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Year 4: Neurology > Brain Injury II (BB2) > Flashcards

Brain Injury II (BB2) Flashcards

1
Q

Describe the injury classifications for TBI [2]

A

Focal injury:
- Coup: at site
- Contrecoup: opposite site

Diffuse injury:
- Diffuse axonal injury

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2
Q

Which scale is used to classify TBI? [1]

Which criteria is it based on? [3]
What is the maximum score for each of the criteria? [1]

A

Glasgow Coma Scale (GCS):

Based on:
- eye opening [/4]
- motor response [/5]
- verbal response [/6]

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3
Q

What are mild, moderate and severe GCSs? [3]

A

Mild: 14-15
Moderate: 9-13
Severe: less than 8

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4
Q

What GCS would cause a CT to be given:

  • straight away? [1]
  • after 2 hrs of assessment [1]
A

GCS less than 13 on intial assessment

GCS less than 15 after 2 hours of injury assessment

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5
Q

Basal skull fractures have at least one of which signs? [4]

A
  • CSF coming out of ear
  • blood behind ear drum
  • raccoon eyes.
  • Hemotympanum (blood in ear drum)

(However, takes approx. a day to appear-earliest in a couple of hours)

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6
Q

What can an MRI scan detect that a CT scan cannot? [3]

A
  • diffuse axonal injury ( the shearing (tearing) of the brain’s long connecting nerve fibers (axons) that happens when the brain is injured as it shifts and rotates inside the bony skull)
  • non-haemorrhagic contusion
  • brainstem injury
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7
Q

What is normal ICP [1]

Was can a ICP of greater than cause herniation? [1]

A

Normal adult ICP: 5 - 15 mmHg (supine position).

A mass lesion with an ICP of ≥ 20 mmHg can cause herniation.

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8
Q

Name the 6 types of brain herniation

A

Uncal
Central (transtentorial)
Cingulate (Subfalcine)
Transcalvarial
Upward cerebellar (transtentorial)
Downward cerebellar (Tosillar)

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9
Q

What is the difference between decorticate and decerebrate brain injury location and presentation? [4]

A

Decerebrate: damage to midbrain, brainstem and/or pons – anything below the red nucleus .

Decorticate: damage to cerebral cortex and/or internal capsule.

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10
Q

What size haematoma would be evacuated regardless of GCS? [1]

A

>30 cm3

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11
Q

5- Acute management of TBI (Severe TBI)

Which drugs can you use to start seizure prophylaxis? [2]

Which drugs can you use to induce coma? [2]

A

Start on seizure prophylaxis: phenytoin/levetiracetam

Sedation/Induce coma with propofol or benzodiazepines

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12
Q

How could you manage severe ICP:

Acutely [2]
Long term [1]

A

Short term:
* mannitol
* hypertonic saline
(shift of water from extravascular space to intravascular space across the BBB-controversy which therapy is better.)

Long term:
* extraventricular drain/ external ventricular drain (EVD) or ventriculostomy

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13
Q

Which of the following mechanism of TBI is depicted in the CT?
1- Skull fracture
2- Contusion (bruise)
3- hematomas (blood clots)
4- lacerations (tear)
5- Diffuse axonal injury (nerve damage)

A

Diffuse axonal injury (nerve damage)

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14
Q
A

Hemotympanum

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15
Q
A

Periorbital ecchymosis

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16
Q

What is the name for this sign of basal skull fracture? [1]

A

Post auricular ecchymosis

17
Q

What type of brain herniations are A & B? [2]

A

A: Downward cerebellar (Tonsillar)

B: Upward cerebellar (transtentorial)

18
Q

What type of herniation is depicted?

Uncal
Central (transtentorial)
Cingulate (Subfalcine)
Transcalvarial
Upward cerebellar (transtentorial)
Downward cerebellar (Tonsillar)

A

What type of herniation is depicted?

Uncal
Central (transtentorial)
Cingulate (Subfalcine)
Transcalvarial
Upward cerebellar (transtentorial)
Downward cerebellar (Tonsillar)

20
Q

What type of herniation is depicted?

Uncal
Central (transtentorial)
Cingulate (Subfalcine)
Transcalvarial
Upward cerebellar (transtentorial)
Downward cerebellar (Tonsillar)

A

What type of herniation is depicted?

Uncal
Central (transtentorial)
Cingulate (Subfalcine)
Transcalvarial
Upward cerebellar (transtentorial)
Downward cerebellar (Tonsillar)

21
Q

What type of herniation is depicted?

Uncal
Central (transtentorial)
Cingulate (Subfalcine)
Transcalvarial
Upward cerebellar (transtentorial)
Downward cerebellar (Tonsillar)

A

What type of herniation is depicted?

Uncal
Central (transtentorial)
Cingulate (Subfalcine)
Transcalvarial
Upward cerebellar (transtentorial)
Downward cerebellar (Tonsillar)

Uncal herniation. Arrows point to the medial temporal lobe that has herniated through the tentorial incisura to compress the midbrain

22
Q

What type of positioning is on the top and bottom? [2]

A

Decorticate posturing (figure top)
decerebrate posturing (figure bottom)

23
Q

Which of the following is most likely to occur to a young adult with a skull fracture?

A: SDH = subdural haematoma
B: EDH = epidural haematoma
C: IPH = intraparenchymal haemorrhage
D: SAH = subarachnoid haemorrhage

A

Which of the following is most likely to occur to a young adult with a skull fracture?

A: SDH = subdural haematoma
B: EDH = epidural haematoma
C: IPH = intraparenchymal haemorrhage
D: SAH = subarachnoid haemorrhage

Year 4: Neurology (34 decks)

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