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Adult Neuro Exam 3 > Brain Injury Lecture > Flashcards

Brain Injury Lecture Flashcards

1
Q

what are some common complications associated with BI? (7)

A
  1. raised ICP
  2. heterotopic ossification
  3. decubiti
  4. DVT
  5. autonomic dysfunction
  6. infections and pulmonary problems
  7. amnesia
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2
Q

what is heterotopic ossification?

A

formation of bone in abnormal anatomical locations

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3
Q

what percentage of patients with BI or SCI develop HO?

A

5-20%

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4
Q

is it more common in males or females?

A

males > females

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5
Q

S/S of HO

A
  1. loss of ROM (common in hip)
  2. swelling
  3. heat
  4. erythema
  5. non-septic fever
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6
Q

what should be avoided with HO?

A

vigorous stretching

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7
Q

what is retrograde amnesia?

A

partial or total loss of the ability to recall events that have occurred DURING THE PERIOD IMMEDIATELY PRECEDING brain injury

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8
Q

what is post-traumatic Amnesia?

A

time lapse between ACCIDENT and the point at which the FUNCTIONS CONCERNED WITH MEMORY ARE RESTORED

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9
Q

what is anterograde amnesia?

A

decreased attention or inaccurate perception; inability to DEVELOP ONGOING SHORT TERM MEMORY (new memories after the BI)

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10
Q

what are the different presentations of amnesia?

A
  1. physical
  2. cognitive
  3. behavioral
  4. medical involvement
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11
Q

what is “comatose”

A

unconscious and unresponsive

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12
Q

what is “stuporous”

A

near unconscious with apparent mental inactivity and reduced ability to respond to stimulation

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13
Q

what is “obtunded”

A

opens their eyes; responds slowing to questions, somewhat confused, decreased interest in environment

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14
Q

what is “lethargic”

A

dull, sluggish, and appears half asleep

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15
Q

what is “alert”

A

vigilantly attentive

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16
Q

what is the primary predictor of outcomes?

A

length of coma

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17
Q

In relation to coma, what is the rancho level?

A

1

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18
Q

In relation to coma, what is the level of arousal?

A

eyes do not open

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19
Q

In relation to coma, what is the level of awareness of auditory/visual stimuli?

A

None

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20
Q

In relation to coma, what is the level of communication and emotion?

A

none

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21
Q

In relation to coma, what is the level of motor response?

A

no purposeful movement

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22
Q

in relation to vegetative state, what is the rancho level?

A

1 or 2

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23
Q

in relation to vegetative state, what is the level of arousal?

A

eyes open spontaneously, sleep-wake cycles resumes, and arousal sluggish and poorly sustained

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24
Q

in relation to vegetative state, what is the awareness of auditory/visual stimuli?

A

may move eyes to person/objects, may orient to sound

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25
Q

in relation to vegetative state,, what is the level of communication and emotion?

A

may moan, make sounds; cry/smile without apparent cause

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26
Q

in relation to vegetative state, what is the level of motor response?

A

withdrawals from noxious stimuli; non-purposeful repetitive movement

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27
Q

In relation to minimally conscious state, what is the rancho level?

A

2 or 3

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28
Q

In relation to minimally conscious state, what is the level of arousal?

A

eyes open spontaneously, normal to abnormal sleep wake cycle, and arousal obtunded to normal

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29
Q

In relation to minimally conscious state, what is the level of awareness of auditory/visual stimuli?

A

tracks objects; localizes sound

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30
Q

In relation to minimally conscious state, what is the level of communication and emotion?

A

communication ability; inconsistent - yes/no, gestures, basic emotions

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31
Q

In relation to minimally conscious state, what is the level of motor response?

A

localizes noxious stimuli, reaches for objects, automatic behaviors

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32
Q

in relation to confusional state, what is the rancho level?

A

4, 5, or 6

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33
Q

in relation to confusional state, what is the level of arousal?

A

fluctuation in level of responsiveness, may be excessively drowsy

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34
Q

in relation to confusional state,, what is the level of awareness of auditory/visual stimuli?

A

response to external stimuli may be accentuated

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35
Q

in relation to confusional state, what is the level of communication and emotion?

A

able to communicate but disoriented; impaired attention and memory

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36
Q

in relation to confusional state, what is the level of motor response?

A

purposeful motor responses

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37
Q

how common is dizziness associated with TBI?

A

15-78%

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38
Q

what percentage of patients experienced abnormal vestibular testing?

A

32-61%

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39
Q

what percentage of patient with post-traumatic dizziness showed at least one vestibular deficit?

A

88%

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40
Q

what percentage of patients with post-traumatic dizziness received a diagnosis of BPPV?

A

61%

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41
Q

what are some of the causes of dizziness associated with TBI?

