Chapter 16 - Disorders of the CNS, PNS, and NMJ Flashcards
Traumatic injury, vascular disorder, tumour growth factors, infections, and inflammatory processes are involves with alterations in _____ function.
CNS
Nerve route, nerve plexus, nerves themselves, or neuromuscular junction alterations are involved with ____ function.
PNS
____________ is the primary cause of death and disability in those under 40 in Canada
traumatic brain injury (TBI)
30% of TBIs in youth are _____ and ______ activity associated.
sport and recreational activity
What is a traumatic brain injury (TBI)?
alteration in brain function or other evidence of a brain disease caused by an EXTERNAL FORCE
Primary TBI is caused by _______ impact
direct
Primary TBI can be ______ or _______
focal or diffuse
Focal TBI
affects only one area of the brain
Diffuse Axonal Injury (DAI TBI)
involves more than one area of the brain
____ of injuries are focal and _____ are diffuse
2/3; 1/3
Secondary TBIs are caused by an _______ result of primary injury
indirect
Systemic responses along with cellular and molecular cerebral events are included in _____ TBIs
secondary
How are TBIs diagnosed?
Glasgow Coma Scale (GCS)
The lower the GCS score, the __________ the damage
more severe
Severe head injury GCS = ___ or less
8
Moderate head injury GCS = ___ to ___
9 to 12
Mild head injury GCS = ___ to ___
13 to 15
The Glasgow coma scale ranks levels of _____, verbal, and ______ responses
eye, verbal, motor
The characteristics no eye opening, verbal response, or motor response are score level __
1
The characteristics eye opening to pain, incomprehensible sounds, and extension to pain are consistent with score level __
2
The characteristics eye opening to verbal command, inappropriate words, and flexion to pain are consistent with score level ____
3
A primary focal TBI can be ______ or _____ injury
closed or open
Closed Injury
head striking a hard surface, moving object strikes head, blast waves
Is a closed or open head injury more common?
closed
With a closed injury, the ____ ____ remains intact and brain tissue _____ exposed
dura mater; is not
Open Injury
penetrating trauma or skull fracture
With a closed injury there is a _____ in the dura mater and brain tissue is _______
break; exposed
What are the 5 primary focal closed injuries?
-coup/countercoup
-contusion
-epidural (extradural) hematoma
-subdural hematoma
-intracerebral hematoma
Primary Focal Close injury means…
specific, observable injury in a precise location
____% of Primary Focal Closed injuries are mild
80%
What are the severe primary focal closed injuries?
contusions, epidural, subdural, and hematomas
Coup
injury at the site of impact
Countercoup
injury from the brain bounding back and hitting the opposite side of the skull
What is a contusion?
brain bruising due to the compression of the skull at point of impact
Contusions result from ______ leaking from an injured vessel
blood
The smaller the contact area, the more _______ the injury
severe
What happens as a result of a contusion?
-edema
-increased ICP
-hemorrhage
-infarction
-necrosis
=pulpy tissue
Where is the most common injury site for a contusion?
frontal lobe
The greatest effects of a contusion peak ___-____ hours after injury
18-36
How are contusions diagnosed?
GCS, CT scan, MRI
How is a contusion treated?
if needed - surgical removal of are of contusion/hemorrhage
slide 13
An epidural hematoma (EH), occurs with bleeding between the ______ and the _____
dura mater and skull
Where is the most common site of an epidural hematoma?
temporal fossa
With an epidural hematoma the person usually ________________
loses consciousness
What symptoms occur as the EH grows?
-severe headache
-confusion
-seizure
__________ and ______ _________ are signs of an EH
hemiparesis and pupil dilation
Hemiparesis
weakness or inability to move ONE side of the body
Injury prognosis is good if treated before…
both pupils dilate
An epidural hematoma is a _________ ________
medical emergency
Subdural hematoma is bleeding between the ____ _____ and the _____
dura mater and brain
An ______ subdural hematoma develops within hours
acute
As a subdural hematoma grows, _____ rises applying pressure to the bleeding veins, assisting in short-term limitation
ICP
What are the symptoms of an acute subdural hematoma?
