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Pharma 2 > Lecture 2: Brain Injury > Flashcards

Lecture 2: Brain Injury Flashcards

1
Q

Brain damage caused by events AFTER birth (not congenital or genetic)

A

Aquired brain injury

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2
Q

An anoxic brain injury is what?
* Is it genetic or aquired?

A

Anoxic brain injury - happens when the brain is deperived of oxygen
* Think something like cardiac arrest, stroke, tumor, infection all causing some kind of brain injury

Its Aquired

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3
Q

Alteration in brain function caused by an external force

A

Traumatic Brain Injury
* Evidence of brain pathology caused by an external force (think blunt force)

Multiple systems involved, leads to secondary impairment. Think getting a lascerantion the impacts the integumentary system as well as the brain

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4
Q

Example of a Mild Traumatic Brain injury

A

Concusion
* Common: atheletes - incidence highest in female atheletes

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5
Q

Motor vehicle releated accidents often lead to what kind of TBI?

A

Moderate/Severe

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6
Q

What scale is commonly utilized w/ traumatic brain injury?

A

Glasgow coma scale

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6
Q

What are the 2 leading causes of brain injury associated hospitilizations?

A

1) Falls (ederly) - most at risk greater than 75 years old
2) Motor vehicle releated incidents

NOTE: Individuals who survive TBI often experience persistent morbidity, with reduced participation and productivity driving the need for ongoing supports for them and their familys

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7
Q

Penetrating break in the skull is open or closed TBI?
* What are breached?
* What is exposed
* Is it focal or diffuse?

A

Open

Meninges are breached

Brain exposed

Focal injury (we can pinpoint it)
* Focal = releating to center or point of interest

NOTE: This can lead to vascular injury

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7
Q

Non-penetrating, no skull fracture or laceration on brain
* Open or closed
* What often causes this?
* Is it focal or diffuse?

A

Closed

Coup/Countercoup
* This is that sloshing of brain back and forth
* Often happens in MVA

Can be both focal and diffuse

KNOW: Subarachnoid and subdural hemorrhage can occur w/ diffuse injury

Coup/Contercoup

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8
Q

Primary TBI (this is the first thing that happens)

1) Brain tissue contacts an object - typically open injury
* Penetrating injury
* Leads to: contusions, lacerations, hematomas

2) Rapid acceleration/deceleration - typically closed injury
* Shear, tensile and compression forces
* Diffuse axonal injury (DAI), tissue tearing, hemorrhages

This can all trigger a metabolic cascade

NOTE: Primary traumatic brain injury occurs at the movent of impact and is the direct result of an external force aplpied to the head.

Secondary = Physiological and biochemical changes that occur after the inital injury. This can include swelling, increased intracranial pressure, and inflammation, which may lead to further damage to cels over time.

A
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8
Q

Diffuse axonal injury, tissue tearing, hemorrhages typically happen w/ open or closed TBIs?

A

Closed
* do to that coup/counter coup

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8
Q

Cell death due to secondary effects of hypoxia and hypotension, ischemia, edema and elevated intracrainial pressure changes

A

Secondary injury

Happens after some primary TBI

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9
Q

Blast injury is made up of a primary, secondary, and tertiary response. Explain what each is for this varient of brain injury

A

1) Primary: Direct effect of overpressure from blast
2) Secondary: Shrpnel contracting person
3) Tertiary: person thrown backwards

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10
Q

Moving of that intracrainal pressure is going to create a herniation somewhere (the brain needs to go somewhere when pressures change)
* often downwards herniation through foramen magnum
* can also affect arteries supplying cerebrum

A
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11
Q

Which of the following causes a primary injury releated to TBI
* Cell death due to hypoxia
* Brain tissue contacting an object
* Formation of a gematoma
* Diffuse axonal injury

A

Brain tissue contacting an object

NOTE: If its a closed injury that axonal injury happens after that coup countercoup (brain is sheared back and forth)

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12
Q

What space is between the skull and the dura matter?

A

Epidural space

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13
Q

What space is between the skull and the brain?

