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Board Review > Brain Injury > Flashcards

Brain Injury Flashcards

1
Q

What Electroencephalogram pattern is associated with a better prognosis after TBI?

A

Rhythmic theta activity, frontal rhythmic delta activity and spindle pattern are associated with better prognosis. Poor prognosis is associated with epileptiform activity, nonreactive, low amplitude and burst suppression patterns with interruption of isoelectricity. Complete isoelectric EEG activity ha the highest mortality.

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2
Q

Common signs of metastatic brain cancer seen on physical examination

A 
Hemiparesis 59%
Impaired cognitive function 58%
Hemisensory loss 21%
Papilledema 20%
Vision field cut 7%
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3
Q

Factors associated with unfavorable outcomes after a stroke

A
  1. Poor Sitting balance
  2. Prior Stroke
  3. Coma at onset
  4. Sig CV disease
  5. Unilateral hemineglect
  6. Poor upper extremity motor function
  7. Older age
  8. B/B incontinence
  9. Lack of motor recover after 1 month
  10. Greater severity of stroke
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4
Q

Rate of DVT in different types of Brain injuries

A 
Brain tumors 21.2%
NTBI 16.3%
Intraparenchymal hemorrhage 14.6%
Penetrating 10.5%
Non-Penetrating 6.4%
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5
Q

True or False
Patients with hemorrhagic strokes are twice as likely to have venous thromboembolism and PE as patients with ischemic stroke

A

True

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6
Q

Patient presents with loss of facial pain and temperature sensation and ipsilateral Horner syndrome symptoms with contralateral loss of bod pain and temperature sensation. She was also found to have nystagmus, dysphagia and dysphonia.

A

What is Wallenberg syndrome. Lesion of the lateral medulla. Other areas that can be affected include:

  1. Vertebral arteries
  2. PICA
  3. Superior Lateral medullary artery
  4. Middle lateral medullary artery
  5. inferior lateral medullary artery
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7
Q

Leading cause of post-stroke disability among nursing home residents

A

Urinary Incontinence

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8
Q

The usual time of onset of diabetes insidious in patients with TBI

A

10 days post injury when the antidiuretic hormone stored in the posterior pituitary is depleted.

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9
Q

Name the neurologic deficit showed improvement with slow repetitive transcranial magnetic stimulation to the un-injured hemisphere in stroke patients

A

Aphasia

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10
Q

Brain tumors in which lies are least likely to be associated with seizures?

A

Cortical tumors have higher incidence of associated epilepsy than non cortical deeper lesion. Tumors involving the frontal, temporal, and parietal lobes are more associated with seizures than occipital lesions.

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11
Q

What medication has the best evidence to accelerate the pace of functional recovery in patients with disorders of consciousness after severe TBI?

A

Amantadine

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12
Q

Most common features of medulloblastoma

A

Most common primary malignant tumor in children. 85% of children will have long-term learning and memory deficits. Highest incidence in children under 10. Arise in the cerebellum and have a long-term survival rate of approximately 80%.

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13
Q

Most common complications during post acute stroke rehabilitation

A 
Asp/PNA 40%
UTI 40%
RSD (CRPS) 30%
Falls 16%
VTE 6%
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14
Q

Internal Capsule Stroke

A

Intact Sensation and cognition

Weakness affecting the hand and foot more than the proximal muscles on the same side.

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15
Q

Reorganization following Brain Injury

A

Refers to tissue adjacent to the affected areas expanding their receptive fields to capture and mediate at least some of the original physiological activities that were destroyed by the injury

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16
Q

Vicariaion following Brain Injury

A

functions taken over by brain areas not originally in charge of that function

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17
Q

Equipotentialitiy following Brain Injury

A

Capacity of anatomically distinct areas of the brain to mediate a rather wide variety of functions.

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18
Q

Diaschisis following Brain Injury

A

Suppression of neural activity in regions that are not involved and may be spatially distal to the lesion following brain injury.

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19
Q

Factors Related to development of late post-traumatic seizures

A

Age, Pre-injury alcohol abuse, family history of seizures, inheritance of apolipoprotein E allele, depressed skull fracture, focal neurologic deficits, retained bone or metal fragments, dural penetration, intracranial hemorrhage, severe TBI, early post-traumatic seizures

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20
Q

Most common neuropsychological dysfunction after a liver transplant

A

Encephalopathy

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21
Q

Risk factors for developing VTE in the setting of brain tumor

A
  1. Larger tumors
  2. Supratentorial location
  3. Presence of intraluminal thrombosis in the tumor pathologic specimen
  4. age over 60
  5. chemotherapy
  6. presence of hemiparesis
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22
Q

Most common presenting symptoms of metastatic brain cancer

A 
Headaches 49%
Mental Disturbance 32%
Focal Weakness 30%
Gait Ataxia 21%
Seizures 18%
Speech difficulty 12%
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23
Q

Leading causes of traumatic spinal cord injury

A
  1. MVA
  2. Falls
  3. Violence
  4. Sports
    # falls have increased over the last 3 decades
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24
Q

Effects of Spinal cord injury on the mensuration cycle

A

41-85% of women will have amenorrhea. Menstruation returns within 6 months aft SCI, 90% will see return within 12 months. Once menstruation resumes, women can become pregnant at same success rates as the general population.

