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Neuromuscular management > Lecture 9 Head Trauma, Seizures, Vertigo > Flashcards

Lecture 9 Head Trauma, Seizures, Vertigo Flashcards

1
Q

What is the most common cause of traumatic brain injury in the US?

A

Falls

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2
Q

The rate of death due to traumatic brain injury is highest above what age?

A

75

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3
Q

Most common cause of TBI per age group?

0-4
5-24
24-64
65+

A

assault
motor vehicle
intentional self harm
falls

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4
Q

What are the 3 categories of the glasgow coma scale?

How is it scored

A

Eye opening

verbal response

best motor response

3 (worst) - 15 (best

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5
Q

75% of TBIs are what?

Where does this rank on the glasgow coma scale?

A

concussion or mild TBI

13-15

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6
Q

Moderate TBI is what score on the glasgow coma scale?

A

9-12

usually associated w/ prolonged loss of conciousness and neurological deficit

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7
Q

Severe TBI is what glasgow coma score?

A

Under 8

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8
Q

Coup vs Contrecoup

A

Coup- the site of the original impact

contrecoup - where your brain bounces off of due to momentum from initial impact (opposite side of coup)

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9
Q

penetrating vs nonpenetrating head injury

A

penetrating usually causes mod-severe tbi

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10
Q

In an MRI you’ll see _____ on one side and _____ on the other side after a traumatic brain injury

A

bleeding - on side of original impact

swelling on side of contrecoup

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11
Q

TBI first and second phase

A

First phase- direct consequences of trauma

second phase - hypoxia and hypoperfusion + inflammation injury

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12
Q

What is the monroe kellie doctrine?

A

Only so much volume can fit inside the skull

brain + CSF + Blood …..

tumor? Extra fluids? swollen brain? = bad

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13
Q

What kind of herniation is E

A

tonsillar herniation

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14
Q

What kind of herniation is A??

A

Cingulate herniation

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15
Q

What kind of hernation is B

A

Uncal herniation

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16
Q

What kind of herniation is C?

A

Central herniation

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17
Q

What CN could be affected if you have an abscence of gag reflex?

A

9 or 10

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18
Q

What are pupil size differences called?

A

anisocoria

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19
Q

How will the pupils look if the pons is injured?

A

Both pinpoint (very small)

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20
Q

How will the pupils look if CN3 is injured?

A

One will be very dilated

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21
Q

How will the pupils look if the pretectal area is damaged?

A

large pupils that do not constrict w/ light

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22
Q

What kind of posturing is this?

What is damaged?

A

Decorticate posturing

Both or one corticospinal tracts

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23
Q

What kind of posturing is this?

What is damaged?

A

Decerebrate

Upper brainstem

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24
Q

What kind of imaging is best for showing blood in brain

A

GRE (its a kind of MRI)

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25
Q

bleeding inside the brain is called

A

intracerebral hemorrhage

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26
Q

bleeding into the subarachnoid space is called

A

subarachnoid hemorrhage

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27
Q

bleeding between the arachnoid and dura is called

A

sub dural hemorrage

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28
Q

bleeding between the skull and dura is called

A

epidural hemorrage

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29
Q

What kind of hemorrage is this?

A

subdural

usually blood across the whole hemisphere

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30
Q

What normally causes a subdural hematoma?

A

Low velocity injury

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31
Q

What kind of hematoma is this?

A

Epidural

usually a lens shape

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32
Q

What is an epidural hematoma usually from??

A

Bleeding from meningeal artery or vein torn by temporal or parietal fx

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33
Q

What kind of hematoma usually has a lucid interval where they seem ok before they are comatose

A

epidural hematoma

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34
Q

How does postconcussion syndrome present?

A

Headache, fatigue, dizziness, difficulty concentratng, disturbed sleep, anxiety, depression

lasts for months to years

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35
Q

What are the 2 hallmarks of a concussion?

A

Confusion and amnesia

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36
Q

How long can a concussion last?

A

1 month

anything over 1 month is post-concussion syndrome

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37
Q

Which gender has more risk of concussion for comparable sports?

Is concussion risk higher in competition or practice?

A

Female

competition

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38
Q

Highest risk sports for concussion in boys?

Highest risk in girls?

A

Football, hockey, lacrosse soccer wrestling basketball

Soccer, hockey, lacrosse, basketball field hockey, softball, gymnastics

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39
Q

why is history of prior concussion a major riskfactor for concussions

A

because subsequent concussions will be worse

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40
Q

How to handle a concussion in sports participants?

A

Standardized symptom checklist administered

if concussion is suspected- remove player from play

CT head scan should not be utilized unless we suspect more severe traumatic brain injury

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41
Q

What are 4 symptoms that will warrant a CT head scan in a player whos had a concussion

A
  • glasgow coma scale < 15
  • deteriorating mental status
  • potential spinal injury
  • progressive worsening symptoms or new neurological signs
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42
Q

Individuals supervising a player w/ a concussion should only allow return to sport (play or practice ) after….

A

LHCP has determined the concussion has resolved

additionally only after theyre asymptomatic and off any medication

43
Q

What are the steps of the concussion return to play protocol

A

Baseline (no activity)

step 1: Light aerobic

step 2: sport specific aerobic

step 3: non contact training drills

step 4: practice w/ full contact

step 5: return to play

44
Q

How does the return to play protocol progress?