A

Subdural

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14
Q

Space within the skull

A

Intracerebral space

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15
Q

What is a contusion?

A

Bruise in the brain

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16
Q

What is a Hematoma?
* What are the three kinds?

A

Pooled blood outside a blood vessel

1) Intracerebral
2) Epidural
3) Subdural

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17
Q

What is a hemorrhage
* Our 3 kinds

A

active bleeding / burst vessel
* can be intracerebral
* Subdural
* Subarachnoid

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18
Q

KNOW: Vascular injury can lead to ischemia/infraction/stroke

Vascular injury can lead to changes in intracrainal pressure
* Brain can be displaced
* Intracrainial pressure increased (because the brain is pushed more over to one side)

A
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19
Q
A
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20
Q

Hypotension is #
* What can this often cause?

A

Systolic BP less than 90 mmHg occuring between injury aand resuscitation can occur

Can often cause hypoxia

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21
Q
A
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22
Q

What can occur because of blockages resulting in decreased blood in the brain, by decreased oxygen in the blood due to concomitant pulmonary insult, or by internal bleeding or extremity injures that cause excessive blood loss?

A

Hypoxia

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23
Q

KNOW: Hypoxia often comes secondary to something else
* Think, an external injury causes you to lose blood = hypotension = hypoxia (not getting enough BF = not enough O2)

A
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24
Q

Injuries that result in hypoxia do what to mortality rate?
* What does it do to morbidity?
* Is early hypotension good or bed?

A

doubles mortality rate

Significant increase in morbidity (having a desease or symptom of a disease)

KNOW: early hypotension is also a strong predictor of poor outcomes

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25
Q

Intracranial hypertension increases or decreases intracranial pressure

A

Increases (duh)

KNOW: Intracranial pressures elevates after injury

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26
Q

What monitors intracranial pressure?
* How does it work

A

Intracranial pressure monitored via ventricular catheter
* Allows some CSF to drain to reduce ICP
* NOTE: ICP is typically incraesed following an injury (makes sense, more BF to the area = more pressure in skull)

Ventriculostomy

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27
Q

Normal intracranial Pressure?

A

5-20

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28
Q

What is our goal for intracranial pressure in an acute care setting?

A

20 mmHg
* NOTE: normal is 5-20mmHG

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29
Q

Paranchymal changes: refer to alterations in the functional tissue of an organ, particulary in the brain. In the context of brain injury, this can include various types of damage or abnomraltities in the brains cellular structure

A
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30
Q

Shear and tensile forces that disrupt the axolemma (cell body around axon)

A

Axonal injury
* This is a parenchymal change or diffusse axonal injury
* Diffuse becuse often happens in the cou countercou motion

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31
Q

Distal axon will detach an trigger
* What do the myelin sheaths do?

A

Wallerian degernation (happens when severed/detached)
* Wallerian degeneration: Process that occurs when a nerve fiber is injuried. It involves the. degreernation of the axon and its myelin sheath distal to the site of injury. This happens because the nerve fiber loses its connection to the body, leading to the breakdown of the aon.
* When conditions right the axon may regerenate over time

This triggers reactional axonal swelling, forming retraction clumps that are full of axon material - detecte in the injured brain within 12 hours of injury

Myelin sheaths pull away from the axon

NOTE: Wallerian degernation happens btoh in CNS and PNS but more sucessful in PNS

These axonal changes may be distrubted throughout the brain regardles of site of impact (so happening everywhere)

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32
Q

In axonal injury (shear and tensile forces that disrupt axolemma) will they present similar to a stroke or tumor?

