brain injury Flashcards
1
Q
One approach that defines TBI into 3 categories… what are they?
A
- local(focal) Brain Damage
- Diffuse Brain Damage
- Secondary Brain Damage
2
Q
what does local (focal) Brain damage consist of?
A
contusions
lacerations
hematomas
herniations
3
Q
what does diffuse brain damage consist of?
A
axonal shearing
small hemorrhages
4
Q
what does secondary brain damage consist of?
A
edema hypoxia hypotension infection salkt/water imbalance concussions post traumatic epilepsy
5
Q
true or false
secondary brain damage can occur months or even years after sustaining an injury
A
true
6
Q
name 6 other ways to categorize TBI
A
scalp injuries skull fractures intracranial injuries traumatic cerebro-vascular lesions CN pathology Prognosis (recovery stages)
7
Q
scalp injuries include?
A
Abrasion/contusion
Hematoma/herniation
Scalp laceration
8
Q
skull fractures include?
A
linear
comminuted
compound
9
Q
intracranial injuries include?
A
Concussion
Epidural hematomas
Subdural hematomas
ICP monitoring
10
Q
traumatic cerebro-vascular lesions include?
A
aneurysms
cartoid-cavernous fistulas
11
Q
CN pathology consist of?
A
CN II
CN III
CN VII
CN VIII
12
Q
Prognosis (recovery stages) include?
A
Glasgow Coma Scale
Rancho Los Amigos Cognitive Scale
13
Q
when dealing with a CNS infectious disease, a PT should?
A
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
14
Q
CNS infections can be caused by?
A
bacterial
parasitic
fungal
viral
15
Q
true or false
most microorganisms attack the CNS through the PNS
A
False
while rabies and herpes simplex attack the PNS, most infections are hematogenously born
16
Q
Brain infection is categorized by ______ and _______
A
location and cause
17
Q
the three categorize of brain infections include
A
Brain Abscess
Meningitis
Encephalitis
18
Q
Leptomeninges =
A
pia + arachnoid mater
19
Q
S/S of a brain abscess include?
A
headaches
convulsions
hemiparesis
incoordination
20
Q
TRUE OR FALSE
Brain abscesses are usually a result to secondary inflammatory process elsewhere such as lungs, heart, sinuses, ear mastoiditis
A
true
21
Q
generalized infection and increased ICP —>
A
specific neurological symptoms
22
Q
What is Leptomeningitis?
A
Infection spread through CSF with inflammatory process of pia mater, arachnoid mater, and superficial CNS tissues, to include subarachnoid space`
23
Q
TRUE or FALSE
CSF is self-contained with plenty of antibodies and cells to prevent an ideal growth medium for microorganisms
A
FALSE
CSF self-contained with no antibodies and few cells, so an ideal growth medium for microorganisms
24
Q
Leptomeningitis is usually classified as ______ or _______
A
bacterial or viral (aseptic)
25
TRUE or FALSE
| Untreated bacterial meningitis can lead to death
true
26
S/S of bacterial Meningitis are?
```
headaches
vomiting
fever
altered consciousness
convulsions
nuchal rigidity
irritability
```
27
Inflamed congested pia-arachmoid mater with PMN exudate leads to?
obstructing ventricular formaina causing increased ICP
28
True or False
| Bacterial Meningitis leads to increased blood sugar levels
False
| decreased blood sugar levels
29
what is a positive Brudzinski Neck sign?
Neck flexion causes hip/knee flexion....sign of bacterial meningitis
30
True or False
| Viral meningitis is similar to bacterial but not as life threatening
true
31
True or false
| Viral Meningitis acts slow
False
| Fulminating= suddenly with great intensity
32
Viral Meningitis affects ?
children and young adults
33
True or False
| With viral meningitis, blood sugar levels are increased dramatically
False
| levels are normal
34
Acute Viral Lymphocytic Meningitis occurs when=
Viral contamination of CSF with an increase in lymphocytes
35
True or False
| Chronic Meningitis is a slowly evolving infection
True
36
Two agents that cause Chronic Meningitis are?
```
Mycobacterium tuberculosis (lung TB)
Treponema pallidum (syphilis)
```
37
If Chronic Meningitis is in the SAS, it may lead to?
hydrocephalus
38
S/S of chronic meningitis include?
```
headaches
vomiting
mental confusion
weight loss
fatigue
night sweats
chest pain
general malaise
```
39
Medical management for Meningitis for bacteria? viral?
antimicrobial antibiotics for bacteria
| treat viral infections symptomatically - antivirals if caught soon enough
40
In chronic meningitis, _______ ______ is found in the meninges with increased number of what 4 cells?
gelatinous exudate
| lymphocytes/plasma cells/macrophages/fibroblasts
41
Encephalitis is a viral infection of?
brain and spinal cord cells (neurons and glia)
42
With encephalitis, _____ and ______ of the brain and spinal cord destroys the ____matter
edema and inflammation
| white
43
With encephalitis, increased ICP leads to?
transtentorial herniation
44
True or False
| With encephalitis, the viral latency period can be months to years
true
45
With encephalitis, the mononuclear cell infiltrate increases with?
Patients who are immunosuppressed
46
S/S of encephalitis include?
headaches, fever, nuchal rigidity, vomiting, general malaise, coma, CN palsies, hemiplegia
47
Encephalitis
inflammation of the brain
48
Encephalomeningitis
inflammation of the brain and spinal cord
49
Encephalomyeloneuropathy
inflammation of the brain, spinal cord, and PNS
50
Acute Viral Encephalitis affects
frontal/temporal lobe gray
51
True or False
| Acute Viral Encephalitis is most fatal with those who survive having sever dementia
true
52
Acute Toxic Encephalitis come about how?
