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Medical Sciences B > Brain & spinal cord trauma > Flashcards

Brain & spinal cord trauma Flashcards

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USMLE® Step 1 flashcards
1
Q

What is the definition of brain trauma?

A
  • traumatic insult to brain

* producing physical, intellectual, emotional, social, vocational changes

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2
Q

What individuals are at risk of of brain trauma?

A
  • 6months to 2yrs
  • school-aged kids
  • 15-35yr olds
  • > 70yr olds
  • men x 1.5
  • high crime areas
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3
Q

What is blunt brain trauma?

A
  • closed; nonmissile
  • head strikes hard surface or fast object strikes head
  • dura intact
  • focal or diffuse injuries
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4
Q

What is open brain trauma?

A
  • penetrating; missile
  • injury breaks dura
  • exposes cranial contents to environment
  • primarily causes focal injuries
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5
Q

What are the causes of brain trauma?

A
  • falls
  • MVA
  • moving objects or moving against stationary objects
  • assault
  • sports
  • blasts (military)
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6
Q

What is the severity of brain trauma?

A

75-90% are not severe

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7
Q

What is the hallmark of severe brain injury?

A

loss of consciousness > 6hrs

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8
Q

List the types of focal brain injury?

A
  • coup - directly below point of impact
  • contre coup - opposite to site of impact
  • coup-contracoup - both together
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9
Q

What can contusions cause?

A
  • extradural (epidural) hemorrhage or hematoma
  • subdural hematoma
  • intracerebral hematoma
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10
Q

What is an extradural haematoma?

A
  • 85% are from arterial bleeding
  • 15% are from meningeal vein or dural sinus
  • 90% are from skull fracture
  • temporal fossa is most common site
  • features: diminishing consciousness, nausea, vomiting, low HR, high BP, fixed dilated pupils
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11
Q

What is a subdural haematoma?

A
  • counts for 10-20% of traumatic brain injury
  • most from MVAs
  • 50% are with fracture
  • common with falls
  • acute: 48hrs post trauma, often top of skull
  • chronic: over wks or mnths, in older adults, alcohol abuse, chronic headache, tenderness at injury site
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12
Q

What is an intracerebral haemorrhage?

A
  • mostly from MVA and falls

* acts as expanding mass -> increasing ICP -> compression -> oedema

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13
Q

List the types of diffuse brain injury?

A
  • diffuse axonal injury (DAI)

* concussions

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14
Q

What is diffuse axonal injury?

A
  • result of shaking (acceleration/deceleration)

* axonal damage due to shearing, tearing, stretching nerve fibers

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15
Q

Describe the concussion grades?

A

I - confusion, disorientation, momentary amnesia

II - momentary confusion and retrograde amnesia

III - confusion, retrograde and anterograde amnesia

IV - “classis concussion”

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16
Q

What are the characteristics of a grade IV concussion?

A
  • disconnection of cerebral systems from brainstem and reticular activating system
  • physiologic and neurologic dysfunction without substantial anatomic disruption
  • lost consciousness (<6hrs)
  • anterograde and retrograde amnesia
17
Q

What is postconcussive syndrome?

A
  • headache
  • cognitive impairments
  • psychogenic and somatic complaints
  • cranial nerve signs and symptoms
18
Q

What is the aetiology of spinal cord trauma?

A
  • commonly from vertebral fractures
  • traumatic compression, pulling, shearing forces
  • most common C1,2,4-7, T1-L2 (most mobile and most canal occupied by spinal cord)
19
Q

What are the mechanisms of spinal cord injury?

A
  • hyper-extension
  • hyperflexion
  • axial compression
  • flexion-rotation
20
Q

List the stages of spinal cord trauma?

A

a. spinal shock

b. neurogenic shock

21
Q

What is spinal shock?

A
  • following trauma, short term
  • spinal cord activity ceases below lesion
  • sites lack continuous nervous discharges from brain
  • complete loss of reflex function (skeletal, bladder, bowel, sexual, thermal, autonomic control)
  • spinal cord not that damaged, it is from oedema
  • partial recovery
22
Q

What is neurogenic shock?

A
  • loss of sympathetic outflow

* results in vasodilation, hypotension, bradycardia, hypothermia

23
Q

What are the consequences of an L1 injury?

A
  • paraplegia

* paralysis below the waist

24
Q

What are the consequences of a T6 injury?

A
  • paraplegia

* paralysis below the chest

25
Q

What are the consequences of a C6 injury?

A

partial paralysis of hands and arms and lower body

26
Q

What are the consequences a C4 injury?

A
  • quadriplegia /tetraplegia

* complete paralysis below neck

27
Q

What is autonomic hyperreflexia?

A
  • also called dysreflexia
  • massive, uncompensated cardiovascular response to stimulation of sympathetic nervous system
  • stimulation of sensory receptors below the level of cord lesion
  • months after spinal shock and healing -> scarred -> hypersensitive -> overreact to full bladder or full rectum -> reaction by high BP
28
Q

Describe chemical and metabolic changes to the spinal cord in spinal cord trauma

A
  • release of toxic excitatory amino acids
  • accumulation of endogenous opiates
  • lipid hydrolysis
  • production of active metabolites
  • local free radical release
  • further ischemia -> vascular damage -> necrosis -> swelling
29
Q

What is the difference between a concussion and a contusion?

A

Concussion:
• microscopic widespread axonal damage
• from shaking
• confusion or lost consciousness

Contusion:
• macroscopic damage
• bleeding due to localized trauma
• increases ICP

30
Q

Why is head motion the principal causative mechanism of diffuse brain injury?

A
  • coup-contrecoup
  • A-P shearing of hemispheres damages corpus callosum
  • punch to the jaw -> rotation force around brainstem -> lesion to reticular activating system -> K.O.
31
Q

Compare UMN and LMN lesions?

A 
UMN-lesion
• in brain and spinal cord
• spastic, keep muscle tone
• reflex intact
• damaged by stroke, brainstem lesions

LMN-lesion
• outside spinal cord
• flaccid, loose muscle tone, fasciculations
• no reflex, no strength
• from compression, broken bone, rapid overstretch, peripheral neuropathy

Medical Sciences B (23 decks)

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