A

No

In a stroke or tumor you won’t have that shearing force that breaks those axons
* Stroke / tumor is going to be cutting off area / pressing on an area

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33
Q

NOTE: in diffuse axonal injury (often caused by that coup / countercoup) the intact axons are interspersed among damaged axons (its a mess)

Metabolic cascade revisited - excitotoxcivity and freee radial formation
* Secondary cell death by necrosis of the cellular membrane results from edema (so changes happening right away and then days and months later)
* Apoptosis or programmed cell death from within the cell through changes in the DNA can result in cell loss that occurs days, weeks, or months after injury
* There is evidence of the potential for recovery of function based on the possible sprouting of undamage axons to reoccupy the areas left vacant by degenerating axons - just doesnt work as well in the CNS
* Excess clutamate releated (its released in times of inflamamtion) - further becomes more excito toxic

I like this picture

A
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34
Q

KNOW:

Neurons deprived of oxygen for a prolonged period die and do not regerenate such as in stroke or truamtic injury; excitotoxicity may add more damage

EXcitoxicity is cell death caused by the over excitation of neurons due to large quantites of glutamate –> excessive glutamate kills postsynaptic neurons

Oxygen deprived neurons release large quantities of glutamate, an excitatory neurotransmitter, from their axon terminals

Rehab research: Neurorestoration (neurogensis and angiogensis): No known drug provides signficant neuroprotection for individuals with strok TBI or neurodegenerative disease

A
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35
Q

Shifting in normal brain symmetry =

A

Herniation

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36
Q

What is the most common herniation?

A

Transtentorial and downward, at the lateral tentorial membrane seperating the cerebral hemisheres from the posterior fossa

really just know it shifts downward
* Due to gravity and space (foramen magnum)

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37
Q

Which of the following values is normal intracranial pressure?
* 37
* 23
* 11
* 4

A

11

5-20mmHg is normal

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38
Q

What imaging is mostly utilized for TBI?

A

CT

Seconary = MRI

Imaging for SCI is typically done at the same time because this area could also be damaged

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39
Q

What goes the glasgow coma scale rate?
* What are the scores for severe, moderate, and mild (quiz)
* It ratess these scores based on 3 repsonses. What are these 3 variables?

A

Rates the severity of brain injury

Mild = 13-15
Moderate = 9-12
Severe = 8 or less

3 responses:
1) Eye opening
2) Motor response
3) Verbal response

This is how its scored

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40
Q

Mild TBI Loss of consciousness =
Moderate TBI =
Severe TBI =

A

0-30min
30-24hrs
>24hrs

I think I really need to know that the longer the LOS is the more severe

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41
Q

KNOW: In moderate to severe TBI there is normally that loss of consciouness that lasts a while
* typically consciouness is recovered
* Lucid period
* Neurologic deterirtation (HA, decline in mental status, focal neurological findings)

A
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42
Q

KNOW: Cognitive impairment does not mean theyll have physical impairement (they don’t go hand in hand)

A
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43
Q
A
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44
Q

Following TBI: Motor:

Cerebral shock: period of time where they are flacid and non responsive (think w/ LOC)

Slowly replaced gradually by increased tone, spasticity and rigidity
* Remember, this is an upper motor neuron syndrome
* So tone, spasticity etc. will all come up after that inital period of shock - so upper motor neuron signs

Abnormal movements depending on which areas of the brain has been injuired

A
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45
Q
A
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46
Q

Paroxysmal sympathetic hyperactivity is also known as
* What is it?
* What happens to HR, BP, RR, temp

What are triggers?

How long does it take to resolve?

A

Storming

Physical reaction from pt where their body starts to shake and works its way up and gets very intense. Its building

Increased:
* HR
* BP
* RR
* Temp
* sweating
* Motor posturing (becoming tense all over)

Triggers: Some kind of noxious stimuli (think pain, suctioning, passive movement, sonstipation)
* These intitate cycles of sympathetic overactivity, but reponses may also be exaggerated to stimuli that are typically not considered painful

Typically resolves several months after injury, but overactivity to external stimuli could persist in more subtle ways beyond the acute period

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47
Q

Long term risk of developing alzheimers disease, parkinson’s disease, frontotemporal dementia and chronic traumatic encephalopathy increase w/ TBI

Link between TBI and depression and anxiety disorders

A
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48
Q

What happens to the HR in storming?
* increase or decrease

A

Increase

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49
Q

Lowest level of consciousness

A

COMA

Its a complete state of unresponsiveness

Advanced brain failure

Unconscious/Unarousable

Eyes closed

No sleep wake cycles

No response to painful stemuli

May be ventilator dependet

May not demonstrate reflex reactions

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50
Q

Wakeful unresponsiveness is also called
* What do they have?
* Are their sleep wake cycles
* Are they aware of surroundings?
* Do they have reflexes
* Permanent/Persistant vegeative times for TBI
* Permanent/Persistant vegetative times for anoxic brain injury?