A
  1. lesions of the peripheral vestibular system
  2. lesions of the central vestibular system
  3. non-vestibular causes
  4. conditions unrelated to trauma
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42
Q

what are some lesions of the peripheral vestibular system?

A
  1. BPPV
  2. perilymphatic fistula
  3. labyrinthine concussion
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43
Q

what are some lesions of the central vestibular system?

A
  1. brainstem concussion/ post-concussive syndrome

2. cerebellar contusion

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44
Q

what are some non-vestibular causes?

A
  1. cervicogenic dizziness

2. migraine

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45
Q

what are some conditions unrelated to trauma?

A
  1. prior history of migraine
  2. CNS disorders
  3. prior compensated peripheral vestibular lesion
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46
Q

why are we concerned about dizziness after TBI?

A
  1. underlying cause of TBI?
  2. complicate rehab for the sequelae of TBI
  3. mimic cognitive impairments seen with TBI
  4. cognitive impairments due to TBI may complicate vestibular rehab
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47
Q

special considerations: Musculoskeletal

A

limit types of exercises a patient can perform

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48
Q

special considerations: cognitive impairments

A

memory problems may influence follow through of exercises; confusion/decreased processing may increase space and motion discomfort = overwhelming to pt

49
Q

special considerations: strategies

A
  1. reduce confusion
  2. improve motivation
  3. encourage consistency with performance
50
Q

what are two “improvements” you can make with patients post TBI having dizziness

A
  1. improve attention

2. improve problem solving ability

51
Q

what kind of learning should you encourage

A

declarative and procedural

52
Q

what level of arousal would you like for these patients?

A

moderate to optimize learning

53
Q

is progress slower for patients who have cognitive impairments?

A

yes

54
Q

what are some s/s of TBI?

A

HA, fatigue/lack of energy, disruption of sleep patterns, dizziness, increase sensitivity to noise/light/distractions

55
Q

what are examples of local brain damage?

A

contusions, lacerations, hematomas, and herniations

56
Q

what are examples of diffuse brain damage?

A

axonal shearing, small hemorrhages

57
Q

what are examples of secondary brain damage?

A

edema, hypoxia, hypotension, infection, salt/water imbalance, concussions or post traumatic epilepsy

58
Q

what are examples of scalp injuries?

A

abrasion/contusion, hematoma/herniation, and scalp laceration

59
Q

what are examples of skull fractures?

A

linear, comminuted, and compound

60
Q

what are examples of intracranial injuries?

A

concussion, epidural/subdural hematomas, and ICP monitoring

61
Q

what are examples of traumatic cerebro-vascular lesion?

A

aneurysms, and carotid-cavernous fistulas

62
Q

what are examples of CN pathologies?

A

CN 2,3,6,7,8 commonly injured

63
Q

how is the prognosis of the recovery stages measured?

A
  1. Glasgow Coma Scale

2. Rancho Los Amigos Cognitive Scale

64
Q

Brain infection can be from: (4)

A
  1. bacterial
  2. parasitic
  3. fungal
  4. viral
65
Q

All of the 4 microorganisms do what?

A

attack the CNS

66
Q

how do the microorganisms get to the brain?

A
  1. most hematogenously (through blood)

2. through PNS (rabies, herpes)

67
Q

How are brain infections categorized?

A

by location and cause

68
Q

what are the 3 common locations infections are found within the brain?

A
  1. abscesses (enclosed infections)
  2. meningitis (infection of meninges)
  3. encephalitis (inflammation of brain/SC)
69
Q

In relation to an abscess, how do organisms reach brain tissue?

A

staph or pseudomonas – secondary to inflammatory process elsewhere - lungs, heart, sinuses, ear mastoiditis

70
Q

what part of the brain tissue does an abscess involve?

A

white matter, most often reaches frontal and parietal lobes through superior sagittal sinus

71
Q

An abscess is a ____________ infections that ______________ _________.

A

generalized; increased ICP

72
Q

Due to the increased ICP, what are some s/s of an abscess?

A

HA, convulsions, hemiparesis, incoordination, and ataxia if the cerebellum is involved

73
Q

what are the 4 kinds of meningitis?

A
  1. leptomeninges
  2. bacterial
  3. viral
  4. chronic
74
Q

what does leptomeninges involve?

A

pia + arachnoid mater (dura mater usually doesn’t get infected)

75
Q

what is the process of leptomeninges?

A

infection spread through CSF with inflammatory process of pia mater, arachnoid mater, and superificial CNS tissues - includes SAS

76
Q

how does infection spread with leptomeninges?