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25
Q

Myotome testing in standard ASIA testing

A

C5 –Elbow flexors (biceps, brachialis)

C6 –Wrist extensors (extensor carpi radialis longus and brevis)

C7 –Elbow extensors (triceps)

C8 –Finger flexors (flexor digitorum profundus) to the middle finger

T1 –Small finger abductors (abductor digiti minimi)

L2 –Hip flexors (iliopsoas)

L3 –Knee extensors (quadriceps)

L4 –Ankle dorsiflexors (tibialis anterior)

L5 –Long toe extensors (extensor hallucis longus)

S1 –Ankle plantar flexors (gastrocnemius, soleus)

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26
Q

According to the international standards of neurologic classification of SCI, what is the specific position used for each myotome tested.

A

C5 –Elbow flexed at 90 degrees, arm at the patient’s side and forearm supinated

C6 –Wrist in full extension

C7 –Shoulder is neutral rotation, adducted and in 90 degrees of flexion with elbow in 45 degrees of flexion

C8 –Full flexed position of the distal phalanx with the proximal finger joints stabilized in a extended position

T1 –Full abducted position of fingers

L2 –Hip flexed to 90 degrees

L3 –Knee flexed to 15 degrees

L4 –Full dorsiflexed position of ankle

L5 –First toe fully extended

S1 –Hip in neutral rotation, neutral flexion/extension, and neutral abduction/adduction, the knee is fully extended and the ankle in full plantarflexion

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27
Q

List in order from most to least common SCI categories

A
  1. Incomplete tetraplegia
  2. Incomplete paraplegia
  3. Complete paraplegia
  4. Complete tetraplegia
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28
Q

Central Cord Syndrome

A

Commonly seen in elderly with cervical spondylosis after a fall resulting in a hyperextension injury. Disproportionally motor impairment of the upper than the lower extremity, bladder dysfunction, urinary retention and varying degrees of sensory loss below the level of the lesion.

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29
Q

Anterior Cord Syndrome

A

Associated with with flexion injuries and vascular insufficiency produced by occlusion of the anterior spinal artery. Lesion that affects the anterior 2/3 of the Spinal Cord while preserving the posterior columns. Patients present with motor paralysis with hyperesthesia, hypoalgesia below the level of the lesion with preservation of touch, proprioception and vibratory sense.

30
Q

Brown-Sequard Syndrome

A

Lesion that results in ipsilateral motor and proprioceptive loss and contralateral loss of pain and temperature below the level of the lesion

31
Q

Autonomic Dysreflexia

A

Occurs in SCI at or above T6.
Vasconstriction due to relatively unopposed sympathetic outflow result in hypertension. Patient will also have bradycardia due to increase parasympathetic stimulation via vagus nerve. Patient may also have the flushing and vasodilation above the level of SCI.

32
Q

Most common time of onset of heterotypic ossification following injury

A

1-4 months

33
Q

Type 1 Odontoid Fracture

A

Fracture in the tip of the odontoid process and considered stable

34
Q

Type 2 Odontoid Fracture

A

Most common. Fracture extend through the base of the odontoid process and are considered unstable with approximately 1/3 of these resulting in nonunion

35
Q

Type 3 Odontoid Fracture

A

Fracture involves the body of the C2 vertebra and is considered stable

36
Q

Traumatic spondylolisthesis of the axis and involves bilateral fractures through the pars interarticularis of the C2 vertebra

A

Hangman fracture

37
Q

Primary Mechanism of Acute Traumatic SCI

A

Initial mechanical injury due to local deformation and energy transformation that occurs within the spinal cord at the moment of injury. Primary mechanisms of injury are irreversible

38
Q

Secondary Mechanism of Acute Traumatic SCI

A

Occurs shortly after the initial trauma and lead to tissue destruction during the first few hours post injury. Examples include ischemia, axonal degeneration and inflammation. Secondary mechanisms of injury are potentially preventable and/or reversible

39
Q

Angle between upper arm and forearm needed to maximize stroke power and minimize shoulder injury from repetitive motion

A

100 and 120 degrees

40
Q

Clinical practice guidelines for SCI in prevention of VTE

A

Anticoagulant pax with either low-molecular weight heparin or adjusted dose unfractionated heparin within 72 hours after SCI. IVC placement s indicated in SCI patients who have failures to respond to or have CI to anticoagulation.

41
Q

Factors predictive of better prognosis in MS

A
  1. Female sex
  2. Younger age at onset
  3. > 5 years btwn attacks
  4. Optic neuritis at initial attack
  5. Complete recovery after the first attack
42
Q

C7 ASIA A level of independence

A

Independent with most activities at a wheelchair level., transfers, weight shifts, feeding and upper body derision. Some assistance maybe required for WC propulsion on uneven terrain. Bathing and grooming can be performed independently with the appropriate adaptive equipment.

43
Q

Common and greatest risk of VTE following TSCI

A

Most common in the first 2 weeks and is at greatest risk by 8 weeks post injury.

