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Medicine II: Neurology > Head and Spinal Cord Injury > Flashcards

Head and Spinal Cord Injury Flashcards

1
Q

How many deaths per year via TBI?

A

52,000

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2
Q

What percent has long lasting symptoms after TBI?

A

10%

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3
Q

What are the basic mechanisms of brain injury?

A

primary (localized at impact site, rotational forces, axonal shearing)
secondary (hypotension, hypoxia, anemia, sepsis)

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4
Q

What are secondary causes of TBI? HASH

A

hypotension
hypoxia
anemia
sepsis

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5
Q

concussion-

A

reversible traumatic paralysis of nervous function, immediate effect. Caused by sudden change in movement of head

diffuse axonal injury caused by shearing motion

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6
Q

What is the mechanism of a concussion?

A

rotational motion of the cerebral hemispheres in the anterior posterior plane, around the fulcrum of the fixed-in-place upper brain stem.

maximal rotational forces exerted around the midbrain and diencephalic region

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7
Q

What are the clinical manifestations of a concussion?

A 
immediate loss of consciousness
supressed reflexed
fall in BP
transient arrest of respiration
convulsive activity
retrograde amnesia or anterograde amnesia
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8
Q

Management of concussion:

A 
ABC's
Imaging recommended in 60
drunk
bleeding tendencies
headache and vomiting
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9
Q

What are the grades of concussions in athletics?

A

1- no loss of consciousness, transient confusion, resolution 15 min
3- loss of consciousness

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10
Q

Post concussion syndrome:

A

interval between head trauma w/ loss of consciousness and development of symptoms, <4 weeks

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11
Q

contusions:

A

heterogenous lesions consisting of areas of punctate hemorrhage, edema and necrosis

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12
Q

coup lesion-

A

contusions of the surface of the brain beneath the point of impact

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13
Q

contrecoup lesions-

A

contusions on the opposite side of impact

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14
Q

cooup/contrecoup lesions-

A

frontal and temporal poles

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15
Q

Types of intracranial hematomas?

A

epidural

subdural

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16
Q

Epidural hematoma:

A

temporal parietal fracture, laceration of the middle meningeal artery or vein, bleeding into epidural space, lens shaped

hematoma on side of trauma
“lucid moment”

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17
Q

Subdural hematoma:

A

tearing of the bridging vein, blood in subdural space
a/w atrophy, coagulopathy, CSF shunts
typically extended over most of cerebral convexity
acute or chronic

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18
Q

Acute SDH:

A

in combination with epidural hemorrhage or contussion
tearing of bridging vein
evolution over many hours
drowsiness, coma; pupillary dilation w/ contralateral weakness then bilateral limb wakness; progressive stupor then coma

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19
Q

Chronic SDH:

A

minor trauma, a/w coagulopathy and brain atrophy
usually in elderly
evolution over days to weeks
headache, progressive alteration in behavior +/- neurological symptoms

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20
Q

Itraparenchymal hematoma:

A

after severe head injury
location: frontal temporal
evolution over 12-48 hours
stupor- coma, dilated pupil, progressive hemiplegia

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21
Q

Risk factors for intraparencymal hemorrhage:

A

coagulopathy

amyloid vasculopathy

22
Q

types of brain herniation:

A

subfalicine
uncal
tonsillar

23
Q

subfalicine herniation-

A

side to side
ACA compression, contralateral leg paresis
somnolence

24
Q

uncal herniation-

A 
side to bottom
TRANSTENTORIAL
aniscoma to "blown pupil"
Midbrain and PCA compression
Somnolence, contralateral hemiparesis, occipital infarct
decrebrate posturing (extensor)
25
Q

Tonsillar herniation-

A 
bottom through the "hole"
somnolence
quadriparesis
cardiac arrythmias
respiratory failure
26
Q

Neuro exam of pupils

A 
tectal- large fixed
pons- pin point
midbrain- midpositioned, fixed
metabolic- small reactive
diencephalic- small reactive
III nerve palsy- one is dilated
27
Q

Decerebrate posture:

A

bilateral extensor posture at elbows and wrists
bilateral or pontine lesions
bilateral supratnetorial lesions involving motor pathways
deep metabolic encephalopathies
omnious sign

28
Q

Decorticate posture:

A

bilateral flexion posture elbows and wrists

rostral to brainstem, superior

29
Q

Glasqow coma scale:

A

looks at eyes open, verbal response, and motor response

<8- severe
9-12- moderate
13-15- mild

30
Q

Late complications of severe head injury:

A

seizures, greatest in patients w/ severe head injury
residual neurological deficit (CN injury I, IV, VII, VII)
CSF fistulas
CNS infections
Post traumatic cognitive and psychiatric disorders

31
Q

Mechanisms of SCI:

A

primary: mechanical injury, followed by petechiae, necrosis and vasogenic edema
secondary: ischemia, ionic derangements, inflammation, NT accumulation

32
Q

Spinal Shock:

A

lasts less than 24 hrs, can be 2 weeks

areflexia
loss of sensation
flaccid paralysis below lesion
flaccid bladder with retention of urine
lax anal sphincter
brady cardia and hypotension - neurogenic shock
33
Q

Anterior cord syndrome

A 
back and neck pain
bilateral paresis or paralysis (UMN pattern)
flaccid paraplegia/quadriplegia
loss of pain and temp sensation
urine and bowl incontinence
34
Q

Central cord Syndrome:

A

mid to lower cervical cord hyper extension injury
decreased pain/temp sensation and muscle weakness in upper extremities bilaterallt
in patients with cervical spondylosis
Arm> leg weakness
lower extremity function recovery > upper

35
Q

Brown sequar syndrome

A

common result from a gun shot or stab wound (injury to 1/2 of spinal cord)

loss of pain and temp contralateral
UMN signs
loss of kinethesia and discriminative touch (ispilateral)

36
Q

Conus Medullaris

A

lesion in the sacral portion of the spinal cord

37
Q

Cauda Equina

A

severe injuries below L2 level of spine can injure lumbar, sacral and coccygeal nerve roots.
decreased sensation over buttocks and perineal region, bilateral leg pain and weakness, bowel and bladder sydfunction.

horse tail lesion in multiple nerve roots

38
Q

What are cuases oc conus medullaris and cauda equina?

A

central disc herniation, epidural meds, schwannoma, meningioma, trauma, epidural abscess, arachnoiditis and CMV polyradiculitis

39
Q

Spinal cord lesiosn:

A

transverse- lower extremities
hemicord- one leg motor loss and other leg pain and temp loss
central cord (small)- lateral arm pain and temp loss
central cord (large)- motor loss from neck down - genitals
posterior cord- vibration and position loss from neck down
anterior cord- motor loss from neck down

40
Q

Tx of SCI:

A

Stabiliation of the spine
methylprednisone
DVT prophylaxis

41
Q

Myelitis

A

infectious

tx with surgery, rehab, DVT

42
Q

What is the most common cause of death in young people?

A

trauma

43
Q

What provides and indication of the severity of the injury?

A

amnesia and mental status

44
Q

Clinical signs of basillar skull fracture:

A

bruising of orbit (raccoon sign), blood in the external auditory meatus (battle sign) and leakage of CSF from ear or nose

CN palsies may also occur

45
Q

tx of basillar skull fracture symptoms:

A

acetazolamide

46
Q

What happens as spacticity increases following a SCI?

A

flexor or extensor spasms or both, of legs become troublesome, especially if pt develops bed sores or UTI. Paraplegia with the legs in flexion or extension may eventually result.

47
Q

unilateral cord lesion leads to an ipsilateral motor disturbance with accomanying impairment of proprioception and contralateral loss of pain and temperature appreciation below lesion

A

Brown sequard syndrome

48
Q

What is the tx for a cord compression?

A

immobilization and early decompressive laminectomy and fusion (w/in 24 hrs) and early tx with corticosteroids - methylprednisone may improve neurological recovery

49
Q

What patients arre at a particular risk of spinal cord trauma?

A

pts with rheumatoid arthritis, down syndrome or any acquired or congenital neck abnormality

these are associated with atlantoaxial (C1-C2) instability

50
Q

Incomplete spinal cord lesions:

A

intact sensation in the perianal region, intact anal sphincter tone, or slight flexor toe movement

51
Q

What heralds the recovery of spinal shock?

A

return of the bulbocavernosus reflex

52
Q

What is the most common mechanism of central cord syndrome?

A

hyperextension injury to the neck

Medicine II: Neurology (12 decks)

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