CNS3 Flashcards
Glasgow Coma Scale
Motor
Verbalization
Eye opening
Eye opening
Spontaneously – 4
To voice – 3
To pain – 2
No response – 1
Verbalization
Orientated – 5 Confused – 4 Inappropriate words – 3 Incomprehensible sounds – 2 No response – 1
Motor
Obeys – 6 Localizes – 5 Normal flexion/withdraws– 4 Abnormal flexion (decort)– 3 Extension (decerebrate) – 2 No response – 1
Concussion: Definition
immediate and transient impairment of neural function
ex: alteration of consciousness, disturbance of equilibrium, etc., due to mechanical forces
MIld GCS
13-15
MOderate TBI GCS
9-12
Sever TBI GCS
3-8
Common Early Symptoms of Concussion
HA Dizziness, lightheadedness or vertigo ↓ awareness of surroundings Muddled thinking NV
Common Late Symptoms of Concussion
Persistent HA Lightheadedness ↓ attention and concentration Poor memory Easy fatigability Irritability Anxiety or depressed mood Sleep disturbance*
Signs of Concussion
Vacant stare Delayed responses Inattention Disorientation Slurred or incoherent speech
dazed, befuddled facial expression
Vacant stare
Signs of Concussion
slow to answer questions or follow instructions
Delayed responses
Signs of Concussion
easily distracted or unable to track conversations
Inattention
Signs of Concussion
exhibited by athlete repeatedly asking a question that has already been answered or exhibiting memory deficits on mental status testing
Memory problems
Signs of Concussion
paralytic coma, unresponsiveness to stimuli
Loss of consciousness
Signs of Concussion
Damage in TBI
Regardless of the direction of the force, frontal & temporal lobes are most affected
Rotational or Translational?
Rotational (angular) forces are more damaging than Translational (linear)
MRI or CT
MRI better at picking up lessions
contrecoup contusions mechanism
Linear (translational) forces cause skull fractures and contrecoup contusions
Biomechanical forces cause: __________ through the hemisphere. Irritation leads to rapid, chaotic electrical depolarization across the cortex
tissue deformation, shearing and fluid wave propagation
Irritation leads to __________ across the cortex
rapid, chaotic electrical depolarization.
When big enough causes unconsciousness
Rotational injuries lead to:
diffuse shearing of small vessels
Diffuse axonal injury is underlying lesion
________ failure and axonal stretch injury lead to Calcium influx and axonal swelling or disintegration
Na – K pump
PET concosion
Similar metabolic derangement to what’s seen in coma
If hemorrhagic lesions are detected on neuroimaging, _______ is certain
axonal injury
Concussion Grading Scales
Grade I: Confusion Only
Grade II: Amnesia, no LOC
Grade III: LOC
Grade I
Concussion Grading Scales
Transient confusion, no LOC, abnormalities resolve in less than 15 minutes
Grade II
Concussion Grading Scales
Transient confusion, no LOC, abnormalities last greater than 15 minutes
Grade III
Concussion Grading Scales
LOC- brief or prolonged
Vascular Pathology
Autonomic dysregulation of intracranial vessels causes cerebrovascular congestion (brain swelling) and high ICP
Second Impact Syndrome
Catastrophic brain swelling occurring if concussions happen near each other in time.
Intracranial vasodilation and cerebrovascular congestion – vascular autoregulation dysfunction
