Head Trauma

Question 1

Coup

Answer 1

Injury to brain in area of original impact.

Question 2

Contracoup

Answer 2

Injury to brain on opposite side of original impact.

Question 3

1’ brain injury

Answer 3

Immediate damage to brain tissue due to an injury force.

Question 4

2’ brain injury

Answer 4

Injury resulting from hypoxia or decreased perfusion of brain tissue after 1’ brain injury

Question 5

ICP

Answer 5

Pressure of brain and contents within skull.

Question 6

Cerebral perfusion pressure (CPP)

Answer 6

= MAP - ICP

Question 7

Mean arterial pressure

Answer 7

= dBP + ⅓(sBP - dBP)

Question 8

Cushing’s refex

Answer 8

Reflex whereby the body reacts to increased intracerebral pressure by raising the BP.

Question 9

Cerebral herniation syndrome

Answer 9

Critical syndrome in which swelling of the brain forces portions of the brain tissue down through the opening at the base of the skull squeezing the brain stem and causing coma, dilatation of pupils, contralateral paralysis or decerebrate posturing (arms and legs extended), elevated BP, bradycardia. Outward downward deviation of eye.

Question 10

Clinical signs of cerebral herniation:

Answer 10

TBI with GCS

Question 11

Brain injuries:

Answer 11

1. Intracranial hemorrhage:
   
   • acute epidural hematoma
   • acute subdural hematoma
   • intracerebral hemorrhage
2. Anoxic brain injury
3. Diffuse axonal injury
4. Subarachnoid hemorrhage
5. Cerebral contusion
6. Concussion

Question 12

Concussion:

Answer 12

No structural injury to brain that can be demonstrated by current imaging techniques. Sometimes loss of consciousness. Retrograde short-term amnesia. Dizziness, headache, ringing in ears, and/or nausea.

Question 13

Cerebral contusion:

Answer 13

Prolonging unconsciousness or serious alteration in LOC (profound confusion, persistent amnesia, abnormal behavior). May have rapid and severe brain swelling. Focal neurological signs.

Question 14

Subarachnoid hemorrhage:

Answer 14

Blood in subarachnoid space. This causes irritation resulting in intravascular fluid leaking into brain causing more edema. Severe headache, coma, vomiting from irritation are common. May result in cerebral herniation.

Question 15

Diffuse axonal injury:

Answer 15

Most common as result of severe blunt head trauma.
Diffuse injury causing generalized edema.
Unconscious with no focal motor deficits.

Question 16

Anoxic brain injury:

Answer 16

Lack of oxygen to brain affect brain in serious fashion. Anoxic episode perfusion to cortex interrupted because of spasm that develops in small cerebral arteries. After 4 - 6min of anoxia restoring oxygenation and BP will not restore perfusion of cortex (no-reflow phenomenon), and there will be continuing anoxic injury to brain cells.

Question 17

Acute epidural hematoma

Answer 17

Tear in middle meningeal artery running along inside of skull in temporal region.

Sx:

• hx of head trauma with LOC followed by lucid interval.
• sx of increasing ICP (vomiting, headache, altered mental status).
• lapse into unconsciousness.
• paralysis on opposite side.
• fixed and dilated pupil on injured side.

Question 18

Acute subdural hematoma

Answer 18

Bleeding between arachnoid and dura.

Sx:

• headache.
• fluctuations in LOC
• focal neurological sx.

Question 19

Intracerebral hemorrhage

Answer 19

Blunt/penetrating injuries