Head Trauma, Seizures, HA, Vertigo Flashcards
what population is TBIs most common in?
75+
what is the most common cause of TBI?
falls
what are the scores of eye opening on the GCS?
4 spontaneous
3 to speech
2 to pain
1 none
what are the scores of verbal response on the GCS?
5 oriented
4 confused
3 inappropriate words
2 incomprehensible words
1 none
what are the scores of best motor response on the GCS?
6 obeys
5 localizes
4 withdraws
3 abnormal flexion (decorticate)
2 abnormal extension (decerebrate)
1 none
GCS of ____ is a mild TBI
13-15
most TBI cases (TBI) are what severity?
mild
GCS of ____ is a moderate TBI
9-12
T/F: imaging can be normal in mild and moderate TBIs
T
GCS of ____ is a severe TBI
3-8
what is the coup?
primary impact on the skull
what is the countercoup?
secondary impact on the skull
where is the most common area for a brain contusion?
frontal lobe
brain contusions occur near the ____
skull
what occurs during the first phase of TBI?
direct consequences of trauma
DAI (sheared axons)
what occurs during the second phase of TBI?
begins quickly after primary
hypoxia and hypoperfusion
inflammation
what principle relates to volume of the brain, especially during swelling?
Monroe Kellie Doctrine
what is common symptom of uncal herniation?
CN 3 palsy
where is the brain injury?
pupils small and reactive
diencephalic
drugs, metabolic encephalopathy
where is the brain injury?
pupils large, fixed, hippus
pretectal
where is the brain injury?
pupil dilated, fixed
uncus or midbrain
CN III
where is the brain injury?
pupils mispositioned, fixed
midbrain
where is the brain injury?
pupils pinpoint
pons
decerebrate posturing indicates damage to the _____
brain stem
decorticate posturing indicates damage to the _______
corticospinal tract
a subdural hematoma usually follows a ____ injury
low-velocity
which hematoma is more dangerous epi or sub dural?
epidural
epidural hematomas consists of bleeding from ______, torn by a ______
meningeal artery or vein
temporal or parietal fracture
epidural hematomas have a ____-shaped clot
lens
which type of hematoma has a lucid interval?
epidural
what is the sequelae of head injury?
hydrocephalus
CSF leak
subarachnoid hemorrhage
vascular injury
infection
what are the hallmarks of a concussion?
confusion and amnesia
concussion lasts up to
post concussion syndrome lasts
concussion - 1 month
post concussion - months to years
what sport has the highest risk of concussion in boys? girls?
boys - football
girls - soccer
indications for a CT and emergency management of a concussion?
GCS <15
deteriorating mental status
potential spinal injury
progressive, worsening of sx or new neuro signs
post concussive syndrome occurs when sx last longer than
1 month
chronic traumatic encephalopathy is a spectrum of disorders associated with long term consequences of a single or REPETATIVE _____
TBIs
what is the earliest manifestation of chronic traumatic encephalopathy?
behavioral changes
motor involvement sx of chronic traumatic encephalopathy
dysarthria
spasticity
motor neuron disease
Parkinsonism
ataxia
when should you call 911 for a seizure?
if it lasts > 5 mins
what is the most common cause of a new onset seizure over 50?
stroke
epilepsy diagnostic criteria
2 or more unprovoked seizures separated in time by greater than 24 hours
OR
single seizure with high risk of another
seizure definition
episode of transient behavioral, sensory, motor, visual symptom, associated with abnormal excessive cortical activity in the brain
what is the most common cause of epilepsy worldwide?
infection
symptoms of focal onset seizure w/o loss of awareness (simple partial seizures)
begins on one side of body
DOES NOT IMPAIR CONSCIOUSNESS
motor: clonic or tonic
sensory: parastheias, visual hallucination
EEG with CONTRA focal discharge
sx of frontal lobe seizures
clusters at night
brief
early posturing
autonomic sx
large amplitude, irregular, complex mvmt
what type of seizure is most common in children?
absence seizures
T/F: Absent seizures have a loss in muscle tone
F!!
ictal EEG shows ___ discharges for generalized tonic-clonic seizures
bilateral
generalized tonic-clonic seizures have ___ muscle tone and __ movements
rigid muscle tone - tonic phase
convulsive movements - clonic
presentation of myoclonic seizures
single brief jerks
involve any or all limbs or torso
occur w/ other generalized seizures
EEG spikes and waves
atonic seizures presentation
head drop
fall backwards
most febrile seizure occur between what ages?