A

organisms cross blood brain barriers and blood CSF barriers; or with trauma to torn meninges from a contaminated wound

77
Q

why is CSF an ideal growth medium

A

contains no antibodies and few cells

78
Q

what is leptomeningitis usually classified as?

A

bacterial or viral meningitis

79
Q

For bacterial meningitis, what are the age specific agents?

A

neonate - e.coli
childhood - h influenza
adolescent - n meningitides
adult - s pneumoniae

80
Q

what is the process of bacterial meningitis?

A

inflamed congested pia-arachnoid mater with PMN exudate - obstructs ventricular foramina – increased ICP

81
Q

what is a symptom of bacterial meningitis?

A

decreased blood sugar levels

82
Q

what are some s/s of bacterial meningitis?

A

HA, vomiting, fever, altered consciousness, convulsions, irritability, and nuchal rigidity

83
Q

what is a test to confirm nuchal rigidity (can’t move the neck)

A

+ Brudzinski Neck Sign (neck flexion causes hip/knee flexion

84
Q

if bacterial meningitis is left untreated, what happens

A

death

85
Q

what are the s/s of viral (aseptic) meningitis?

A

similar to bacterial but not life-threatening

86
Q

what is an adjective used to describe viral meningitis?

A

fulminating (occurs suddenly)

87
Q

who does viral meningitis affect?

A

children and young adults

88
Q

what are the blood sugar levels like for viral meningitis?

A

normal

89
Q

what is the process of viral meningitis?

A

viral contamination of CSF with an increase in lymphocytes (acute viral lymphocytic meningitis)

90
Q

what are some agents for viral meningitis?

A

mumps, ECHO, lymphocytic choriomeningitis, and coxsackie B

91
Q

what are some agents for chronic meningitis?

A

mycobacterium tuberculosis (lung TB), preponema pallidum (syphillis)

92
Q

what is the process of chronic meningitis?

A

gelatinous exudate in meninges, increased lymphocytes/plasma cells/macrophages/fibroblasts

93
Q

what happens if chronic meningitis is in the SAS

A

hydrocephalus

94
Q

what are some s/s of hydrocephalus?

A

gait disturbances, incontinence, altered mental status

95
Q

what are some s/s of chronic meningitis?

A

HA, vomiting, mental confusion, weight loss, fatigue, night sweats, chest pain, malaise

96
Q

what is the medical management of meningitis?

A

antimicrobial antibiotics for bacteria; treat viral infections symptomatically - antivirals if caught soon

97
Q

what is the process of encephalitis?

A

viral invasion of brain ans SC cells (neurons and glia)

98
Q

what does encephalitis cause?

A

edema and inflammation of the brain/SC destroying white matter

99
Q

what does ICP lead to?

A

transtentorial herniation (tentorium spearates cortex from cerebellum)

100
Q

S/S of encephalitis

A

HA, fever, nuchal rigidity, vomiting, malaise – coma, CN palsies (III), hemiplegia

101
Q

what does encephalitis stand for?

A

inflammation of the brain

102
Q

what does encephalomeningitis mean?

A

inflammation of the brain and SC

103
Q

what does encephalomyeloneuropathy?

A

inflammation of the brain, SC, and PNS

104
Q

what does acute viral encephalisis affect?

A

frontal/temporal lobe gray matter

105
Q

what is the most fatal type of encephalitis?

A

acute viral encephalitis

106
Q

what is acute viral encephalitis a combination of?

A

herpes simplex I and II, CNS primary infection

107
Q

what is parainfectious encephalitis a combination of?

A

rubella measles, paramyxovirus mumps, and varicella zoster chicken pox

108
Q

what is acute toxic encephalitis?

A

arbovirus arthropod-borne systemic infection

109
Q

what diseases are associated with acute toxic encephalitis?

A

lyme disease, west nile virus

110
Q

what is the progress of the slow virus encephalitis?

A

incubation periods, fatal within months - progressive dementia

111
Q

what does slow virus encephalitis look like in the brain?

A

“spongiform” bubbles and holes in brain cortex, resembles degenerative disease

112
Q

what are the s/s of the slow virus encephalitis?

A

personality abnormalities, visual and spatial orientation/coordiation problems – leads to dementia with myoclonus

113
Q

what is creutzfeldt Jacob Disease caused by?

A

prion

114
Q

what is the etiology of CJD

A

familial, sporadic, and iatrogenic

115
Q

does CJD show symptoms immediately?

A

no, it takes decades for the s/s to show

116
Q

what are the s/s in the beginning for CJD

A

altered mental status, gait disturbances, no safety awareness, poor behavioral reactions, no memory

117
Q

when should CJD be considered?

A

when patient develops rapid dementia and myoclonus

118
Q

patients with CJD die when?

A

within 6 months-1 year

Adult Neuro Exam 3 (7 decks)

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