Brain and spinal cord injury

Question 1

Question 1 of 9

While you were working in the emergency department last week, two patients with severe neurological injuries required care. The first was a young male, age 22, named Brian. He suffered a traumatic head injury while snowboarding in the half-pipe.

When Brian first arrived at the emergency department, bruising behind the ears was noted. In those suffering traumatic head injuries, this type of bruising is known as \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.
Murphy’s sign
Battle’s sign
Cullen sign
Grey Turner sign

Answer 1

Battle’s sign

Battle’s sign is bruising behind the ear when a traumatic head injury occurs. Murphy’s sign is used for gallbladder inflammation, whereas the Grey Turner and Cullen signs help detect bleeding in the abdominal cavity.

Question 2

Question 2 of 9

Based on the bruising, Brian suffered a fracture in the base of the skull known as a(n) \_\_\_\_\_\_\_\_\_ fracture.
Basilar
Linear
Depressed
Epidural

Answer 2

Basilar

A basilar fracture occurs at the base of the skull. A linear fracture is the most common type of skull fracture and usually does not require intervention. A depressed skull fracture normally displaces portions of the skull inward, injuring brain tissue. A compound skull fracture occurs with fractured skull bones accompanied by lacerations.

Question 3

Question 3 of 9

After speaking with Brian’s friends who witnessed the accident, you learn that he missed a landing, causing him to fall backward. Brian was wearing a helmet, but his head struck the ground several times. You realize Brian must have suffered a(n) \_\_\_\_\_\_\_\_\_ injury, as his brain was moving in one direction and struck the interior of the skull which caused the brain to rebound and hit the opposite side of the skull.
Coup-contrecoup
Skull depression
Diffuse
Epidural

Answer 3

Coup-contrecoup

In a coup-contrecoup injury, because of momentum, the brain strikes one area of the interior of the skull, only to bounce off the area of impact and strike the opposite part of the skull. This form of impact injury is very common in traumatic head injuries.

Question 4

Question 4 of 9

Brian is under continual observation since \_\_\_\_\_\_\_\_\_\_\_\_\_\_ may elevate, leading to increased risk of herniation of the brain if not managed.
Epidural pressure
Subdural pressure
Ventricular pressure
Intracranial pressure

Answer 4

Intracranial pressure

Intracranial pressure, ICP, is the pressure within the brain and cerebrospinal fluid. This pressure is closely monitored and managed by the body to be maintained in a narrow range. Traumatic head injuries may increase intracranial pressure, leading to further damage of the brain tissue.

Question 5

Question 5 of 9

You inform Brian’s family that they will need to be aware of signs and symptoms of head trauma that may occur several weeks or more after the initial injury. This is known as \_\_\_\_\_\_\_\_\_.
Murphy’s sign
Battle’s sign
Postconcussion syndrome
Level of consciousness

Answer 5

Postconcussion syndrome

Recovery from traumatic head injuries may take days, weeks, months or longer depending on the severity of injury. Often, signs and symptoms may be present several weeks after the initial event; this is known as post-concussion syndrome.

Question 6

Question 6 of 9

The second individual with a neurological injury was a young female, also age 22, named Abigail. Abigail suffered a spinal cord injury. She was riding on the back of an ATV driven by her boyfriend. While traveling at high speeds, the ATV flipped over after hitting a deep gulley.

Abigail’s spinal cord injury is apparent as soon as she arrives at the emergency department. However, you know that until \_\_\_\_\_\_\_\_\_\_\_\_ resolves, it is impossible to determine the extent of the spinal cord injury.
Spinal shock
Spinal herniation
Healing
Level of consciousness (LOC)
Check Answer

Answer 6

Spinal shock

Spinal shock occurs initially following a severe injury to the spinal cord. During this time, spinal cord functioning is depressed. At first, all reflexes below the level of injury are lost. Gradually, depending on the injury, some of this function may return.

Question 7

Question 7 of 9

With further analysis, Abigail is diagnosed with a spinal cord injury at T11-T12. Had Abigail’s injury been at T6 or above, she may have developed \_\_\_\_\_\_\_\_\_\_\_\_\_\_ shock.
Cardiogenic
Hemodynamic
Progressive
Neurogenic

Answer 7

Neurogenic

Spinal cord injuries occurring at T6 or above may disrupt the functioning of the sympathetic nervous system and cause neurogenic shock. Dysregulation of the heart rate and blood pressure may result in inadequate circulation and perfusion of tissues.

Question 8

Question 8 of 9

In addition to other clinical information, a(n) \_\_\_\_\_\_\_\_\_\_\_\_ revealed areas of Abigail’s body in which sensation was still present, enabling the medical team to determine the area of injury.
Dermatome map
Myotome
Glasgow scale
EMG

Answer 8

Dermatome map

A dermatome is an area of skin innervated by a specific spinal nerve. Lack of sensation within areas can indicate an inability for sensory information from this location to reach the brain for processing. Injury to the spinal cord can prevent ascending, sensory information from reaching the brain.

Question 9

Question 9 of 9

Unfortunately for Abigail, all function below her area of injury appears to be lost. This is known as a(n) _________________ spinal cord injury.
incomplete
complete
ischemic

Answer 9

complete

A complete transection of the spinal cord results in the loss of all functions below the area of injury. An incomplete spinal cord injury indicates at least some function has been retained.

Question 10

Question 1 of 5

An impact injury to the skull that results in the brain striking one area of the skull and rebounding in the opposite direction is known as _____________________.

subdural tearing
coup-contrecoup
cerebrovascular accident
epidural hematoma

Answer 10

coup-contrecoup

Question 11

Question 2 of 5

Which condition will most likely increase intracranial pressure (ICP)?

Blunt head trauma causing hemorrhage
Lobectomy
External drainage of cerebrospinal fluid (CSF)
Decompressive craniectomy

Answer 11

Blunt head trauma causing hemorrhage

Question 12

Question 3 of 5

Level of consciousness __________________.

is elevated with severe head trauma
is evaluated using magnetic resonance imaging
is normally unaltered in head trauma
is evaluated on a continuum from “alert” to “coma”

Answer 12

is evaluated on a continuum from “alert” to “coma”

Question 13

Question 4 of 5

Which of the following is a mild form of traumatic brain injury?

Diffuse axonal injury
Concussion
Cerebral artery rupture
Epidural ble

Answer 13

Concussion

Question 14

Question 5 of 5

In a complete spinal cord injury, ____________________.

only motor control is affected
both sensation and motor function are lost
spinal shock does not occur
only sensation is affected

Answer 14

both sensation and motor function are lost