Lecture 2: Brain Injury Flashcards
1
Q
Brain damage caused by events AFTER birth (not congenital or genetic)
A
Aquired brain injury
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
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
4
Q
Example of a Mild Traumatic Brain injury
A
Concusion
* Common: atheletes - incidence highest in female atheletes
5
Q
Motor vehicle releated accidents often lead to what kind of TBI?
A
Moderate/Severe
6
Q
What scale is commonly utilized w/ traumatic brain injury?
A
Glasgow coma scale
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
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
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
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
8
Q
Diffuse axonal injury, tissue tearing, hemorrhages typically happen w/ open or closed TBIs?
A
Closed
* do to that coup/counter coup
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
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
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
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)
12
Q
What space is between the skull and the dura matter?
A
Epidural space
13
Q
What space is between the skull and the brain?
A
Subdural
14
Q
Space within the skull
A
Intracerebral space
15
Q
What is a contusion?
A
Bruise in the brain
16
Q
What is a Hematoma?
* What are the three kinds?
A
Pooled blood outside a blood vessel
1) Intracerebral
2) Epidural
3) Subdural
17
Q
What is a hemorrhage
* Our 3 kinds
A
active bleeding / burst vessel
* can be intracerebral
* Subdural
* Subarachnoid
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
19
Q
A
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
21
22
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?
Hypoxia
23
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)
24
Injuries that result in hypoxia do what to mortality rate?
* What does it do to morbidity?
* Is early hypotension good or bed?
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
25
Intracranial hypertension increases or decreases intracranial pressure
Increases (duh)
KNOW: Intracranial pressures elevates after injury
26
What monitors intracranial pressure?
* How does it work
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
27
**Normal intracranial Pressure**?
5-20
28
What is our goal for intracranial pressure in an acute care setting?
20 mmHg
* NOTE: normal is 5-20mmHG
29
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
30
Shear and tensile forces that disrupt the axolemma (cell body around axon)
Axonal injury
* This is a parenchymal change or diffusse axonal injury
* Diffuse becuse often happens in the cou countercou motion
31
Distal axon will detach an trigger
* What do the myelin sheaths do?
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)
32
In axonal injury (shear and tensile forces that disrupt axolemma) will they present similar to a stroke or tumor?
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
33
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
34
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
35
Shifting in normal brain symmetry =
Herniation
36
What is the most common herniation?
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)
37
Which of the following values is normal intracranial pressure?
* 37
* 23
* 11
* 4
11
5-20mmHg is normal
38
What imaging is mostly utilized for TBI?
CT
Seconary = MRI
Imaging for SCI is typically done at the same time because this area could also be damaged
39
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?
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
40
Mild TBI Loss of consciousness =
Moderate TBI =
Severe TBI =
0-30min
30-24hrs
>24hrs
I think I really need to know that the longer the LOS is the more severe
41
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)
42
KNOW: Cognitive impairment does not mean theyll have physical impairement (they don't go hand in hand)
43
44
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
45
46
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?
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
47
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
48
What happens to the HR in storming?
* increase or decrease
Increase
49
Lowest level of consciousness
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
50
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?
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 reproducible**c
* 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
51
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?
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
52
State of altered mental status and responsivenes
* are they arousable?
* Do they have motor/verbal responses?
Stupor
Arousable only to strong stimuli (vigorous, unpleasant)
Minimal voluntary verbal or motor responses
53
Diminished arousal and awareness
* How much do they sleep?
* What are they like when they're awake
* what are interactions like?
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
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?
*
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
Awake, alter and oriented surroundings
alert
56
**A&OX4 / AAOX4 means**
alert and oriented to person, place, time and event/situation
57
Reversable, acute confusion state
* What causes it? (3)
* is it reversable?
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
**In which level of consciousness can a pt begin productive interactions such as responding briefly to questions**
Legargic state
59
What are our 4 types of attention?
Remember attention is being able to direct our focus on something
1) Focused/selective
2) Sustained
3) Divided
4) Alternating
60
Ability to attend to a task despite environmental, visual or auditory stimuli is what kind of attention?
Focused/Selective
61
Ability to attend to relevant information during activity is what kind of attention
Sustained
EX: Doing a tennis serve and only paying attention to how the ball moves opposed to the crowd
62
Ability to respond simultaneously to two or more tasks/stimuli when all stimuli are relevant is what kind of attention
Divided
Essentailly multitasking
63
Ability to move flexibly between tasks and respond appropriately to demands of each task is what kind of attention?
Alternating
64
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
Selective
65
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
sustained
66
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
Divided
67
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
Alternating
68
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?
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
**Ranchos Los Amigos level of cognitive function scale** quiz
70
What is IX
9
71
Ranchos Los Amigos (RLA) level I
* defintion
* Cognitive Assistance
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
Ranchos Los Amigos (RLA) level 2
* defintion (how do patientres react, what are responses like?)
* Cognitive Assistance
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
If a patient is in a coma what level on the RLA scale are they most likely in?
Level 1
74
**Ranchos Los Amigos (RLA) level III** - quiz
* defintion (how does the patient react to stimuli, **can the follow simple commands?**)
* Cognitive Assistance
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
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?
