CNS Injuries & Damage Flashcards

Question

What is a Intracerebral haemorrhage? What are its risk factors? How would you identify in an X-ray

Answer 1

* aka intraparenchymal haemorrhage * Similar presentation to ischemic stroke Risk factors include * Hypertension * Alcohol intake * Low cholesterol (contrast to ischemic stroke risk) * Genetic risk * Anticoagulants * Drug use (e.g. cocaine) In an X-ray: deeper brain structures are affected (light areas in the middle of the brain)

Answer 2

Hypoxia, Anoxia, and Ischemia

Answer 3

* Hypoxia – restricted supply of oxygen * Anoxia – absence of oxygen Brain cells die after just a four minutes without sufficient oxygen. Extent of damage, likelihood of recovery & symptoms depend on various factors: duration of hypoxia/anoxia & which brain regions were affected.

Answer 4

Causes: Anything that prevents effective ventilation or circulation, including: * Ischaemic stroke * Cardiac arrest, respiratory arrest/lung injury * Haemorrhagic/hypovolemic shock * Suffocation/strangulation/choking * Smoke inhalation * Near drowning * Drug overdose * Anaphylaxis * Severe asthma

Answer 5

Priority= restore ventilation, heartbeat, and blood pressure – prevent ongoing injury Treatment of any associated injuries e.g. heart/lung/neck Most improvement in brain function comes in the first few months Rehabilitation team would include occupational therapists, physiotherapists, speech/language therapists As with other brain injuries, younger age generally have better prognosis

Answer 6

* Haemorrhagic strokes * Ischemic strokes * Transient ischemic attack (TIA) Ischemia is disruption of blood supply. Note this is different (but with some overlap) from anoxia/hypoxia, which are disrupted oxygen supply.

Answer 7

The majority of strokes are ischemic (approx. 85%) * A blood clot blocks blood flow within the brain * The clots often form as a result of atherosclerosis Atherosclerosis * Atrial fibrillation also increases risk Atrial fibrillation - NHS * Risk increases with age – arteries become narrower and stiffer Risk factors: * Smoking * Alcohol * Hypertension * Obesity * Diabetes * High cholesterol Specifics and severity depend on brain regions affected. General advice: BE FAST (Balance, Eyes, Face, Arm, Speech, Time) > ROSIER carried out on clinical assessment (Recognition of Stroke in Emergency Room) > CT scan will likely be performed

Answer 8

Thrombolysis drugs * Altepase Thrombectomy * Surgical removal of the clot Aspirin/long-term antithrombotic therapy * Only once haemorrhagic stroke ruled out

Answer 9

* Blood supply temporarily blocked, usually by a blood clot * Symptoms are the same as ischemic stroke, but will be temporary * Resolve in minutes/hours with little or no lasting effects * Indicates risk of future strokes * Prevention of future attacks: Lifestyle advice, anti- platelet/anticoagulants, blood pressure and cholesterol control.

Answer 10

* Post-traumatic amnesia (PTA) can occur after a TBI. * PTA can occur regardless of whether the patient lost consciousness, but is more common following a period of unconsciousness. * The main symptom of PTA is: loss of memory (particularly of recent events), confusion, disorientation & uncharacteristic behaviours. PTA can last a few minutes to several weeks, with longer duration indicating a more severe brain injury.

Answer 11

Following a brain injury patient may suffer ongoing memory problems. Retrograde amnesia: loss of memories from before the injury Anterograde amnesia: difficulties forming new memories since the injury * Both can range in severity. Both retrograde & anterograde can cause significant problems for patients, anterograde amnesia has been reported by patients to be a bigger problem as it is an ongoing issue.

Answer 12

Several brain regions are involved in memory Damage to any one of them may impact upon memory to some degree. * Hippocampus has an important role in memory formation, particularly consolidating short term memory into long term memory. Damaged hippocampus can result in anterograde amnesia.

Answer 13

explicit memories – which are about events that happened to you (episodic), as well as general facts and information (semantic) – there are three important areas of the brain: the hippocampus, the neocortex and the amygdala. Implicit memories, such as motor memories, rely on the basal ganglia and cerebellum. Short-term working memory relies most heavily on the prefrontal cortex. https://qbi.uq.edu.au/brain-basics/memory/where-are-memories-stored

Answer 14

blow to the head can result in being knocked out - the person becomes unconscious. Swelling, bruising, and movement of the brain within the skull result in a disruption to the normal function of the brain (similar to TBI). This may present with: – very minor symptoms (perhaps a bit of a headache) – the person may remain conscious but become dizzy, disorientated & nauseous – loss of consciousness In most cases loss of consciousness= temporary, lasting secs to mins. * Acquired brain injuries (traumatic or non-traumatic) can result in longer term impairments of consciousness. * Note that short term impairments of consciousness can also be caused by internal factors - this is syncope (fainting). * Can be caused by factors such as low blood pressure, which can result in insufficient blood flow to the brain and therefore a disruption of normal brain function.

Answer 15

* No sign of being awake or aware * Duration is variable – Generally longer duration -> worse prognosis * Waking from a coma is a gradual process * In some patients they may wake from the coma but remain in a vegetative state, or a minimally conscious state, for a period of time. This may be temporary in some cases but can also be long term.

Answer 16

* Used to assess degree of consciousness * NICE guidelines indicate a patient who has suffered a head injury should not be discharged unless they score 15 on the GCS * Three criteria: – Eye opening – Verbal response – Motor response * Scores 3-15 (<8 = coma)

Answer 17

* A coma may be induced to reduce the energy demands of the brain * Aim is to protect the damaged areas as they attempt to heal (i.e. swelling to reduce, bruising to heal), and to reduce intracranial pressure to minimise further damage * Coma can be induced and regulated using drugs such as barbiturates.

Answer 18

* Periods of wakefulness but no signs of awareness * Basic reflexes, but no meaningful responses (such as responding to voices) * Can occur when there has been damage to the higher centres of the brain, but the brain stem has remained intact and functional and so the patient is still able to regulate their breathing and heart rate * >4 weeks = continuing (or persistent) vegetative state * >6-12 months, then the patient may be considered a permanent vegetative state.

Answer 19

* Patient does show signs of awareness, but this may be limited and/or inconsistent * May be able to respond to voices, questions, or other stimuli with a simple response e.g. moving a finger or moving/blinking their eyes. * Better prognosis for minimally conscious state than it is for vegetative state – Minimally conscious state is not usually considered permanent until it has continued for several years.

Answer 20

* Patient is conscious but is unable to move or speak * They are entirely paralysed other than eye movement * Caused by damage to the pons, which is part of the brain stem

Answer 21

Eye Opening Response * Spontaneous--open with blinking at baseline 4 points * To verbal stimuli, command, speech 3 points * To pain only (not applied to face) 2 points * No response 1 point Verbal Response * Oriented 5 points * Confused conversation, but able to answer questions 4 points * Inappropriate words 3 points * Incomprehensible speech 2 points * No response 1 point Motor Response * Obeys commands for movement 6 points * Purposeful movement to painful stimulus 5 points * Withdraws in response to pain 4 points * Flexion in response to pain (decorticate posturing) 3 points * Extension response in response to pain (decerebrate posturing) 2 points * No response 1 point