Head injuries, brain trauma, stroke

Question 1

primary and secondary headaches

Answer 1

primary - first start between 20 and 40 years old including migraines and tension headaches
secondary - caused by problems elsewhere in the head or neck e.g. meds, meningitis, tumour

Question 2

neuro emergencies can effect CBF because of:

Answer 2

structural changes or damage
circulatory changes
alteration in ICP

Question 3

CPP =

Answer 3

MAP - ICP

Question 4

MAP =

Answer 4

SBP + (2 x DBP)

over 3

Question 5

Abnormal CPP

Answer 5

lower than 30mmHg

Question 6

raised ICP

Answer 6

greater than 20mmHg

Question 7

glucose metabolism

Answer 7

glucose is broken down through glycolysis to produce pyruvic arid which is broken down to produce ATP, H2o and Co2

Question 8

categories of brain injury

Answer 8

mild diffuse injury
moderate diffuse injury
diffuse axonal injury
focal injury

Question 9

RAS

Answer 9

a network of nerve fibers in the thalamus, hypothalamus, brain stem and cerebral cortex
essential for wakefulness, attention, concentration and introspection - GCS

Question 10

signs and symptoms of concussion

Answer 10

vomiting
combativeness
transient visual disturbances 
defect in equilibrium and coordination 
changes in BP, HR and resps (rare)

Question 11

moderate diffuse injury

Answer 11

results in small petechial bruising of brain tissue

involves the brain stem and RAS leading to unconsciousness

Question 12

diffuse axonal injury

Answer 12

results from movemennt of the brain within the skull secondary to acceleration or decceleration forces

Question 13

focal injury

Answer 13

lesions that result from skull fracture, contusion, oedema with increased ICP, ischaemic, haemorrhage, penetrating injury y

Question 14

cerebral ischaemia can result from

Answer 14

vascular injuries
secondary vascular spasm
increased ICP

Question 15

types of haemorrahge

Answer 15

epidural.extradural
subdural
subarachnoid
intracerebral haematoma

Question 16

Epidural haematoma

Answer 16

blood between the cranium and dura in the epidural space

Question 17

subdural haematoma

Answer 17

blood between the dura and the surface of the brain in the subdural space

Question 18

subarachnoid haemaorrhage

Answer 18

bleeding into the CSF

meningeal irritation

Question 19

intracerebral haemorrhage

Answer 19

blood of more than 5ml somewhere within the substance of the brain

Question 20

signs of severe brain trauma

Answer 20

abnormal posturing - flexor spasms, extensor spasms, flaccidity
pupillary changes
relaxation of the sphincter tone of the bowels and bladder
altered resps

Question 21

Cushing’s triad

Answer 21

increased SBP and widened pulse pressure
bradycardia
irregular or abnormal resps

Question 22

5th and 7th nerves

Answer 22

5th trigeminal - sensory innervation to the skin of the face
7th facial - innervates muscles of facial expression and supplies the anterior 2/3 of the tongue with taste fibers

Question 23

le forte 1 fractures

Answer 23

horizontal fractures crossing the lateral wall of the maxillary sinus up to the level of the nasal sinnus

Question 24

le forte II fractures

Answer 24

include the bony nasal skeleton and the middle third of the face including the medial orbits

Question 25

le forte III fractures

Answer 25

craniofacial dislocation involving all bones of the face and creating a mobile mid face

Question 26

signs of le forte fractures

Answer 26

``` mid facial oedema unstable maxilla lengthening of the face epistaxis numb upper teeth nasal flattening nasal CSF leakage ```

Question 27

acute treatment of ischaemic stroke

Answer 27

thrombolytics - tPA anticoagulants - warfarin, heparin antiplatelet - aspirin osmotic agents - mannitol