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OMS - 2 Neuro Final > Head Trauma > Flashcards

Head Trauma Flashcards

1
Q

Physical exam for a patient presenting with head trauma would include ______

A

examination of the nose, scalp & cranium

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2
Q

When examining the nose, scalp and cranium of a patient who presents with head trauma, you are looking for _______ (3)

A
  1. lacerations
  2. hematoma
  3. deformity
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3
Q

What are the A-B-C-Ds in trauma?

A
  • Airway
  • Breathing
  • Circulation
  • Disability (GCS)
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4
Q

What are the GCS scores that correlate with a severe TBI? Moderate? Mild?

A
  • 3-8
  • 9-13
  • 14-15
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5
Q

4 Limitations of GCS

A
  1. confounded by drugs, alcohol
  2. intended to measure deterioration overtime, not a snapshot
  3. does not distinguish between different injuries
  4. measures behavior, not underlying pathophysiology
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6
Q

Types of brain herniation (4)

A
  1. uncal transtentorial (MC)
  2. central transtentorial
  3. upward transtentorial
  4. cerebellotonsillarr
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7
Q

Sx/s of increrased cranial pressure (8)

A
  1. severe headache
  2. vision change
  3. numbness
  4. focal weakness
  5. AMS
  6. hypertension
  7. bradycardia
  8. agonal breathing
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8
Q

What would you suspect in a patient who presents with ipsilateral fixed & dilated pupil?

A

uncal herniattion (unopposed sympathetic tone)

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9
Q

Which herniation syndrome can lead to sudden death?

A

cerebellotonsillar

(also demonstrates pinpoint pupils & flaccid paralysis)

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10
Q

Which herniation syndrome presents with myosis, conjugate downward gaze & absence of vertical eye movement?

A

upward transtentorial

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11
Q

Which herniation syndrome presents with bilateral myosis, b/l babinski sign and increased muscle tone?

A

central transtentorial

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12
Q

What 4 signs would you expect in a patient who has an impending herniation?

A
  1. motor posturing
  2. hemiparesis
  3. progressive neuro deterioration
  4. pupil changes
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13
Q

categories of skull fx (3)

A
  1. location (basilar)
  2. open/closed
  3. pattern (compression/linear)
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14
Q

complications of skull fx (5)

A
  1. dural lacerations
  2. infection
  3. hearing loss
  4. vertigo
  5. CN dysfunction
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15
Q

What makes a basilar fx unique?

A
  1. does not have localizing sx
  2. causes battle sign and/or raccoon eyes
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16
Q

What must you AVOID if a cribriform plate fx is suspected

A

placing an NG tube

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17
Q

How do you manage skull fx (4)

A
  1. CT
  2. admit
  3. abx
  4. surgery (neuro or otolaryngologist consult)
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18
Q

What is the difference in the causes of brain contusion vs. diffuse axonal injury (concussion)?

A
  • contusion is due to an impact & acceleration/deceleration
  • concussion is due to a shearing of axons
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19
Q

Appearance of diffuse axonal injury on CT

A

blurring of the white and gray matter

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20
Q

____ is the most important cause of persistent disability after brain injury

A

diffuse axonal injury

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21
Q

Cerebral contusions are often associated with ________.

A

subarachnoid hemorrhage

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22
Q

contusions of the temporal lobe often present with ______ (2)

A
  1. aggression
  2. delirium
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23
Q

When do you order serial CTs?

A

brain contusion with mental mental status change & coagulopathy

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24
Q

Traumatic subarachnoid hemorrhage is due to disruption of the ______ and ______.

A
  • parenchyma
  • subarachnoid vessels
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25
Q

subarachnoid hemorrhage may lead to ______

A

increase ICP → blocking CSF outflow from 3rd & 4th ventricles

26
Q

Subarachnoid hemorrhage sx (3)

A
  1. blood in CSF
  2. photophobia
  3. meningeal signs
27
Q

_________ is the most common CT abnormality in TBI patients (moderate-severe)

A

subarachnoid hemorrhage

28
Q

Best time to image for SAH?

A

8 hours post-injury (otherwise you may miss it)

29
Q

IF you suspect SAH and they develop an altered level of consciousness or neuro findings, ________.