-headache
-confusion
-loss of consciousness
-pupil dilation
-hemianopia
-anopia
Hemianopia
blindness over half the vision field
Anopia
blindness
A _______ subdural hematoma develops over weeks to months
chronic
Chronic subdural hematomas are common with…
alcohol abuse
With chronic subdural hematomas, there is ____ bleeding that fills the subdural space with blood
mass
What forms around a chronic subdural hematoma?
vascular membrane
What are the symptoms of a chronic subdural hematoma?
-headache
-tenderness over hematoma
-worsening dementia and paratonia
Paratonia
rigidity
What is the treatment for a chronic subdural hematoma?
craniotomy to remove the jelly-like blood
An intercerebral hematoma is bleeding where?
within the brain
Intercerebral hematomas make up __-__% of head injuries.
2-3%
Where do intercerebral hematomas mainly occur?
frontal and temporal lobes
An intercerebral hematoma results from penetrating and shearing forces that injure ______ blood vessels and form a growing mass
small
What are the symptoms of an intercerebral hematoma?
-sudden, rapid decrease in consciousness
-pupil dilation
-positive Babinski reflex
Babinski Reflex (+)
tool dragged across foot, big toe bends up towards top of foot and other toes fan out
Babinski Reflex (-)
tool dragged across foot, toes scrunch together
Name a primary focal open injury:
compound skull fracture/missile injuries
A compound skull fracture opens a ____ between cranial contents and the __________
path; environment
Compound skull fractures should be considered when…
scalp, tympanic membrane, sinus, eye, or mucous membranes are cut
Compound skull fractures can be ______ or ______ injuries
crush or stretch
Crush Injury
cutting or crushing (whatever the missile touches)
Stretch Injury
blood vessels and nerve damage without direct contact
What are the symptoms of a compound skull fracture?
loss of consciousness
Basilar skull fractures (type of CSF) are usually caused by _____ ______ trauma
blunt force
A basilar skull fracture involves at least on of the bones at the _____________
base of the skull
What results from a basilar skull fracture?
spinal fluid leaking from ear or nose, blackened eyes
Primary diffuse injuries result from…
-high levels of acceleration/deceleration (whiplash)
-rotational forces
What results from a DAI (diffuse axonal injury)?
shearing of axonal fibres and white matter tracts
The degree of shearing with a DAI determines congitive ________ and ________ of _______ __________
type and extent of cognitive impairment
How are primary diffuse injuries diagnosed?
electron microscope to detect axonal damage
A secondary injury is an indirect result of a ________ brain injury (incl. trauma and stroke syndromes)
primary
_________ and _______ processes are involved with secondary brain injuries
systemic and cerebral
Systemic Processes
hypotension, hypoxia, etc.
Cerebral Processes
inflammation, edema, increased ICP
The primary effects of secondary injuries disrupt the _____ and lead to neuronal death
BBB
How are secondary brain injuries managed?
-prevention of hypoxia
-maintaining cerebral perfusion pressure
-removal of hematomas
-nutritional management
Mild TBIs are characterized by immediate but _______ clinical manifestations
transitory (short term)
With a mild TBI, loss of consciousness occurs in less than ____ mins
30
What are the symptoms of a mild TBI?
-headache
-nausea
-vomiting
How is a mild TBI diagnosed?
blood test to determine need for CT scan
A moderate TBI is characterized by a loss of consciousness more than ___ min but up to __ hours
30; 6
Moderate TBIs result in _________ defects in arousal and attention
permanent
What are the symptoms of a moderate TBI?
-confusion and amnesia lasting more than 24 hours
-abnormal brain imaging
A severe TBI is characterized by a loss of consciousness for more than ___ hours
6