A

Vegetative state
* Normalization of vegeative functions - respiration, digestion and BP (so we have those vegetaive functions still, but the higher level brain is not working)
* NOTE: They can be weaned off the ventilator if on it prior

Slee wake cycles present

**No awareness of surroundings - meaninful cognitive and communcation are absent

Reflexes in response to externial stimuli - movement will not be reproduciblec
* So they will have reflexes?

Permanet/persistent vegeative state: lacks meaningful motor or cognitive function and complete absence of awareness or self or the environment for a period greater than 1 year after TBI and 3 months after anoxic brain injury

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51
Q

Minimally conscious state
* What are sleep wake cycles like?
* Can they be aroused?
* What will they do when stimuli is present
* What can they do visually?

A

Irregular sleep wake cycles

Normalization of vegetative functions - respiration, digestion and BP

May be aroused, minimal evidence of self or environmental awareness

Cognitively mediated behaviors occur inconsistently

Instead of withdrawing of withdrawing or posturing to stimuli patients will localize to stimuli and may inconsistently reach for objects

Patients may localize to sound location and demonstrate sustained visual fixation and visual pursuit
* So they can follow you across the room
* may look at you if you slam the door

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52
Q

State of altered mental status and responsivenes
* are they arousable?
* Do they have motor/verbal responses?

A

Stupor

Arousable only to strong stimuli (vigorous, unpleasant)

Minimal voluntary verbal or motor responses

53
Q

Diminished arousal and awareness
* How much do they sleep?
* What are they like when they’re awake
* what are interactions like?

A

Obtunded

  • Sleeping more than awake
  • Drowsy and confused when awake

Non-productive interactions

Therapist; gently shake patient to awaken, use simple questions
* You’re not going to walk this pt or anything

54
Q

Lethargic
* What is consciouness like
* What is level of arousal like?
* Can they respond to questions at this stage?
* Do they sleep often?
* What is their focus like?
*

A

Altered consciouness

Level of arousal diminished

Drowsy byt can open eyes and respond briefly to questions

Easily falls asleep if not continually stimulated

Difficulty maintaing focus

Therapist: speek in loud voice, using simple directed questions

55
Q

Awake, alter and oriented surroundings

A

alert

56
Q

A&OX4 / AAOX4 means

A

alert and oriented to person, place, time and event/situation

57
Q

Reversable, acute confusion state
* What causes it? (3)
* is it reversable?

A

Delirum

Deprivation of oxygen to the brain, metabolic imbalance, or adverse drug reactions can all induce this
* Its acute and reversable

Clouding of consciousness, dulling of cognitive processes, imaired alterness

Inattentive, incoherent, and disorganized with fluctuating levels of consciousness

Hallucinations and agitation are also common

can happen when someone is drugged or when they take a drug that has a bad effect on them

58
Q

In which level of consciousness can a pt begin productive interactions such as responding briefly to questions

A

Legargic state

59
Q

What are our 4 types of attention?

A

Remember attention is being able to direct our focus on something

1) Focused/selective
2) Sustained
3) Divided
4) Alternating

60
Q

Ability to attend to a task despite environmental, visual or auditory stimuli is what kind of attention?

A

Focused/Selective

61
Q

Ability to attend to relevant information during activity is what kind of attention

A

Sustained

EX: Doing a tennis serve and only paying attention to how the ball moves opposed to the crowd

62
Q

Ability to respond simultaneously to two or more tasks/stimuli when all stimuli are relevant is what kind of attention

A

Divided

Essentailly multitasking

63
Q

Ability to move flexibly between tasks and respond appropriately to demands of each task is what kind of attention?

