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Clin Med- Neuro > Concussion/Brain injury Lecture > Flashcards

Concussion/Brain injury Lecture Flashcards

1
Q

What is the max score on the Glasgow Coma scale?
Minimum score?

A

Max= 15 pts

Min= 3 pts

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2
Q

A 15 point scale used to rate mental status and function

Used to rate severity of brain injury and to predict outcome

A

Glasgow Coma Scale

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3
Q

A score of under 9 on the Glasgow Coma Scale (GCS) indicates what severity of TBI?

A

Severe!

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4
Q

A score of 9-12 on the GCS indicates what severity of TBI?

A

Moderate

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5
Q

A score of 13-15 on the GCS indicates a TBI of what severity?

A

Mild

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6
Q

What 3 things are the Glasgow coma based on?

A
  1. Eye opening
  2. Verbal response
  3. Motor response
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7
Q

When should you do the Glasgow Coma Scale?

A

Do right at triage for a potential trauma pt

continuously repeat during evaluation

*** A DECEASE IN SCORE IS A VERY BAD SIGN

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8
Q

How many possible points are each section of the GCS worth?

(eye opening, verbal response, motor response)

A

Eye opening: 4 possible points

Verbal response: 5 possible points

Motor response: 6 possible points

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9
Q

How many points do the following findings receive?

A. Eyes open to speech
B. Eyes open spontaneously
C. Eye open to pain
D. Eyes do not open

A

Eyes open spontaneously= 4 points
Eyes open to speech= 3 points
Eyes open to pain= 2 points
Eyes do not open= 1 point

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10
Q

How many points do the following findings receive?

A. Incomprehensible sounds
B. Oriented, coherent and appropriate speech
C. No verbal response
D. Confused words..coherent but disoriented
E. Inappropriate words

A

Oriented, coherent and appropriate speech… 5 points
Confused, coherent but disoriented speech…4 points
Inappropriate words… 3 points
Incomprehensible sounds… 2 points
No verbal response…1 point

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11
Q

How many points do the following findings receive?

A. Can localize pain
B. Flexion/withdrawal from pain
C. Obeys commands
D. Abnormal flexion (decorticate)
D. Extension to pain (decerebrate)
E. No motor response

A

Obeys commands… 6 points
Can localize pain… 5 points
Flexion/withdrawl from pain… 4 points
Decorticate.. 3 points
Decerebrate.. 2 points
No motor response… 1 point

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12
Q

Abnormal flexion seen with brain injury

A

Decorticate

(flexion, towards the core)

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13
Q

Extension posturing seen with brain injury

A

Decerebrate

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14
Q

3 types of tissue deformation that can occur in primary injury?

A
  1. compresion
  2. tensile (stretching)
  3. shear (distortion when tissue slides over tissue)
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15
Q

Do you always get brain injuries with skull fractures, lacerations and hematomas?

A

NO..but must be suspicious of and must R/O!

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16
Q

Battle’s sign
Raccoon Eyes
CSH rhinorrhea or otorrhea
Hemotympanum

signs of?

A

Basilar skull fracture

17
Q

Blood pooling behind ear

A

Battle’s sign

18
Q

Pt with a mild TBI and any of the following…..

*GCS under 15, 2 hours after injury
*suspected skull fx
*any signs of basilar skull fx
*2+ episode of vomitting
*65+ yo
*amnesia before impact of 30+ mins
*dangerous MOI

what should you do?

A

Get a non contrast CT scan!

19
Q

Complex pathophysiological process affecting brain
Induced by traumatic biomechanical forces

*may be caused by direct blow to head, face, neck or elsewhere with an impulsive force transmitted to the head

may or may not have LOC
rapid onset of short lived impairments that resolve spontaneously

A

Concussion

20
Q

Vacant stare
Delayed verbal expression
Inability to focus
Disorientation
Slurred/incoherent speech
Gross observable incoordination
Inappropriate emotions
Memory deficits
Any LOC

A

Signs of concussion

*may evolve over mins to hours

21
Q

Diffuse cerebral swelling that can increase ICP
rare but fatal!

*must be careful athletes do not return to play too quickly!

A

Second impact syndrome

22
Q

Which concussion grade…

*LOC for less than 1 minute
OR
*post traumatic amnesia or other symptoms for 30+ mins, but less than 24 hours

A

Grade 2

athletes can return to play in 2 weeks asymp at rest and on exertion for 7 days

23
Q

What concussion grade…

No LOC
Post traumatic amnesia or other signs lasting less than 30 mins

A

Grade 1

athlete may return to play if asymptomatic for 1 week

24
Q

What concussion grade…

*LOC for greater than 1 minute
OR
*Post traumatic amnesia or other symptoms last for 24+ hours ​

A

Grade 3

athletes can return in 1 month if asymptomatic at rest and on exertion for 7 days

25
Q

When can athletes return to play for grade 1, 2, and 3 concussions?

A

Grade 1: return to play if asymptomatic for 1 week

Grade 2: return to play in 2 weeks asymp at rest and on exertion for 7 days

Grade 3: return to play in 1 month asymp at rest and on exertion for 7 days

26
Q

What is the difference bteween early post traumatic seizures and post traumatic epilepsy?

A

Early post traumatic seizures: within first week after injury

Post traumatic epilepsy: within 5 years of a traumatic event
(50% in first year, 80% in first two years)

(25% occur within first hour, 50% within first 24 hours)

27
Q

Vertigo
Anosmia or hyposmia (no or decreased ability to smell)
Diplopia
Trigeminal/occipital neuralgia

A

Potential post-traumatic complications

28
Q

Can occur even after mild TBIs (30-80% of time)
Occurs days to weeks after initial concussion

sxs: HA, dizziness, vertigo, memory problems, difficulty concentrating, sleep problems, restlessness, irritability, apathy, depression or anxiety

*can last for weeks
*more common in those with pre-existing psych disorders

A

Post-concussion syndrome

29
Q

Dementia pugilistica
Chronic traumatic encephalopathy
Cerebral atrophy
Plaques, neurofibrillary tangles, tau proteins (similar to Alzheimer’s)

A

Cognitive defects from repeated TBIs

30
Q

LOC, amnesia, confusion lasting seconds to minutes after a blunt trauma to head

A

Concussion

31
Q

HA unlike anything before
LOC
Will often wake up with confusion and irritability

A

Subarachnoid hemorrhage (SAH)

32
Q
  • *Decreased** glucose
  • *Increased** protein, and increased opening pressure
A

Bacterial meningitis

Clin Med- Neuro (10 decks)

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