44
Q

Most common clinic presentation of those with expanding post traumatic syringomyelia

A

Pain, often unilateral and neuropathic in description.

45
Q

Potential Complications of tracheostomy tube for patients requiring long-term mechanical ventilation

A 
Granulation formation
Stomal Infection
Tracheomalacia
Tracheal perforation
Stenosis
Fistula Formation
Decrease voice volume
Inability to perform glossopharyngeal breathing
46
Q

Duration of anticoagulation in uncomplicated complete AIS A and B

A

8 weeks

47
Q

Duration of anticoagulation in complicated complete AIS A and B

A

12 weeks

Complicated defined as: lower limb fracture, history of VTE, cancer, heart failure, obesity, age over 70

48
Q

Anticoagulation duration for AIS C SCI, AIS D SCI

A

up to 8 week

While hospitalized

49
Q

List different stages of Pressure Ulcers

A

Deep Tissue Injury
Stage 1: nonblanchable redness
Stage 2: Partial thickness loss of dermis
Stage 3: Full thickness wound but no exposure of bone, tendon or muscle
Stage 4: Full thickness with exposed bone, tendon, or muscle

50
Q

Most Common site and organism for epidural abscesses

A

Thoracic Spine

Staphylococcus Aureus

51
Q

List in order the most common causes of rehospitalization following SCI

A
  1. Genitourinary complaints
  2. Pressure ulcers
  3. Respiratory symptoms
  4. Symptoms of MSK system
52
Q

List in order common fracture sites in SCI patients

A
  1. Supracondylar femur
  2. Tibia Proximal>distal
  3. Femoral shaft and neck
  4. Humerus
53
Q

Most Common causes of SCI in the general population

A
  1. MVA 39%
  2. Falls 28%
  3. Firearms 15%
54
Q

List in order from most to least limiting cervical braces

A
  1. Halo
  2. Four poster brace
  3. SOMI
  4. Philadelphia collar
55
Q

Strongest predictor of dysphagia in SCI patients

A
  1. Trachestomy at admission
  2. Anterior Cervical approach spinal surgery
  3. Tracheostomy with mechanical ventilation
  4. Older Age
56
Q

Classic Triad Of Miller Fisher Syndrome

A
  1. Areflexia
  2. External Ophthalmoparesis
  3. Ataxia
57
Q

Strategies to increase survival rate in ALS patients

A

Aggressive nutritional intervention including early placement of feeding tubes to supplement calories

58
Q

Risk Factors for development of statin-induced myopathy

A

Higher Statin doses
Small body mass index
Age over 65
Female gender

59
Q

Myotonic Muscular Dystrophy

A

Progressive, predominately distal, muscle weakness and myotonia that is AD inheritance pattern. Associated findings include frontal baldness, gonadal atrophy, cataracts and cardiac dysrhythmias. There are multiple psychiatric associations including OCD, depression and avoidant personality disorder. Patient will maintain ability to ambulate, but gait patterns will be abnormal

60
Q

Inclusion Body Myopathy

A

Autosomal recessive myopathy that affects distal lower extremity muscles first and spares the quadriceps. Muscle biopsy will reveal rimmed vacuoles and the accumulation of tubulofilaments in the cytoplasm and nuclei of muscle fibers.

61
Q

Metastatic Brain tumors most commonly affect the

A

Cerebral hemispheres

62
Q

The usual time of onset for Diabetes Insipidus following TBI

A

10 days, this is when ADH in posterior pituitary becomes depleted

63
Q

Minimum Conscious State

A

Refers to the return of self- or environmental awareness. Corresponds with Rancho Level 3

64
Q

Prefer study to diagnose brain tumors

A

MRI with/without contrast

65
Q

Factors correlating to successful return to work following stroke

A
  1. Age >55
  2. Prior professional/managerial position
  3. Higher education
  4. Household income above 30k
  5. shorter rehab LOS
  6. Higher Barthel Index scores at discharge
66
Q

TMS with stimulation applied to the uninjured hemisphere following stroke showed improvement in what neurodeficit?

A

Aphasia

67
Q

Poor Prognosticators following hemorrhagic stroke

A
  1. > 5cm hemorrhage in Basal ganglia had certain 30-day mortality
  2. ICP monitoring with elevated ICP associated with herniation and poorer outcomes
68
Q

Uncal Herniation

A

Increased intracranial pressure resulting in the medial edge of the temporal lobe pushing through the tectorial foramen

69
Q

Which class of drugs have been shown to be effective in improving neuropschologic performance in patients with TBI injury?

A

Dopaminergic

70
Q

Poor Prognosticators following Stroke

A
  • Poor sitting Balance
  • Prior Stroke
  • Coma at onset
  • Sig Cardiovascular Disease
  • Unilateral hemineglect
  • poor UE motor function
  • Older Age
  • Bowel/bladder incontinence
  • Greater Stroke Severity
  • Lack of recovery 1 moth after stroke
71
Q

Brain Tumor in which lobe is least associated with seizures

A

Occipital

72
Q

Treatment strategy for spatial neglect

A

Limb activated therapy with augmented with electrical stimulation via TENS

Board Review (6 decks)

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