brain injury

Question 1

2 categories of brain injury

Answer 1

primary

secondary

Question 2

primary brain injury

Answer 2

occurs immediately at onset of brain injury

• trauma: shearing, tearing, stretching
• stroke, ischemia: necrosis

Question 3

secondary brain injury

Answer 3

development of further neurologic damages and changes subsequent to primary injury
- leads to progressive neuro-degeneration and delayed cell death, damage some distance away form primary injury

Question 4

increased intracranial pressure

Answer 4

normal: 0-15 mmHg
increased: acute brain injury, impaired neuro function: compression of brain.

Question 5

3 components of brain volume

Answer 5

brain tissue
CSF
blood
- slight increase in one will be offset by a decrease in others.

Question 6

common causes of increased ICP

Answer 6

stroke
trauma
tumor

Question 7

S/S of increased ICP

Answer 7

HA
vomiting
altered LOC
blurry vision
-later stages:
decreased pupil response
altered respiratory pattern 
unresponsive

Question 8

brain compression

Answer 8

complication of increased ICP

Question 9

brain herniation

Answer 9

protrusion of brain tissue through opening in supporting dura

Question 10

traumatic brain injury

Answer 10

characterized by severity, location, and mechanism of injury

• concussion
• contusion
• intracranial hematomes

Question 11

severity of brain injury

Answer 11

GCS on admission or lowest in 48 hours

Question 12

nontraumatic brain injury

Answer 12

cerebrovascular disease
cerebral aneurysm
arteriovenous malformation
CNS infection

Question 13

contusion

Answer 13

an area of brain tissue damage

• focal injury
• polar injury
• diffuse axonal injury

Question 14

focal injury

Answer 14

coup

localized to site of impact

Question 15

polar injury

Answer 15

coup-countercoup

due to acceleration-deceleration movement

Question 16

diffuse axonal injury

Answer 16

due to movement of brain within the skull

Question 17

intracranial hematoma: 3 types

Answer 17

epidural
subdural
subarachnoid

Question 18

epidural hematoma

Answer 18

blood between dura and skull
brief period of disturbed consciousness followed by a period of normal cognition (lucid interval) then consciousness rapidly deteriorates
-typically involves artery

Question 19

subdural hematoma

Answer 19

blood between dura and outer layer of arachnoid membrane
-typically involves veins, onset may be slower
Acute: s/s in 24hours
Subacute: increased ICP 2-10days later
Chronic: variable presentation days to weeks later

Question 20

subarachnoid hemorrhage

Answer 20

blood between arachnoid and pia mater
Traumatic: due to rupture of bridging veins
Nontraumatic: rupture of cerebral aneurysms or arteriovenous malformations
-blood spreads through CSF causing meningeal irritation, hydrocephalus, HA, vasospasms, ischemia

Question 21

cerebrovascular disease and stroke

Answer 21

abnormal cerbral perfusion

• TIA
• ischemic stroke
• hemorrhage stroke

Question 22

s/s of stroke

Answer 22

• numbness/ weakness in face, arm, leg, unilateral
• confusion, trouble talking
• visual disturbance
• dizzy. loss of balance

Question 23

Transient ischemic attacks (TIA)

Answer 23

neuro symptoms typically last only minutes, but the may last as long as 24 hours.
-warning signs of thrombotic disease and carry a significant risk for subsequent stroke

Question 24

ischemic stroke

Answer 24

sudden occlusion of cerebral artery secondary to thrombus or embolization

• thrombus: atherosclerosis and hypercoagualbe states
• emboli: cardiac source: a-fib

Question 25

acute ischemia in brain

Answer 25

neuro deficit within 1 minutes | can have infarct and necrosis

Question 26

hemorrhagic stroke

Answer 26

hemorrhage in brain parenchyma | - due to HTN

Question 27

parenchyma

Answer 27

functional tissue

Question 28

stroke Tx

Answer 28

assure airway, resp. status and CV function assess neuro deficit CT to determin ischemic or hemorrhagic

Question 29

Hemorrhagic stroke tx

Answer 29

returning BP to normal could result in ischemia | - return to normal slowly once pt is stable

Question 30

ischemic stroke tx

Answer 30

aspirin: affects platelet aggregation and inhibits thrombus size thrombolytic therapy BP management anticoagulant therapy

Question 31

Stroke sequelae

Answer 31

Motor: - flaccidity or paralysis: recovery about 6wks sensory: - may involve neglect or visual impairment Language - aphasia Cognitive deficit - impaired language skills, spatial relationship skills, concentration, reasoning, and short-term memory

Question 32

cerebral aneurysm

Answer 32

lesion of an artery that results in dilation and ballooning of a segment of vessel - HTN, acute alcohol use, recreational drug use ( cocaine)

Question 33

cerebral aneurysm s/s

Answer 33

``` increased ICP distorts intracranial structures secondary cerebral vasospasm (constriction around rupture) -reduced blood flow - increased ischemia, possible infarct risk for rebleed risk for hydrocephalus ```

Question 34

cerebral aneursym tx

Answer 34

surgical stabilization

Question 35

arteriovenous malformation

Answer 35

vascular lesions though to be congenital failure of capillary system to develop, arteries shunt blood directly to veins. - high pressure causes vessels to progressively enlarge - risk of rupture and hemorrhage

Question 36

vascular steal syndrome

Answer 36

abnormal shunting of blood to arteriovenous malformation results in ischemia in normal tissue - neuro dysfunction

Question 37

arteriovenous malformation tx

Answer 37

surgically removed | shrink with gamma radiation

Question 38

bacterial meningitis

Answer 38

microbial invasion of CNS most common cause: streptococus pneumoniae usually bacterial

Question 39

s/s of bacterial meningitis

Answer 39

headache fever stiff neck cerebral dysfunction

Question 40

CNS infections organisms gain acces to CNs by

Answer 40

hematogenous: blood middle ear or paranasal sinuses vertical: maternal fetal exchange

Question 41

encephalitis

Answer 41

``` inflammation of the brain commonly causes by viruses -west nile -western equine - herpes simplex ```

Question 42

treatment of encephalitis

Answer 42

``` supportive with control of symptoms antiviral steroids anti-seizure fluid resuscitation ```

Question 43

brain abscess

Answer 43

localized collection of pus in brain parenchyma -penetrating wounds -direct extension or retrograde thrombophlebitis neighboring structure -blood-borne form distant site s/s 1-4 weeks after initial infection

Question 44

brain abscess tx

Answer 44

drainage or excision IV abx post infection: neuro deficits -cognitive, motor, sensory