A

Alternating

64
Q

Patient is struggling with which kind of attention (selective, sustained, divided, alternating) if they are easily distracted by any activity in the environment; responds to background noise; difficulty attending to therapists directions while in a crowded therapy clinic

A

Selective

65
Q

Patient is struggling with which kind of attention (selective, sustained, divided, alternating) if they have difficulty with details; stops a task midway; stops doing exercises after six repetititions when asked to do 15

A

sustained

66
Q

Patient is struggling with which kind of attention (selective, sustained, divided, alternating) if they are unable to do two things at one time: complete dressing and answer questions about weekend plans

A

Divided

67
Q

Patient is struggling with which kind of attention (selective, sustained, divided, alternating) if they are unable to return to original tasks if interrupted: during cooking activity, therapist stops patient to correct use of mobility devicel patient requires cue to resume cooking task

A

Alternating

68
Q

The cognitive skills involving planning, manipulating information, self-monitoring, problem-solving and abstract thinking
* which part of the brain is this primarily in and what kind of injury can affect this area?
* What 4 things are done here?

A

Executive functions
* this all happens in that frontal lobe area and thats where that coup is first attacked in a TBI (pre frontal cortex is so important in this)

  • Requires attention
  • Cognitive flexibility
  • Goal setting
  • Information processing
  • Perforontal cortex is so important in this
69
Q

Ranchos Los Amigos level of cognitive function scale quiz

A
70
Q

What is IX

A

9

71
Q

Ranchos Los Amigos (RLA) level I
* defintion
* Cognitive Assistance

A

No response to anything
* Patient appears to be in a deep sleep and is completely unresponsive to any stimuli
* Think coma

Cognitive assistance = total

72
Q

Ranchos Los Amigos (RLA) level 2
* defintion (how do patientres react, what are responses like?)
* Cognitive Assistance

A

Defentition: Generalized response
* Patient reacts inconsistently and non-puposefully to stimuli in a nonspecific manner
* responses are limited and often the same regardless of stimulus presented (they don’t really knwo what they’re doing)
* responses may be phsyiological changes, gross body movements, and or vocalization

Cognitive assistance: Total

73
Q

If a patient is in a coma what level on the RLA scale are they most likely in?

A

Level 1

74
Q

Ranchos Los Amigos (RLA) level III - quiz
* defintion (how does the patient react to stimuli, can the follow simple commands?)
* Cognitive Assistance

A

Defintion: Localized response
* Patient reacts specifically but inconsistently to stimuli
* Responses are directly releated to the type of stimulus presented
* May follow simple commands such as closing eyes or squeezing hand in an inconsistent, delayed manner

NOTE: with these stages they can move linearly through them, however, they can get stuck in certain stages
* were glad when they make it out of the first two stages

Cognitive assistance: total

75
Q

Ranchos Los Amigos (RLA) level IV
* defintion (are they at a heightened or lowered state of activity, what is behavior like, can they discrimate between persons and objects, what are their verbilizations like?)
* Cognitive Assistance
* Does pt have short and long term recall?

A

Defeintion: Confused, agitated
* Patient is at a heightened state of activity
* Behavior is bizarre and non purposeful relative to immediate environment (think walking around drunk)
* Does not discriminate among persons or objects; is unable to cooperate directly with treatment effort
* Verbailizations frequently are incoherent and/or inappopriate to the environment; confabulation may be present

They lack short and long term recall, so you can’t teach them anything at this stage
* They’re confused and agetated, learning is not happening

Cogntiive Assistance: Maximal

76
Q

Ranchos Los Amigos (RLA) level V
* Defintion
* Can the patient repond to simple commands?
* Can the pt demonstrate gross attention to environment? Can they focus attention on one specific task?
* Can the converse on a social automatic level
* What is verbilization like?
* What is memory like?
* What do they do w/ objects?
* Can they perform previously learned tasks?
* Can they learn new information?
* Cognitive Assistance

