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Neuro 2 Mine > CNS Injury > Flashcards

CNS Injury Flashcards

1
Q

Types of Skull Fractures

A
  • linear
  • depressed
  • basilar
  • growing
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2
Q

Signs of Skull Base Fracture

A
  • CSF rhinorrhoea
  • bilateral peri orbital hematomas (raccoon eyes)
  • subconjunctival hemorrhage
  • bleeding from external auditory meatus
  • CSF otorrhoea
  • battle sign
  • facial nerve palsy
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3
Q

Epidural Hematoma

A
  • contact phenomena
  • intracranial extradural arterial hemorrhage
  • associated with skull fracture
  • classic lucid interval
  • low mortality rate
  • lens appearance
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4
Q

Translational Injury

A
  • results from head movement in single plane the instant after impact
  • results in stretching and tearing of veins between brain and dura (subdural hematoma) and contusions
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5
Q

Most Common Area of Cerebral Contusion

A

-frontal and temporal lobes

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6
Q

Subdural Hematoma

A
  • acceleration injury (translational)
  • rupture of bridging veins in subdural space
  • associated w/ contusions
  • high mortality rate
  • banana shape
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7
Q

Rotational Injury

A
  • results from head moving in more than one plane
  • results in diffuse axonal injury (microscopic tearing of nerve cells)
  • no recognizable injury detected w/o microscope
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8
Q

Pathomorphology of Diffuse Axonal Injury (DAI)

A
  • spheroids appear when coma exceeds 6 hrs
  • only detectable at LM level after 24 hours
  • corpus collosum and brainstem most commonly affected
  • invisible on CT/MRI
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9
Q

Intracranial Compensation

A
  • any inc. in intracranial volume dec. CSF (into spinal subarachnoid space) or CBV (in jugular venous system)
  • once these mechanisms are exhausted, additional inc. in volume produce extreme inc. in ICP
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10
Q

Exhaustion of Compensation

A
  • once compensation mechanisms are exhausted, small inc. in volume will lead to marked inc. in ICP
  • raised ICP may dec. CBF resulting in vicious cycle
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11
Q

Herniation

A
  • ICP inc. not equally distributed leads to pressure gradient
  • laterally (cingulate herniation)
  • downwards (transtentorial herniation)
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12
Q

Pathophysiologic Changes of TBI

A
  • astrocyte swelling -> cytotoxic edema
  • free radicals from excitotoxicity and mechanical trauma to vessels -> vasogenic edema
  • swollen brain -> areas of reduced perfusion, ischemia, energy failure, more cytotoxic and vasogenic edema
  • areas of hyperperfusion from dysautoregulation
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13
Q

Cytotoxic Edema

A
  • BBB remains intact, but disruption in cell metabolism impairs functioning of NA/K pump in glial membrane leading retention of Na and H2O
  • swollen astrocytes occur in grey and white matter
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14
Q

Vasogenic Edema

A
  • BBB is disrupted

- extracellular edema which mainly affects white matter through leakage of fluid out of capillaries

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15
Q

Glasgow Coma Scale

A
  • high score is good (13-15)
  • low score is bad (3-8)
  • based on eye, motor, and verbal responses
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16
Q

Brainstem Reflexes

A
  • pupillary reflex (CN 2, 3, midbrain)
  • corneal blink reflex (CN 5, 7, pons)
  • cold caloric testing “doll’s eyes” (CN 8, 6, 3, pons -> midbrain)
  • gag reflex (CN 9, 10, medulla)
17
Q

Normal ICP

A

3-15 mmHg

18
Q

Forces Resulting in Cerebral Trauma

A
  • contact phenomena
  • acceleration
  • penetration
  • secondary injury
19
Q

Anesthesia Definition

A

-loss of sensation

20
Q

Paresthesia and Dysesthesia

A
  • numbness, tingling, burning sensation

- dysesthesia are same but more unpleasant

21
Q

Paresis

A

-dec. strength

22
Q

Plegia

A

-complete loss of strength

23
Q

Landmark Dermatomes of Arm

A
  • C3: upper neck
  • C4: lower neck and top of shoulder
  • C5: lateral side of antecubital fossa
  • C6: dorsal surface of first finger and thumb
  • C7: middle finger
  • C8: 4th and 5th fingers
  • T1: medical side of antecubital fossa
24
Q

C5 Cervical Root: motor function, sensory territory, reflex, foramen

A
  • motor function: deltoid, infraspinatus, biceps
  • sensory: shoulder, upper lateral arm
  • reflex: biceps w/ C6
  • foramen: C4-C5
25
Q

C6 Cervical Root: motor function, sensory territory, reflex, foramen

A
  • motor: wrist extenstion, biceps
  • sensory: 1 and 2 digits of hand
  • reflex: biceps, brachioradialis
  • foramen: C5-C6
26
Q

C7: motor function, sensory territory, reflex, foramen

A
  • motor: triceps
  • sensory: 3rd digit
  • reflex: triceps
  • C6-C7
27
Q

L1, L2, L3, L4, L5, S1 dermatomes

A
  • L1: Midway between the key sensory points for T12 and L2
  • L2: On the anterior medial thigh
  • L3: At the medial epicondyle of the femur
  • L4: Over the medial malleolus
  • L5: Big tow, and lateral malleolus
  • S1: On the lateral aspect of the calcaneus
28
Q

L4 Lumbosacral Root: motor function, sensory territory, reflex, foramen

A
  • motor: psoas, quads
  • sensory: knee, medial leg
  • reflex: patellar
  • foramen: L4-L5
29
Q

L5 Lumbosacral Root: motor function, sensory territory, reflex, foramen

A
  • motor: foot dorsiflexion, big toe extension, foot eversion/inversion
  • sensory: dorsum of foot, great toe
  • reflex: none
  • foramen: L5-S1
30
Q

S1 Lumbosacral Root: motor function, sensory territory, reflex, foramen

A
  • motor: foot plantar flexion
  • sensory: lat foot, small toe, sole of foot
  • reflex: achilles
  • foramen: S1-S2
31
Q

Clinical Assessment of Reflexes

A
  • 0= reflex absent
  • 2+ = normal
  • 3+ = brisk
  • 4+ = nonsustained clonus
  • 5+ = sustained clonus
32
Q

Clinical Assessment of Strength

A 
0/5= no contraction
1/5= muscle flicker, no movement
2/5= movement possible, but not against gravity
3/5= movement possible against gravity, but not resistance
4/5= movement possible against some resistance
5/5= normal strength
33
Q

Mild TBI

A
  • concussion
  • hallmarks are confusion or amnesia
  • no LOC
34
Q

Pathophysiology of Concussion

A
  • irritation leads to rapid, chaotic electrical depolarization across cortex
  • NTs are released in excessive amounts, inc. cellular metabolism and inc. lactic acid levels
  • Na/K pump failure and axonal stretch leads to Ca influx and axonal swelling
35
Q

Second Impact Syndrome

A

-catastrophic brain swelling occurring if concussion happen too near each other in time

Neuro 2 Mine (9 decks)

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