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Neurology > Brain Trauma > Flashcards

Brain Trauma Flashcards

1
Q

X rays

Pros

A
  • Fast
  • Limited
  • Good - bones + FBs
  • Cheap
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2
Q

X rays

Cons

A
  • Virtually no information about soft tissues
  • Must be done in multiple planes
  • almost no acute management = Head trauma
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3
Q

CTs

Pros

A
  • Fast
  • few contraindications (Preg, peds = but high Radio)
  • all 3 planes
  • Good = bones, blood, FBs
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4
Q

CTs

Cons

A
  • VERY HIGH radiation

* Bad = soft tissue (MRI better)

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5
Q

MRI

Pros

A
  • good - soft tissue/ligaments, brain/spinal

* no radiation

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6
Q

MRI

Cons

A

Slow, expensive
Contraindications (stent)
*Low use in acute ettign

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7
Q

Traumatic Brain Injury

Death risks

A
  • Older = Falls
  • Self-harm = middle age
  • MVC = young
  • Assault = infant
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8
Q

Injury w/

  • consciousness loss
  • memory loss - events preceding accident
  • mental status altering
  • focal neuro s/s
A

Mild TBI

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9
Q

= Mild TBI

  • transient LOC
  • lightheadedness
  • n/V
  • vision
  • cognitive/ memory
A

Concussion

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10
Q

TBI

Initial management

A
  • triage
  • +/- trauma team
  • Image (CT w/o contrast)
  • Labs: CBC, BMP, Coags (PT etc.), UA/Utox
  • Neurosurgical consult
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11
Q

Initial Neuro exam

A
  • Inspect cranium
  • Cranio-cervical junction
  • Seizure
  • Alertness
  • CN exam
  • Motor exam
  • Sensory exam
  • Reflexes
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12
Q

Assess consciousness?

A

Glasgow Coma Scale

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13
Q

Assess concussion?

A

Possible eval tool = ACE (acute concussion evaluation) , MANY OTHERS POSSIBLE

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14
Q

Concussion management

A

*REST
*return to play once symptoms have resolved
(7-14 days, possibly weeks to months)
-FOLLOW LOCAL TOOL for stepwise play activity assessment (must complete step w/o symptoms for 24 hours) = VERY LETIGIOUS

*Managing these S/S = REFER TO NEURO

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15
Q

Concussion lasting 3 months + ?

A

Post-concussive syndrome

  • Refer to neuro
  • Delayed hydrocephalus? Post traumatic seizures?
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16
Q

S/s w/

  • Severe headache
  • Vomiting
  • Age >60
  • Intoxication
  • Amnesia
  • Post-traumatic seizure
  • Blood thinners
  • PE - trauma above clavicle

????

A

RED FLAG - SCAN NOW
Activate Trauma team

(Especially - Intoxication + bruise + confusion)

17
Q

CT rules out

A 
Blood
Hydrocephalus
Cerebral swelling
Skull fracture
Pneumocephalus
Midline shift
18
Q
  • acute/subacute/trauma
  • distant trauma Hx
  • size, midline shift, GCS, location
A

SAH
*size, midline shift, GCS, location

*ANY SIGN? = REFER TO NEURO OR

19
Q

CT findings

  • Acute blood =WHITE
  • crescent shaped/ concave
  • +/- Mass Effect
  • +/- Midline shift
A

Subdural Hematoma

20
Q

*Head injury w/ brief traumatic LOC–> Lucid Interval–> Deterioration –>Coma

A

Epidural Hematoma

  • Less common than Subdurals
  • Middle meningial arterial bleeding
21
Q

CT

Acute blood white
Biconvex shape (egg) next to skull
A

Epidural Hematoma

22
Q

CT

Subdural vs. Epidural Hematoma

A

Subdural = crescent shape

Epidural = balloon shape

23
Q

Epidural hematoma

Management

A
  • surgery

* can herniate quickly!

24
Q

5 forms of herniation

A

Central (transtentorial)
Uncal

Cingulate/subfalcine
Upward cerebellar
Tonsillar

25
Q
  • altered mental status
  • respiration, oculomotor motor problems

Diencephalon through tentorial incisura

Shear pituitary stalk - DK

A

Central Herniation

*trapped PCA’s/pca strokes = cortical blindness

26
Q
  • Dilated Pupil
  • contralateral weakness
  • rapid expanding traumatic hematomas = push uncus + hipoccampus OVER tentorium
A

Uncal Herniation

  • 3rd nerve
  • Midbrain compression - contra weakness
27
Q
  • gunshot wounds - most lethal

* soft tissue/skull factors

A

Penetrating trauma

*bacteria dragged in

28
Q

Craniectomy vs Craniotomy

A
  • otomy = skull bone put back

- ectomy = no bone put back

29
Q

Penetrating trauma workup

Image

A

Cerebral angiogram

30
Q
  • bleeding into Subarachnoid layer
  • usually small vessels
  • severe TBI s/s
A

SubArach Hemorrhage - Trauma

  • seizure prophylaxis
  • not operable
31
Q

Intracerebral hemorrhage/ Cerebral contusion

A
  • Trauma
  • w/ tSAH
  • have to do mutliple CTs to see
  • not operative
32
Q

CTs = how often

A

Every 6 hours

33
Q

*decline in memory/executive function
*Mood/behavior change
*eventual dementia
AFTER REPEATED TRAUMA

A

Chronic Traumatic Encephalopathy

  • DX ONLY post-mortem
  • s/s usually decades after trauma (40-50 y/o)
34
Q

Danger!!!!

Head trauma w/

A

*BLOOD THINNER
(Aspirin, Coumadin, Eliquis, Pradaxa)

  • Intoxicated (DRUNK)
  • unexplainable abnormal exam finding
35
Q

“He’s just drunk”

A
  • Liver disease –> clotting factors

* S/s drunk SAME as TBI

Neurology (20 decks)

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