A

Definition: Confused, inappropriate, non-agitated
* Patient is able to respond to simple commands fairly consistently, However, with increased complexity of commands or lack of any external structure, responses are non-purposeful, random, or fragmented
* Demonstrates gross attention to the environment but is highly distractable and lacks ability to focus attention on a specific task
* With structure, may be be able to converse on a social automatic level for short periods of time
* Verbailization is often inappropraite and confabulatory
* Memory is severly impaired; often shows inappropraite use of objects; may perform previously learned tasks with structure but is unable to learn new information

Cognitive Assistance:
* Maximal

77
Q

Ranchos Los Amigos (RLA) level VI
* defintion
* A patient in this stage shows goal directed behavior but is dependent on
* Can they follow simple directions here?
* Do they show carryover from what kind of tasks?
* Why may responses be incorrect?
* What kind of memories show more depth and detail, recent or past?
* Cognitive Assistance

A

Defintion: Confused, appropriate
* Patient shows goal directed behavior but is dependent on external input or direction
* Follows simple directions consistently and shows carryover from relearned tasks such as self-care (which is why were happy when they can make it to this stage) - still not really learning anything new
* Responses may be incorrect due to memory problems, but they are appropraite to the situation
* Past memories show more deph and detail than recent memories

Cognitive Assistance: Moderate

78
Q

Ranchos Los Amigos (RLA) level VII
* defintion
* What does pt go through daily routine as?
* Do they have recall?
* Can they learn new things?
* What is judgement like?
* Cognitive Assistance

A

Defintion: Automatic, appropriate
* Patient appears appropraite and oriented within the hospital and home settings; goes through daily routine automatically but frequently robot like
* Patient shows minimal to no confusion and has shallow recall of activities
* Shows carryover for new learning but at a decreased rate
* With structure is able to initiate social or recreational activities; judgment remains impaired

Cognitive Assistance: Minimal for routine ADLs

79
Q

Ranchos Los Amigos (RLA) level VIII
* defintion
* Cognitive Assistance

A

Defintion: Purposeful, appropriate

Cognitive Assistance: Stand by

80
Q

Ranchos Los Amigos (RLA) level IX
* defintion
* Cognitive Assistance

A

Defintion: Purposeful appropriate

Cognitive Assistance: Stand by on request

81
Q

Ranchos Los Amigos (RLA) level X
* defintion
* Cognitive Assistance

A

Defintion: Purposeful, appropriate

Cogntiive Assistance: Modified independent

82
Q

RLA 8-10
* Patient is able to recall and integrate past and recent events and is aware of and responsive to environment
* Shows carryover for new learning and needs not supervision once activities are learned
* May continue to show a decreased ability relative to premorbid abilities, abstract reasoning, tolerance for stress and judgement in emergencies or unsusal circumstances
* VIII = standby assisnt
* IX = stand by on requires
* X = modified independent

A
83
Q

Stages that stick out to her

3 = follows simple commands (doesnt mean learning)

6 = follows simple directions consistently and carry over from relearned tasks (things they’ve done before)

Cognitive impact does not equate to physical ability (can be messed up in head but still able to move around find)

A
84
Q

When is carryover for relearned tasks?

A

VI

85
Q

Treatment for TBI
* Coordinated care and service from the onset of injury through the persons life
* Initially (on scene) - rapid triage, resuscitation and transport
* Emergency department = determination of head injury severity, identification of persons at risk of deterioration and control of hypoxia and hypotension. Prevention of secondary brain damage caused by edema, increasing ICP, or bleeding should be addressed. Treatment of the medical complications
* Surgical intervention
* ICP monioring
* BP control
* Management of secondary injuries
* Restoration of mobility, self-care, employment and recreational activities
* Community based programs
* Role of rehab
* Pharmacological interventions

A
86
Q
A
87
Q

Patients who have poorer recovery:
* Low initial GCS
* Older age
* Low education lvl
* Previous TBI
* Midline shift (think laterl shift)
* Duration of post traumatic amensia (PTA) - GOAT or O-Log
* Brainstem damage - loss of pupillary light reflex

A
88
Q

What is post traumatic amnesia?
* What is used to measure it? (2)
* What can they perdict?

