brain injury Flashcards
One approach that defines TBI into 3 categories… what are they?
- local(focal) Brain Damage
- Diffuse Brain Damage
- Secondary Brain Damage
what does local (focal) Brain damage consist of?
contusions
lacerations
hematomas
herniations
what does diffuse brain damage consist of?
axonal shearing
small hemorrhages
what does secondary brain damage consist of?
edema hypoxia hypotension infection salkt/water imbalance concussions post traumatic epilepsy
true or false
secondary brain damage can occur months or even years after sustaining an injury
true
name 6 other ways to categorize TBI
scalp injuries skull fractures intracranial injuries traumatic cerebro-vascular lesions CN pathology Prognosis (recovery stages)
scalp injuries include?
Abrasion/contusion
Hematoma/herniation
Scalp laceration
skull fractures include?
linear
comminuted
compound
intracranial injuries include?
Concussion
Epidural hematomas
Subdural hematomas
ICP monitoring
traumatic cerebro-vascular lesions include?
aneurysms
cartoid-cavernous fistulas
CN pathology consist of?
CN II
CN III
CN VII
CN VIII
Prognosis (recovery stages) include?
Glasgow Coma Scale
Rancho Los Amigos Cognitive Scale
when dealing with a CNS infectious disease, a PT should?
Self-protect from contagious diseases
Understand how etiology and prognosis affects treatment goals
Be able to communicate with other health care providers
Be able to provide patient and family education
CNS infections can be caused by?
bacterial
parasitic
fungal
viral
true or false
most microorganisms attack the CNS through the PNS
False
while rabies and herpes simplex attack the PNS, most infections are hematogenously born
Brain infection is categorized by ______ and _______
location and cause
the three categorize of brain infections include
Brain Abscess
Meningitis
Encephalitis
Leptomeninges =
pia + arachnoid mater
S/S of a brain abscess include?
headaches
convulsions
hemiparesis
incoordination
TRUE OR FALSE
Brain abscesses are usually a result to secondary inflammatory process elsewhere such as lungs, heart, sinuses, ear mastoiditis
true
generalized infection and increased ICP —>
specific neurological symptoms
What is Leptomeningitis?
Infection spread through CSF with inflammatory process of pia mater, arachnoid mater, and superficial CNS tissues, to include subarachnoid space`
TRUE or FALSE
CSF is self-contained with plenty of antibodies and cells to prevent an ideal growth medium for microorganisms
FALSE
CSF self-contained with no antibodies and few cells, so an ideal growth medium for microorganisms
Leptomeningitis is usually classified as ______ or _______
bacterial or viral (aseptic)
TRUE or FALSE
Untreated bacterial meningitis can lead to death
true
S/S of bacterial Meningitis are?
headaches vomiting fever altered consciousness convulsions nuchal rigidity irritability
Inflamed congested pia-arachmoid mater with PMN exudate leads to?
obstructing ventricular formaina causing increased ICP
True or False
Bacterial Meningitis leads to increased blood sugar levels
False
decreased blood sugar levels
what is a positive Brudzinski Neck sign?
Neck flexion causes hip/knee flexion….sign of bacterial meningitis
True or False
Viral meningitis is similar to bacterial but not as life threatening
true
True or false
Viral Meningitis acts slow
False
Fulminating= suddenly with great intensity
Viral Meningitis affects ?
children and young adults
True or False
With viral meningitis, blood sugar levels are increased dramatically
False
levels are normal
Acute Viral Lymphocytic Meningitis occurs when=
Viral contamination of CSF with an increase in lymphocytes
True or False
Chronic Meningitis is a slowly evolving infection
True
Two agents that cause Chronic Meningitis are?
Mycobacterium tuberculosis (lung TB) Treponema pallidum (syphilis)
If Chronic Meningitis is in the SAS, it may lead to?
hydrocephalus
S/S of chronic meningitis include?
headaches vomiting mental confusion weight loss fatigue night sweats chest pain general malaise
Medical management for Meningitis for bacteria? viral?
antimicrobial antibiotics for bacteria
treat viral infections symptomatically - antivirals if caught soon enough
In chronic meningitis, _______ ______ is found in the meninges with increased number of what 4 cells?
gelatinous exudate
lymphocytes/plasma cells/macrophages/fibroblasts
Encephalitis is a viral infection of?
brain and spinal cord cells (neurons and glia)
With encephalitis, _____ and ______ of the brain and spinal cord destroys the ____matter
edema and inflammation
white
With encephalitis, increased ICP leads to?
transtentorial herniation
True or False
With encephalitis, the viral latency period can be months to years
true
With encephalitis, the mononuclear cell infiltrate increases with?
Patients who are immunosuppressed
S/S of encephalitis include?
headaches, fever, nuchal rigidity, vomiting, general malaise, coma, CN palsies, hemiplegia
Encephalitis
inflammation of the brain
Encephalomeningitis
inflammation of the brain and spinal cord
Encephalomyeloneuropathy
inflammation of the brain, spinal cord, and PNS
Acute Viral Encephalitis affects
frontal/temporal lobe gray
True or False
Acute Viral Encephalitis is most fatal with those who survive having sever dementia
true
Acute Toxic Encephalitis come about how?
Arbovirus arthropod-borne systemic infections
Vertebrate host, mosquito vectors, tick-borne
S/S of “slow virus” encephalitis are?
first personality abnormalities, visual and spatial orientation/coordination problems leading to severe dementia with myoclonus
“Slow Virus” Encephalitis has a ______ latent incubation; however it is fatal within _______ and progresses to ________
slow
month
dementia
“Slow Virus” Encephalitis resembles?