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
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
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
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
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
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
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
Ranchos Los Amigos (RLA) level VIII
* defintion
* Cognitive Assistance
Defintion: Purposeful, appropriate
Cognitive Assistance: Stand by
80
Ranchos Los Amigos (RLA) level IX
* defintion
* Cognitive Assistance
Defintion: Purposeful appropriate
Cognitive Assistance: Stand by on request
81
Ranchos Los Amigos (RLA) level X
* defintion
* Cognitive Assistance
Defintion: Purposeful, appropriate
Cogntiive Assistance: Modified independent
82
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
83
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)
84
When is carryover for relearned tasks?
VI
85
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
86
87
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
88
What is post traumatic amnesia?
* What is used to measure it? (2)
* What can they perdict?
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
**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**
48.5 days
Need to know we want this # to be lower
* **Short PTA is favorable for prognosis**
90
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
91
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)
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
What is Second Impact Syndrome?
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
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
94
Tons of different symptomes after concusion
95
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
96
Non quiz portion forward - on exam but not quiz 2 (basal ganglia, MS, ALS, vestibular is on quiz)
97
These are CNS tumors
98
Does neoplasm mean malignant or benign?
malignant
99
Where does a primary tumor originate?
In the CNS tissue
100
Where does a secondary tumor orginate?
Originates elsewhere and metastasizes to the brain (so does not originate in the CNS)
101
What is paraneoplastic syndrome?
Remote/indirect effect on the CNS from cancer elsewhere
102
Leptomeningeal carcinomatosis is
Metastasis in multiple areas of the meninges of the brain or SC
103
What is a glioma
* what are 3 examples of these?
a tumor that originates in the glial cells of the brain or spinal cord
1) Astrocytoma
2) Oligodendroglioma
3) Ependymoma
104
What kind or glial cells provide nutrients to neurons
Astrocytes
105
What kind of glial cell produce myelin sheaths
Oligodendrocytes
106
Which kind of glail cells line the ventricles and produce CSF?
Ependymoma
107
Astrocytoma more common in what part of the brian in adults?
* what about kids?
Adults = cerebrum
Cerebellum = peds
108
which ventricle are ependymomas primarily in?
* most common in what pt popul;ation
4th ventricle
* also more common in peds
109
Medulloblastoma: kind of brain tumor
* most common in what age group
* Often in the
* Is is slow or agerssive
Peds
Cerebellar vermis
Highly aggressive
110
Meningioma is a kind of brain tumor
* is it fast or slow growing
* Maliginat or benign
slow, benign
111
Pituitary adenoma is a kind of brain tumor
* Is it malignant or benigns
* Where does it normally sit?
Benign
Sits on the sella turcica
112
Neurinoma/Neuroma is a kind of brain tumor
* wjere does it originate?
Schwann cells
113
Hemiangioblastoma is a kind of brain tumor.
* Where does it sit
* Is it malignant or benign
* Slow or gast growing
* Orinates where
Posterior fossa
Benign
Slow growing
Originates from the blood vessel lining
114
115
Intradual intramedullary
* where is it?
* Most common type in who?
In the thecal sac, in the cord
Most common type in peds
116
Intradural extramedullary
* located?
* Most common type in who
In the thecal sac, outside the cord
Most common type in adults
117
Extradural extramedullary
* location?
* What does it normally do?
Outside the thecal sac, outside the cord
Usually metastasis from elsewhere
* makes sense, its just kinda stuck on the outside of the SC
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Inflammation of meninges of brain and SC
* who gets them the most age
* What kind of disease causes
* what two viruses can cause
Meningitis
highest in children udner 1
higher in native amerians, alaskan natives, aboriginal australians
Immunocompromised
Low socioenconomic status
Enteroviruses - can cause
Arboviruses - can cause
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meninges
* know the layers
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What kind of meningitis - most from enteroviruses, followed by mumps, measles, herpes, west nile, epstein-barr SLE
Aseptic (viral)
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What kind of menigitis is - severe, mycobacterium tuberculopsis causes abscesses in the mingeal layers
Tuberculous
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What kind of menegitis is group B strep, s. pneumoniae, inflammation is subarachnoid, causes venous vasculitits, damage to neuronal cell bodies
Bacterial
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What kind of menegitits is cryptoccus neoformans, rare in healthy people, common in severely compromised immune system
Fungal
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What kind of meneginits is syphilis infection that spread to the brain (neurosyphilis); lyme disease?
Spirochetal
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S/s of meningitits
nuchal rigidity = stiffness around the nucal ligament
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Kernig sign happens w/ meningitits. What is this?
When you passively move the LE they have pain.
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What is Brudzinski sign w/ meningitits
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
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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
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Inflammation of the tissue of the brain (mostly gray matter)
* caused by what 3 things
* what causes the virus
* clinical manifestations
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
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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
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**REgardkess if the cause of the dysfunction, resultatnt signs and symptoms depend on the site and the size of the lesion**
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**Knowledge check: What would be atypical of meningitits**
increased intracranial pressure
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Important ICF info