A

The length of time between the injury and the time at which the patient is able to consistently remember ongoing events

Measured by the Galveston Orientation and Amnesia Test (GOAT)
* Or the Orientatition Log (O-Log)
* During inpatient rehab can perdict functional indepdence, employment, good overall recovery and indepdent living 1 year after injury

NOTE: Amnesia = loss of memory

89
Q

Patients w/ post traumatic amnesia less than _ days are likely to have higher functional scores on tests used (functional indepdence measures - FIM) at dischage from patient rehabilitation

A

48.5 days

Need to know we want this # to be lower
* Short PTA is favorable for prognosis

90
Q

KNOW: pts who suffer TBI may go to trasnitional rehabiliation progreams (residential) which are like day long programs
* Won’t be a classic dischage where they go from acute care –> inpatient –> outpatient, that transitional rehabiliation will be stuck in there sometimes (or could be a combo of this + outpatient). Just depends on the person if they need this or not

A
91
Q

Mild traumatic brain injury
* Is going to be
* GCS score of
* How long does it take for full recovery?
* What can they develop and how long do deficits last from this
* Where is it most commonly seend
* When increases recovery time (6)

A

This is a concussion
* Induced by biomechanical forces that disrupt physiological brain function

GCS 13-15
* NOTE: we wouldnt do this glassnow on someone w/o a brain injury

Full recovery in approx 7-10 days

Can develop post convussion syndrome (deficits for months to years)

Common in sports

Increased recovery time:
* Loss of consciousness (LOC) > 1min
* Greater than 1 minute
* Cognitive symptoms
* Young
* Female
* Hx of depression

92
Q

What is Second Impact Syndrome?

A

Catastrophic reaction to a second concussion

2nd concussion occurs before the resolution of first one

Rapid progression to severe disability or death if not addressed immediately

93
Q

Chronic Traumatic Encephalopathy (just swelling or damage to the brain)
* Incidence and cuases = unclear
* Maybe due to Multiple concussive events
* Progressive degreantive disease
* Cognitive and behavioral changes
* can also be due to drug diseases/metabolic disorders

A
94
Q

Tons of different symptomes after concusion

A
95
Q

Traumatic Brain Injury in Children
* Nonaccidental injury: Battered child or shaken baby syndrome
* Infants typically have tears in the white matter of the temporal and orbitofrontal lobes
* - the infant will more often sustain a subdural or epidural hemorrhage than an oler child but is less likely to have skull fractures because the skull is softer
* Near drowning
* Motor activity return and pupillary light responses are pronosticators of outcome
* Pediatroc glasgow coma scale

A
96
Q

Non quiz portion forward - on exam but not quiz 2 (basal ganglia, MS, ALS, vestibular is on quiz)

A
97
Q

These are CNS tumors

A
98
Q

Does neoplasm mean malignant or benign?

A

malignant

99
Q

Where does a primary tumor originate?

A

In the CNS tissue

100
Q

Where does a secondary tumor orginate?

A

Originates elsewhere and metastasizes to the brain (so does not originate in the CNS)

101
Q

What is paraneoplastic syndrome?

A

Remote/indirect effect on the CNS from cancer elsewhere

102
Q

Leptomeningeal carcinomatosis is

A

Metastasis in multiple areas of the meninges of the brain or SC

103
Q

What is a glioma
* what are 3 examples of these?

A

a tumor that originates in the glial cells of the brain or spinal cord
1) Astrocytoma
2) Oligodendroglioma
3) Ependymoma

104
Q

What kind or glial cells provide nutrients to neurons

A

Astrocytes

105
Q

What kind of glial cell produce myelin sheaths

A

Oligodendrocytes

106
Q

Which kind of glail cells line the ventricles and produce CSF?

A

Ependymoma

107
Q

Astrocytoma more common in what part of the brian in adults?
* what about kids?

A

Adults = cerebrum

Cerebellum = peds

108
Q

which ventricle are ependymomas primarily in?
* most common in what pt popul;ation

A

4th ventricle
* also more common in peds

109
Q

Medulloblastoma: kind of brain tumor
* most common in what age group
* Often in the
* Is is slow or agerssive

A

Peds

Cerebellar vermis

Highly aggressive

110
Q

Meningioma is a kind of brain tumor
* is it fast or slow growing
* Maliginat or benign

A

slow, benign

111
Q

Pituitary adenoma is a kind of brain tumor
* Is it malignant or benigns
* Where does it normally sit?

