CH34: Craniocerebral Trauma

Question 1

Most common cause of diplopia occurring unilaterally twice as often as bilaterally (p. 908)

Answer 1

Trochlear nerve palsy

Question 2

Transvere fractures through petrous bone (p. 909)

Answer 2

immediate facial palsy

Question 3

Longitudinal fracture of petrous bone (p. 909)

Answer 3

facial palsy delayed for several days

Question 4

How many percent of carotid cavernous fistula resolve spontaneously? (p. 909)

Answer 4

5-10%

Question 5

More elaborate way to distinguish rhinorrhea? (p. 909)

Answer 5

tau protein

Question 6

Mucus vs CSF (p. 909)

Answer 6

Mucus: stiffen handkerchief. CSF: no

Question 7

Concussion symptoms (p. 909)

Answer 7

transient loss of consciousness, amnesia after a blow to the head, transient arrest of respirations, period of bradycardia, fall in blood pressure

Question 8

Shock waves traveling through the brain and disrupts neural function throughout the cerebral hemisphere or in the reticular formation of the midbrain (p. 910)

Answer 8

Blast injury

Question 9

One index of severity of concussive injury (p. 911)

Answer 9

anterograde amnesia

Question 10

Zones subjected to the greatest torque in cases of severe head injury (p. 913)

Answer 10

midbrain and subthalamus

Question 11

GCS that reflect severe trauma (p. 914)

Answer 11

Equal of below 7

Question 12

New Orleans Criteria (p. 915)

Answer 12

GCS 15 patients 
HAVE PDS
Headache
Age > 60
Vomiting
Evidence of traumatic soft tissue or bone injury above clavicles
Persistent anterograde amnesia
Drug or alcohol intoxication
Seizure

Question 13

Canadian CT Rule (p. 915)

Answer 13

GCS 13-15
HIgh risk of neurosurgical intervention
GCS < 15 within 2h of surgery
Suspected open or depressed skull fracture
Any sign of basal skull fracture
Two or more episodes of vomiting
Age > 54
Moderate risk of brain injury at CT scan
Retrograde amnesia > 30mins
Dangerous mechanism

Question 14

Drug which showed slight emergence from vegetative r minimally conscious state (p. 917)

Answer 14

Amantadine, given 4-12 weeks

Question 15

The dilation of ipsilateral pupil is a fairly reliable indicator to the side of hematoma although this sign may be misleading in how many percent of cases (p. 920)

Answer 15

10%

Question 16

Most important factor in the expansion of subdural fluid in SDH (p. 921)

Answer 16

pathologic permeability of the developing capillaries in the outer psuedomembrane of the hematoma

Question 17

In blast injury, after the brain which is the next organ most often affected? (p. 923)

Answer 17

lung

Question 18

Autonomic Dysfunction (Storm) Syndrome drug (p. 925)

Answer 18

Bromocriptine with sedatives

Question 19

Most prominent feature of acute and chronic traumatic encephalopathy (p. 925)

Answer 19

Memory disorder

Question 20

Pathologic findings in traumatic encephalopathy (p. 926)

Answer 20

Alzheimers NF but NOT Lewy bodies
Absence of discrete amyloid plaques
extensive immunoreactive deposits of beta- amyloid

Question 21

This finding came to define chronic traumatic encephalopathy (p. 927)

Answer 21

Tau protein

Question 22

Post concussion syndrome symptoms (p. 927)

Answer 22

Headache, dizziness, poor endurance, lack of mental clarity

Question 23

Also found with the vertigo of postconcussion syndrome (p. 927)

Answer 23

Diminished excitability of both the labyrinth and chochlea

Question 24

Strongest predictor of post concussion syndrome (p. 928)

Answer 24

Previous anxiety disorder

Question 25

Gold standard of pressure measurements (p. 929)

Answer 25

Ventricular catheter

Question 26

Indications of inctracranial monitoring (p. 930)

Answer 26

Glasgow coma 3 and 8
Abnormalities in CT scan

If no abnormality:
age over 40
posturing
SBP below 90

Desirable level of ICP below 20

Question 27

Ideal fluids for craniocerebral trauma (p. 930)

Answer 27

Normal saline, with or without added dextrose

Question 28

Preferable drugs for reducing agitation because they are mildy sedating (p. 932)

Answer 28

Etomidate and Dexmedetomidine