CNS Trauma

Question 1

Most Common/Important Event Post Severe TBI

Answer 1

Brain edema

Question 2

Edema Progression

Answer 2

Begins as cytotoxic (intracellular) and progresses to vasogenic (EC, w/in 24 hours)

Question 3

Cell Swelling

Answer 3

Astrocytes swell the most (cytotoxic), leading to breakdown of BBB (vasogenic)

Question 4

Open Head Injury

Answer 4

Penetrating injury w/ depressed/displacing skull fracture, usually w/ laceration of dura

Question 5

Treatments for Cytotoxic vs. Vasogenic

Answer 5

Osmotic agents to remove H2O vs. steroids

Question 6

Closed Head Injury

Answer 6

No fracture or only linear fracture

Question 7

Physical Mech/Anatomical Problems of Closed Head Injuries (2)

Answer 7

Higher mass of brain vs. skull so move/accelerate at different rates
Skull inside is rough and has ridges that can work like knives

Question 8

4 Types of Lesions

Answer 8

Concussion (transient loss of consciousness)
Contusion (bruise - coup and countrecoup)
Laceration (tissue torn/disrupted)
Hemorrhage

Question 9

Coup vs. Countrecoup Lesions

Answer 9

Side of blow, accelerating vs. opposite side, deccelerating

Question 10

Plaque Jaune

Answer 10

Yellow plaques - when contusions heal w/ some pigment

Question 11

Diffuse Axonal Injury (DAI)

Answer 11

Very severe brain injury from very violent episodes like car wrecks

Question 12

3 Signs of DAI (1 gross, 2 histological)

Answer 12

Contusion on corpus callosum. Cortex might look fine
Spheroids on silver stain
Amyloid Precursor Prot (APP), like AD

Question 13

Chronic Lesion DAI

Answer 13

Coma

Question 14

Subdural Hematoma

Answer 14

From bridging veins on cortex initially, then granulation tissue encapsulates and its small veins can leak intermittently causing same effect as tumor. Between dura and arachnoid

Question 15

4 People at Risk for Subdural Hematomas

Answer 15

Elderly
Alcoholics
Epileptics
Pts on Anticoagulants

Question 16

5 Long Term Complications of TBI/CTE

Answer 16

Epilepsy, ALS, parkinsonism, deposition of tau/TDP-43, dementia pugilistica (punch-drunk)

Question 17

Most Common Spinal Cord Injury Location (SCI)

Answer 17

Cervical, bc most flexible

Question 18

3 Features of Human SCI

Answer 18

Spinal Shock - like its form of concussion, temporary paralysis
Lesions often small/multiple
Rare to find complete transections - hope for regen someday

Question 19

Big Complicating Factor of SCI

Answer 19

Almost always have laceration of dura which has shitload of fibroplasts -> connective tissue scarring which is disastrous and impossible to regen from