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Adams 10th ed > Craniocerebral Trauma > Flashcards

Craniocerebral Trauma Flashcards

1
Q

Among Immediately fatal head injuries, autopsy reveals an intact skull in what percent of cases?

A

20-30%

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2
Q

Mechanical factors of importance in brain injury

A

Differential mobility of head on neck
Mobility of brain within the cranium
Tethering of upper brainstem
Striking of parts of brain on dural septa and bony prominences

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3
Q

Battle sign

A

Tissue behind the ear and over the mastoid becomes boggy and discolored, from damage to sigmoid sinus

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4
Q

In basal skull fractures, cranial nerves most liable to injury

A

Olfactory
Facial
Auditory

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5
Q

Fracture of this bone may lacerate the optic nerve, resulting in blindness from the onset, unreactive pupil to direct light but with consensual light reflex

A

Sphenoid bone

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6
Q

Trochlear nerve injury

A

Diplopia worse on looking down and compensatory tilting of head

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7
Q

Match CN7 involvement with type of petrous bone fracture
1. Immediate facial palsy, requiring surgical intervention to regain function
2. Facial palsy delayed for several days, usually transitory
A. Transverse fracture
B. Longitudinal fracture

A

1A

2B

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8
Q

In concussion, what could explain immediate loss of consciousness?

A

Torque at level of of upper reticular formation

From point of tethering in the high midbrain

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9
Q

Reversible traumatic paralysis of nervous function; may last for a variable time

A

Concussion

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10
Q 
Blows to 
1. Back of head
2. Front of head
3. Side of head
Mainly cause 
A. Coup
B. Contrecoup
C. Either or Both
A

1A
2B
3C

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11
Q

Usual location of lesions seen in concussion

A

Reticular Activating System
Corpus callosum
Superior cerebellar peduncles
Dorsolateral tegmentum of the midbrain

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12
Q

Pathology of diffuse axonal injury (DAI)

A

Uneven but diffuse degeneration of the white matter

In cases of shorter survival, ballooning and interruption of axis cylinders

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13
Q

All brainstem hemorrhages when there is mass effect that distorts the brainstem

A

Duret hemorrhage

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14
Q

In a small group of patients with these characteristics, there is a significant risk of ICH or other delayed complications of trauma

A

Slow in regaining consciousness
Severe headache
Vomiting
Skull fracture

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15
Q

Presence of skull fracture in children is a relatively poor indicator of intracranial injury EXCEPT when the fracture is in the following

A

Fracture through the squamous bone
Fracture through the groove of the Middle Meningeal Artery

= Risk for arterial and epidural hemorrhage

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16
Q

New Orleans Criteria for Head CT

A

Use in pts with head trauma and LOC seen gcs15 and neurologically normal
Any 1 of the ff warrants Head CT

Headache
Vomiting
Age >60y
Drug or alcohol intoxication
Persistent anterograde amnesia (deficits in short term memory)
Evidence of soft tissue or bone injury above clavicles
Seizure

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17
Q

Canadian CT Head Rule

A

Use for pts GCS13-15 with at least one of the ff
LOC, amnesia for the event, witnessed disorientation
Exclusion: age<16y, pt on blood thinners, sz after injury

Presence of any 1 requires CT
High risk for neurosurgical intervention
1. GCS <15 within 2H after injury
2. Suspected open or depressed skull fracture
3. Any sign of basal skull fracture (racoon eyes, hemotympanum, battle sign, CSF oto/rhinorrhea)
4. 2 or more episodes of vomiting
5. Age >54y

Moderate risk of brain injury detected by CT

  1. Retrograde amnesia for >/= 30mins
  2. Dangerous mechanism (pedestrian vs vehicle, occupant ejected from vehicle, fall for >3ft or >5stairs)
18
Q

Most important factor in the expansion of subdural fluid

A

Pathologic permeability of developing capillaries in the outer pseudomembrane of the hematoma

19
Q

Drug that has through a randomized trial shown effect of slight acceleration of emergence from vegetative or minimally conscious state.
Dosing and duration?

A

Amantadine
100mg twice a day increasing to 200mg twice a day
Given for 4weeks bet the 4th and 12th weeks after injury.