Arbovirus arthropod-borne systemic infections
| Vertebrate host, mosquito vectors, tick-borne
53
S/S of "slow virus" encephalitis are?
first personality abnormalities, visual and spatial orientation/coordination problems leading to severe dementia with myoclonus
54
“Slow Virus” Encephalitis has a ______ latent incubation; however it is fatal within _______ and progresses to ________
slow
month
dementia
55
“Slow Virus” Encephalitis resembles?
“Spongiform” bubbles and holes in brain cortex; resembles degenerative disease
56
Creutzfeldt-Jacob Disease Etiology? (3)
1. Familial
2. Sporadic
3. Iatrogenic
57
True or False
| Creutzfeldt-Jacob Disease ( CFD) can decades to show symptoms?
True
58
Creutzfeldt-Jacob Disease should be considered when a patient develops ___________ and _________?
rapid dementia
| myoclonus
59
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.
60
what test is 95% effective for diagnosing CFD?
14-3-3 protein spinal fluid test
61
True or False
| A pathologically benign tumor may be “clinically” malignant
True
62
________ and _______ of tumor determines the clinical picture
location and size
63
true or false
| Brain tumors can spread via the CSF to produce carcinomatous meningitis
true
64
With Brain Tumors, survival time is _____ in older persons with a prognosis of _______
shorter
| poor
65
what two groups are afflicted the most with Brain Tumors?
0-15 yo
| adult 50-70 yo
66
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
```
67
what is the Intra-cranial pressure triad?
headaches
nausea, vomiting
Papilledema ( optic disc edema)
68
Cerebellar S/S include?
disorder of equilibrium, gait, coordination; ataxia
69
Bitemporal hemianopia
Temporal ½ visual field loss in both eyes
70
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)
71
Most primary brain tumors are ______ followed ______
Glioblastoma (50%)
| Meningioma (17%)
72
Secondary Neoplasms are ______ tumors usually from ______
metastatic
| carcinomas
73
secondary neoplasms originate from?
```
lungs
breast
skin
kidney
GI tract
```
74
Diagnosis of Neoplasms
Clinical S/S
Radiology + Computer Tomography + MRIs
Tissue Biopsy
Laboratory findings
75
Medical/Surgical Management of neoplasm include?
Chemotherapy
Radiation
Surgery
Stereotactic Radiosurgery
Combination of all of the above
76
What are common complications of a Brain Injury?
Raised Intracranial Pressure
Heterotopic Ossification
Decubiti
DVT
Autonomic Dysfunction
Infections and Pulmonary Problems
Amnesia
77
normal intracranial pressure is?
up to 15 mmHg
78
____-______ of patients with BI or SCI develop heterotropic ossification
5-20%
79
what is heterotrophic ossification ?
formation of bone in abnormal anatomical locations
80
S/S of heterotrophic ossification include?
```
sudden loss of ROM
Swelling
local heat
Erythema
non-septic fever
```
81
true or false
| Vigorous stretching should be avoided with heterotrophic ossification
true
82
what is retrograde amnesia?
partial or total loss of the ability to recall events that have occurred during the period immediately preceding BI
83
postraumatic amnesia is?
the time lapse between the accident and the point at which the functions concerned with memory are restored
84
anterograde amnesia is?
decreased attention or inaccurate perception; inability to develop ongoing short-term memory
85
Levels of alertness are?
```
comatose
stuporous
obtunded
lethargic
alert
```
86
what does comatose mean?
unconscious and unresponsive
87
Stuporous means?
near unconscious with apparent mental inactivity and reduced ability to respond to stimulation
88
obtunded is?
opens their eyes, responds slowly to questions, somewhat confused, decreased interest in the environment
89
lethargic means?
dull, sluggish and appears half asleep
90
Coma: what is the Rancho level?
1
91
Coma: what is the level of arousal?
eyes do not open
92
Coma: Awareness of Auditory and Visual Stimuli
No evidence of
93
Coma: communication and emotion?
no evidence of
94
Coma: Motor Response?
no purposeful movement
95
Vegetative State: Rancho Level?
I or II
96
Vegetative State: Level of arousal?
Eyes open spontaneously
Sleep-Wake cycle resumes
Arousal sluggish and poorly sustained
97
Vegetative State: Awareness of Auditory and Visual Stimuli?
May move eyes to person or objects
| May orient to sound (startle)
98
Vegetative State: Communication and Emotion?
May moan make sounds
| Cry or smile without apparent cause
99
Vegetative State: Motor Response?
Withdrawals from noxious stimuli
| Non-purposeful repetitive movement
100
Minimally Conscious State: Rancho Level?
II or III
101
Minimally Conscious State: Levels of Arousal?
Eyes open spontaneously
Normal to abnormal sleep-wake cycle
Arousal obtunded to normal
102
Minimally Conscious State: Awareness of Auditory and Visual Stimuli?
Tracks objects
| Localizes sound
103
Minimally Conscious State: Communication and Emotion
Communication ability
| Inconsistent (Yes/no, Gestures, Basic emotions)
104
Minimally Conscious State: Motor Response?
Localizes noxious stimuli
Reaches for objects
Automatic behaviors (scratching)
105
Confusional State: Rancho Level
IV, V, and VI
106
Confusional State: Level of Arousal?
Fluctuation in level of responsiveness
| may be excessively drowsy
107
Confusional State: Awareness of Auditory and Visual Stimuli
Response to external stimuli may be accentuated
108
Confusional State: Communication and Emotion?
Able to communicate but disoriented
| Impaired attention and memory
109
Confusional State: Motor Response
Purposeful motor responses