A

monitor via ICP in critical care setting

30
Q

Epideral hematoma is located _______-

A

between the skull and dura mater

31
Q

epideral hematoma is caused by ______.

A

blunt force to the side of the head

(middle meningeal artery)

32
Q

_________ usually have a lucid period before deterioration

A

epidural hematoma

33
Q

Epidural hematomas are ______ -shaped on CT ; subdural hematomas are ______- shaped.

A
  • biconvex (football shaped) mass in temporal region
  • crescent (cross suture lines)
34
Q

Epidural hematomas typically do NOT have underlying brain parenchyma injury, but typically the injury leads to ________.

A

brain herniation

(w/in hours due to rapid expansion; if evacuation occurs before neuro deficits → good outcome)

35
Q
A

epidural hematoma w/mass effect (slight midline shift)

36
Q

Subdural hematoma forms ______ (location)

A

between the dura mater and arachnoid

(venous origin)

37
Q

Subdural hematomas usually occur via ________

A

acceleration-decceleration injury → tearing of bringing dural veins

38
Q

Structure damaged with subdural hematoma

A

bridging veins

(mostly patients w/underlying parenchymal damage)

39
Q

Benign falls can cause ______ in elderly and children < 2 y.o.

A

subdural hematoma

(no recollection of injury)

40
Q

subacute subdural hematomas are _______ on CT; chronic are ______ on CT.

A
  • isodense (difficult to ID)
  • hypodense (dark)
41
Q

_______ (acute/subacute) subdural hematomas more likely require surgical repair

A

acute

(all require neurosurgery eval)

42
Q
A

subdural hematoma R fronto temporal

43
Q

Penetrating trauma > 8 GCS and reactive pupils mortality?

< 5 GCS mortality?

A
  • 25%
  • 100%

(as bullet passes through brain can create cavity 3-4 x larger than diameter)

44
Q

Penetrating trauma to the brain treatment (3)

A
  1. intubate
  2. abx (vancomycin or ceftriaxone)
  3. surgery
45
Q

Mild traumatic brain injury (mTBI) s/sx (9)

A
  1. N/V
  2. balance issues
  3. dizzy
  4. diplopia
  5. photophobia
  6. phonophobia
  7. confusion
  8. behavior changes
  9. sleep difficulty
46
Q

mTBI w/amnesia indicates

A

more serious injury

47
Q

What is included in the concussion specific neuro exam (5)?

A
  1. awareness/alertness
  2. cognition
  3. C-spine
  4. oculomotor
  5. balance
48
Q

mTBI leading to significant brain injury are evident by ______ (amt of time).

A

4 hours

49
Q

mTBI home instructions (3)

A
  1. avoid reading, texting, tv
  2. monitored by friend/family 24 hrs
  3. return if: HA, AMS, N/V
50
Q

most mTBI symptoms resolve w/in _____ (time frame)

A

7-10 days

51
Q

mTBI should be referred to ______ (2) if symptoms persist

A
  1. neuro
  2. sports med

(specialist in head injuries)

52
Q

Postconcussive syndrome is when _____ becomes chronic.

A

symptoms of mTBI

53
Q

post-concussion syndrome should be referred to _______.

A
  1. neuropsych
  2. mTBI clinic
54
Q

_____ (#) recurrent concussions pose a risk for long-term sequale.

A

3 or more

55
Q

Second impact before the brain has healed leads to loss of _______ → ______→ _______.

A

auto-regulation → ion imbalance → rapid cerebral edema

56
Q

Signs of intracranial HTN on CT (3)

A
  1. compressed lateral ventricles
  2. attenuation of the sulci & gyri
  3. poor white/gray matter distinction
57
Q

Indication for poor outcomes of TBI in the Er (4)

A
  1. SBP <90 mmHg
  2. PaO2 < 60 mmHg
  3. fever
  4. hyperglycemia
58
Q

patients in the ER w/GCS<8 require

A

intubation

59
Q

CPP = ______ - ______

A

MAP - ICP

(cerebral perfusion pressure)

60
Q

_______ (2) can lower ICP

A

mannitol & hypertonic saline

OMS - 2 Neuro Final (36 decks)

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