rim of boarderline hypoxic tissue
Penumbra
Bleeding occurs in brain tissue or subarachnoid and subdural spaces. HTN is primary cause of this type of stroke
Hemorrhagic
Dilated area or ballooning of cerebral vessel in the brain bc the vessel is weak. Born with it, trauma, smoking or hereditary
Most common indicator of this is hemorrhage
Aneurysm
Escape of blood into subarachnoid space
Hemorrhage
A mass of dilated vessels, no capillary bed in between. Present at birth can be a symptomatic or have headache and seizures
Arteriovenous malformation
Inflammation of brain or spinal cord
Meningitis
Acute inflammation of the brain, *usually of viral origin
*herpes simplex 1
Can be mild or life threatening
Encephalitis
For encephalitis keep intracranial pressure as normal as you can and treat cause
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Chronic progressive immune mediated inflammatory disease
Multiple areas of myelin loss.
*disrupts nerve conduction
Weaknesses
Impaired gait
Visual disturbances
More common in women ages 20-40
Multiple sclerosis
__ ___ ___ is Acquired inflammatory disease that causes demyelination of peripheral nerves
Acute onset, ascending motor paralysis
Humoral and cellular immunologic reaction
Lower extremities, after infection
Months-2 year to recover
Guillain barre syndrome
Acquired chronic autoimmune disease. Results from defect in nerve impulse transmission at neuromuscular junction
Rare and more common in women
Prob with thymus gland
Myasthenia gravis
a primary brain tumor that originate from brain substance
Extra cerebral tumors is outside of the brain..
Astrocytoma makes up 75% of all tumors of brain and spinal cord and is most common glioma
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Metastatic brain tumor is most prevalent brain tumor and comes from outside of the brain an spread to the brain
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Spinal cord tumor are rare
Intramedullary tumor originate from spinal cord
Extramedullary tumor outside of spinal cord
Compressive syndrome motor and sensory function affected when tumor gets bigger-pain
Irritating syndrome- result of compressed nerve roots, numbness and weakness, continuous pain
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