“Spongiform” bubbles and holes in brain cortex; resembles degenerative disease
Creutzfeldt-Jacob Disease Etiology? (3)
- Familial
- Sporadic
- Iatrogenic
True or False
Creutzfeldt-Jacob Disease ( CFD) can decades to show symptoms?
True
Creutzfeldt-Jacob Disease should be considered when a patient develops ___________ and _________?
rapid dementia
myoclonus
S/S of Creutzfeldt-Jacob Disease include?
Initial symptoms are subtle and ambiguous: depression, confusion, personality and behavioral changes, strange physical sensations, and memory, coordination and visual problems. Language, sight, muscle weakness and coordination problems worsen.
what test is 95% effective for diagnosing CFD?
14-3-3 protein spinal fluid test
True or False
A pathologically benign tumor may be “clinically” malignant
True
________ and _______ of tumor determines the clinical picture
location and size
true or false
Brain tumors can spread via the CSF to produce carcinomatous meningitis
true
With Brain Tumors, survival time is _____ in older persons with a prognosis of _______
shorter
poor
what two groups are afflicted the most with Brain Tumors?
0-15 yo
adult 50-70 yo
what are some theories of cause of brain tumors?
Heredity Familial incidence by toxic or infectious exposure Petrochemicals, organic solvents, rubber Electromagnetic field exposure Ionizing radiation, high dose
what is the Intra-cranial pressure triad?
headaches
nausea, vomiting
Papilledema ( optic disc edema)
Cerebellar S/S include?
disorder of equilibrium, gait, coordination; ataxia
Bitemporal hemianopia
Temporal ½ visual field loss in both eyes
Common manifestations of brain tumor include
Intra-cranial pressure triad
Cerebellar S/S
Bitemporal hemianopia
Disorders of cognitive ability, speech, personality
Dysfunction of the long motor tracts: weakness, head tilt
Sensory disturbances: hypesthesia (decreased sensation)
Symptoms of increased ICP: seizures
Abnormal reflexes (ex.: + Babinski)
Most primary brain tumors are ______ followed ______
Glioblastoma (50%)
Meningioma (17%)
Secondary Neoplasms are ______ tumors usually from ______
metastatic
carcinomas
secondary neoplasms originate from?
lungs breast skin kidney GI tract
Diagnosis of Neoplasms
Clinical S/S
Radiology + Computer Tomography + MRIs
Tissue Biopsy
Laboratory findings
Medical/Surgical Management of neoplasm include?
Chemotherapy
Radiation
Surgery
Stereotactic Radiosurgery
Combination of all of the above
What are common complications of a Brain Injury?
Raised Intracranial Pressure
Heterotopic Ossification
Decubiti
DVT
Autonomic Dysfunction
Infections and Pulmonary Problems
Amnesia
normal intracranial pressure is?
up to 15 mmHg
____-______ of patients with BI or SCI develop heterotropic ossification
5-20%
what is heterotrophic ossification ?
formation of bone in abnormal anatomical locations
S/S of heterotrophic ossification include?
sudden loss of ROM Swelling local heat Erythema non-septic fever
true or false
Vigorous stretching should be avoided with heterotrophic ossification
true
what is retrograde amnesia?
partial or total loss of the ability to recall events that have occurred during the period immediately preceding BI
postraumatic amnesia is?
the time lapse between the accident and the point at which the functions concerned with memory are restored
anterograde amnesia is?
decreased attention or inaccurate perception; inability to develop ongoing short-term memory
Levels of alertness are?
comatose stuporous obtunded lethargic alert
what does comatose mean?
unconscious and unresponsive
Stuporous means?
near unconscious with apparent mental inactivity and reduced ability to respond to stimulation
obtunded is?
opens their eyes, responds slowly to questions, somewhat confused, decreased interest in the environment
lethargic means?
dull, sluggish and appears half asleep
Coma: what is the Rancho level?
1
Coma: what is the level of arousal?
eyes do not open
Coma: Awareness of Auditory and Visual Stimuli
No evidence of
Coma: communication and emotion?
no evidence of
Coma: Motor Response?
no purposeful movement
Vegetative State: Rancho Level?
I or II
Vegetative State: Level of arousal?
Eyes open spontaneously
Sleep-Wake cycle resumes
Arousal sluggish and poorly sustained
Vegetative State: Awareness of Auditory and Visual Stimuli?
May move eyes to person or objects
May orient to sound (startle)
Vegetative State: Communication and Emotion?
May moan make sounds
Cry or smile without apparent cause
Vegetative State: Motor Response?
Withdrawals from noxious stimuli
Non-purposeful repetitive movement
Minimally Conscious State: Rancho Level?
II or III
Minimally Conscious State: Levels of Arousal?
Eyes open spontaneously
Normal to abnormal sleep-wake cycle
Arousal obtunded to normal
Minimally Conscious State: Awareness of Auditory and Visual Stimuli?
Tracks objects
Localizes sound
Minimally Conscious State: Communication and Emotion
Communication ability
Inconsistent (Yes/no, Gestures, Basic emotions)
Minimally Conscious State: Motor Response?
Localizes noxious stimuli
Reaches for objects
Automatic behaviors (scratching)
Confusional State: Rancho Level
IV, V, and VI
Confusional State: Level of Arousal?
Fluctuation in level of responsiveness
may be excessively drowsy
Confusional State: Awareness of Auditory and Visual Stimuli
Response to external stimuli may be accentuated
Confusional State: Communication and Emotion?
Able to communicate but disoriented
Impaired attention and memory
Confusional State: Motor Response
Purposeful motor responses