A

Benign

Sits on the sella turcica

112
Q

Neurinoma/Neuroma is a kind of brain tumor
* wjere does it originate?

A

Schwann cells

113
Q

Hemiangioblastoma is a kind of brain tumor.
* Where does it sit
* Is it malignant or benign
* Slow or gast growing
* Orinates where

A

Posterior fossa
Benign
Slow growing
Originates from the blood vessel lining

114
Q
A
115
Q

Intradual intramedullary
* where is it?
* Most common type in who?

A

In the thecal sac, in the cord

Most common type in peds

116
Q

Intradural extramedullary
* located?
* Most common type in who

A

In the thecal sac, outside the cord

Most common type in adults

117
Q

Extradural extramedullary
* location?
* What does it normally do?

A

Outside the thecal sac, outside the cord

Usually metastasis from elsewhere
* makes sense, its just kinda stuck on the outside of the SC

118
Q

Inflammation of meninges of brain and SC
* who gets them the most age
* What kind of disease causes
* what two viruses can cause

A

Meningitis

highest in children udner 1

higher in native amerians, alaskan natives, aboriginal australians

Immunocompromised

Low socioenconomic status

Enteroviruses - can cause

Arboviruses - can cause

119
Q

meninges
* know the layers

A
120
Q

What kind of meningitis - most from enteroviruses, followed by mumps, measles, herpes, west nile, epstein-barr SLE

A

Aseptic (viral)

121
Q

What kind of menigitis is - severe, mycobacterium tuberculopsis causes abscesses in the mingeal layers

A

Tuberculous

122
Q

What kind of menegitis is group B strep, s. pneumoniae, inflammation is subarachnoid, causes venous vasculitits, damage to neuronal cell bodies

A

Bacterial

123
Q

What kind of menegitits is cryptoccus neoformans, rare in healthy people, common in severely compromised immune system

A

Fungal

124
Q

What kind of meneginits is syphilis infection that spread to the brain (neurosyphilis); lyme disease?

A

Spirochetal

125
Q

S/s of meningitits

nuchal rigidity = stiffness around the nucal ligament

A
126
Q

Kernig sign happens w/ meningitits. What is this?

A

When you passively move the LE they have pain.

127
Q

What is Brudzinski sign w/ meningitits

A

when you passively flex the head and feet it causes pain

NOTE lahermits sign is a zinger down the spine w/ someone who has MS

This is looking at stretching of the meninges

128
Q

NOTE: neck rotation w/ menegitis can be painful because you’re stretching the meneges

these are focal deficits

vision loss or photophobia

cranial nerve palsy

Increased ICP

Rash

A
129
Q

Inflammation of the tissue of the brain (mostly gray matter)
* caused by what 3 things
* what causes the virus
* clinical manifestations

A

Encephaltitis

1) Viral invasion
2) Hypersensitivity to a virus in the body
3) High viral load

They get the virus from ticks/mosquitoes but other things can cause it as well
* easkes, mumps, rubella, rabies, ebola, epstein-bar, hep A, parasites, bacteria, drug toxicity, herpes, zika can all cause it

Clinical Manigestations:
* HA
* Nausea/vomiting
* Altered consciousness leading to coma
* Focal signs
* Seizure

130
Q

Brain abscess = any infection that reaches the brain can cause an abscess
* named for its location

Most common contributors
* Lungs or heart infection
* Otitis
* Cranial osteomyelitits
* Sinusitits
* Blood borne metastases
* Mastoiditits

A
131
Q
A
132
Q

REgardkess if the cause of the dysfunction, resultatnt signs and symptoms depend on the site and the size of the lesion

A
133
Q

Knowledge check: What would be atypical of meningitits

A

increased intracranial pressure

134
Q
A

Important ICF info

Pharma 2 (23 decks)

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