6mo - 3 years
sx of nonepileptic seizures
gradual onset
prolonged duration
thrashing, struggling, crying, thrust
motor activity starts and stops
B jerking with retain consciousness
T/F: it is impossible to have bilateral jerking with no LOC during an epileptic event
T
____% of epilepsy pts will have a normal initial EEG
40%
status epilepticus is generalized seizure activity last
> 5 mins
what is a major concern with anti-epileptic drugs side effects?
black box warning: suicidality
what are some common anti-epileptic drugs?
valproic acid
phenytoin
topiramate
carbamazepine
levetiracetam (most common)
what are primary headaches?
migraines
tension HA
cluster HA
secondary HA causes
brain tumor
increased ICP
meningitis
encephalitis
aneurysm
HTN
> 90% of HA are
primary
what are the red flags for HA?
SSNOOP4:
Systemic sxs
Secondary disease
Neurologic sxs
Onset - suddent, abrupt
Older - new onset after 50
Previous HA hx - different than normal
Positional
Papilledema
Precipitants - cough, Valsalva
Migraine criteria
> 5 HAs
4-72 hrs
2/4:
- throbbing, unilateral, mod-sev, worse
with activity
1/2:
- N/V, photophobia/phonophobia
what is a classic aura of a migraine?
positive scintillating scotomata with fortification spectra
what meds are given for migraines >3 days?
acute absortive
what meds are given for migraines >5 days?
prophylaxis
(take everyday)
what type of HA is worse in the AM?
analgesic rebound/withdrawal HA
tx for analgesic rebound/withdrawal HA
stop all acute meds and caffeine
start prophylaxis
cluster HA sx
severe unilateral orbital, supraorbital, or temporal pain lasting 15-180 mins
tension HA sx
bitemporal, bioccipital, or bifrontal
“tight band”
perceived as continuous months-years
what med is useful for chronic daily HAs (tension)?
tricyclics
trigeminal neuralgia in young patients may be due to _____ or _____
MS or brainstem mass
meds for trigeminal neuralgia
carbamazepine
oxcarbamazepine
what is vertigo?
sensation that you are moving, spinning
what is opscillopsia?
the sensation that the world is moving
what is the most common cause of recurrent vertigo?
Benign Paroxysmal Positional Vertigo
(BPPV)
BPPV sx
episodic vertigo lasting 10-30 sec
triggered by: tilt head, rolling over, straightening after bending
~85% of BPPV is due to involvement of the ___ canal
posterior
what is used to diagnose BPPV?
Dix-Hallpike
what is used to treat BPPV?
Epley maneuver
what is a sudden onset of prolonged vertigo that is constant, lasting days?
peripheral vestibulopathy:
viral labyrinthitis & vestibular neuritis
Meniere’s disease sx
episodic severe vertigo and vomiting
lasts minutes to hours
feeling of fullness in ear
tinnitus
hearing loss, often progressive
vertigo due to posterior fossa mass or infarction will have limb ataxia ____ to the lesion
ipsilateral
brainstem signs of vertigo
diplopia
cortical blindness
dysarthria, dysphagia
quadriparesis
tinnitus
hearing loss
how does nystagmus present in vertigo due to brainstem lesions?
long duration
not fatigable
what is the most common chronic vestibular condition?
persistent postural-perceptual dizziness
med for persistent postural-perceptual dizziness
SSRIs
what meds can be a short term treatment for vertigo?
antihistamines