20
Q

Volume of traumatic ICH found to be fatal in 9 out of 10 patients

A

> 25mL

21
Q

Indicators of poor outcome in Shaken Baby Syndrome

A

Low initial GCS
Severe retinal hemorrhages
Skull fractures

22
Q

3 Surgical problems outlined by Meirowsky in missile injuries

A
  1. prevention of infection
  2. Control of increased intracranial pressure
  3. Prevention of life-threatening systemic complications
23
Q

Seizures are the most common delayed sequelae of craniocerebral trauma. Its overall incidence in pts with closed head injuries is? In those with compound skull fracture and direct wounds of the brain?
Severe head injury (LOC or amnesia >24h, sdh, brain contusion)?
Moderate (LOC or amnesia 30min-24h, skull fx)?
Mild

A 
5%
50%
7% in 1 yr, 11.5% in 5y
0.7%, 1.6%
Not significantly greater than general population
24
Q

Early Epilepsy

A

Seizures within 1st week of injury

Associated with more frequent late seizures than immediate epilepsy

25
Q

Posttraumatic epilepsy

A

Late epilepsy

Develop several weeks or months after closed head injury (1-3mos in most cases)

26
Q

Persistent hypotension in a patient with cerebral trauma should raise suspicion of the ff:

A

Thoracic or abdominal bleeding
Extensive fractures
Trauma to cervical cord
Diabetes insipidus

27
Q

Plaques jaunes

A

Old cortical contusions

28
Q

This is considered to have an adverse effect on seizure and even in patients in whom seizures have ceased, this could precipitate recurrence

A

Alcoholism

29
Q

Syndrome of episodic vigorous extensor posturing, profuse diaphoresis, hypertension, and tachycardia lasting mins to an hour esp in pts in the vegetative state and those comatose from severe head injury

A

Autonomic Dysfunction (“Storm”) Syndrome

30
Q

Drug found most effective in the treatment of autonomic Dysfunction sydrome

A

Bromocriptine

31
Q

Factors that make permanent cognitive and personality changes more likely among pts with craniocerebral trauma

A

Lower GCS immediately after injury

Longer posttraumatic gap

32
Q

Neuropathologic pattern of chronic traumatic encephalopathy

A

Perivascular hyperphosphorylated tau protein embedded in astrocytic or neurofibrillary tangles with a predilection for depths of sulci of the frontal and temporal lobes (also in cortex, thalamus, brainstem) and eventually most extensive in the medial temporal lobes

33
Q

Strongest predictor of occurrence of postconcussion syndrome

A

Previous anxiety disorder

34
Q

Characteristic cranial pain of Postconcussion Syndrome

A

Generalized or localized pain, variable character, intensified by mental and physical effort, straining, stooping, and emotional excitement. And, relieved by rest and quiet.

35
Q

ICP monitoring is deemed appropriate if

A

GCS 3-8 with

  1. Abnormality on CT scan
    OR
  2. No abnormality on CT BUT with any 2: age>40y, posturing, SBP<90mmHg
36
Q

Duration for which ventricular catheter for ICP monitoring may be left in place

A

3-5days

May remove in fewer days if clinical state and ICP stable x 24-48hrs

37
Q 
Mechanism of Action of the ff Hyperosmolar agents:
Mannitol
Glycerol
Urea
Hyperosmolar saline
A

Mannitol, Glycerol, Urea
- produce serum hyperosmolarity > diuresis which maintains this state > 2rily causes hypernatremia and hypovolemia

Hyperosmolar saline
- raises serum sodium directly expanding intravascular volume

38
Q

Recommended boluses of Hypertonic Saline
Accdg to concentration
3%, 7.5%, 23%

A

3% - 150mL
7.5% - 75mL
23% - 30mL

39
Q

Main problem in using hypothermia

A

Rewarming induces substantial brain swelling and return of ICP to prior levels or higher

40
Q

Results of the CRASH trial

A

Effect of infusion of methylprednisolone 2g ff by 0.4g/h for 48h favored Survival in the UNTREATED patients

41
Q

Antihypertensives of choice for BP lowering in cases of craniocerebral trauma

A

Diuretics, B-Blockers, ACEi

Adams 10th ed (11 decks)

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