A

Player must be asymptomatic for 24 hours before moving onto the next step

if they have symptoms they go back 1 step

45
Q

post concussive syndrome is when symptoms persist more than

A

1 month

46
Q

What are the symptoms of post concussion syndrome

A

persistent low grade headache and light headedness

poor attention/memory/concentration

depression anxiety irritability

intolerance of noise and lights

sleep disturbances

47
Q

What is Chronic Traumatic Encephalopathy

A

Spectrum of disorders associated w/ long term consequences of single or repetitive TBI

seen in contact sports

years of play increase risk

48
Q

What are the symptoms of CTE

A

Behavioral changes are the earliest manifestation

  • agression
  • agitation

cognitive impairment develops overtime

  • can progress to dementia

motor involvement

  • dysarthria
  • spasticity
  • looks like parkinsons disease
  • ataxia
49
Q

If a patient is having a seizure what should you do

A

put him in bed, lying on side, rails up, protect patient from injury

dont put anything in their mouth

someone must stay w/ them

be ready to describe the seizure to nurse or doctor

50
Q

Why should we time a seizure?

A

Should resolve in 1-2 minutes

more than 5 they might need medication or 911

51
Q

What are the most common causes of seizure?

A

Brain Tumor, subarachnoid hemorrage, severe TBI

52
Q

Seizure vs Epilepsy

A

Seizure - single unprovoked or provoked episode

Epilepsy - two or more unprovoked seizured separated by more than 24h

53
Q

Episode of transient behavioral/sensory/motor/visual symptoms associated w/ abnormal excessive cortical activity in the brain

A

seizure

note: 8-10% of the population will have a seizure

54
Q

Focal vs generalized seizure

A

focal- starts in one area of the body, easy to localize in brain

generalized - not easy to localize

55
Q

Seizure etiology

Genetic:

Structural:

A

Genetic: gene mutations

structural: any lesion that disrupts neural networks

56
Q

How can the metabolic system cause a seizure?

A

hypo or hyperglycemia

hypocalcemia

hyponatremia

uremia

drugs

57
Q

What is the most common etiology of a seizure world wide

A

Infectious

HIV, Malaria, Congenial Zika, Congential CMV, Neurocysticercosis

58
Q

Seizure that begins on one side of the body

Does not impair conciousness

Motor involvement, clonic or tonic

Sensory: Paresthesias, visual hallucinations

EEG with contralateral focal discharge

A

“Focal Onset seizure without loss of conciousness”

AKA

Simple Partial Seizure

59
Q

How can simple partial seizures present?

A

Visual- seeing flashes

Auditory: hearing ringing or hissing

Focal motor: tonic clonic movements of upper or lower limbs

facial- grimancing

autonomic- sweating/flushing/epigastric sensations

60
Q

What is a Complex partial seizure also called

A

focal onset seizure with loss of awareness

61
Q

Seizure w/o loss of awareness lasting seconds
OR
with loss of awareness usually more than 1 min

sensory aura- olfactory, auditory hallucinations, epigastric rising

experiental aura- psychic feeling, de ja vu

autonomic aura- flushing nausea pallor

aphasia if dominant side is affected

typically followed by confusion, fatigue, gradual recovery

A

temporal lobe seizure

just think that temporal lobe processes sensory so a temporal lobe seizure has a lot to do with sensory

62
Q

Seizure that occurs in clusters at night

brief in duration

may have aura

early posturing or clonic activity

may have large amplitude, irregular, complex movements

autonomic features

brief post-ictal phase (recover)

A

Frontal lobe seizure

63
Q

Sudden onset of unresponsiveness lasting seconds with interruption of ongoing activity but no loss of muscle tone (patient can stay standing)

patient returns to normal activity (no post-ictal state)

EEG with generalized 3Hz spike and wave

A

abscence seizure

64
Q

What kind of seizure is common in children

A

absence seizure

can explain why some children may appear to underpreform in school/lose concentration, this kind of seizure is hard to spot

65
Q

Sudden onset of loss of conciousness with onset of rigid muscle tone (tonic phase) followed by rhythmic convulsive movements lasting up to several minutes (clonic phase)

post-ical somnolences lasts minutes to hours (confusion afterwards)

Ictal EEG shows bilateral discharges

A

Generalized tonic-clonic seizure

66
Q

Tonic vs Clonic phase of a seizure

A

Tonic - generalized stiffness of limbs w/ back arched

Clonic - jerks of limbs, body, and head

67
Q

What is a myoclonic seizure?

A

Single brief jerk

may involved any or all limbs or the torso

typically occur with other generalized seizures

NOT ALL MYOCLONUS IS A SEIZURE

68
Q

What is a seizure called where the person collapses/falls foward/their head drops

A

atonic seizure

69
Q

Seizure that occurs in 2-5% of children, occurs when they have a FEVER

most occur between 6 months to 3 years

33% will have atleast one recurrence 10% will have 3 or more

A

febrile seizure

70
Q

What is the prognosis like for febrile seizures?

A

excellent

no antiepileptic drugs needed, diastat can be taken as needed

71
Q

Is it possible to have bilateral seizure symptoms and remain concious

A

No

72
Q

What is NOT a seizure?

A

Prolonged duration

gradual onset

thrashing, struggling, crying, pelvic thrusting

motor activity that starts and stops

arrhythmic jerking

retaining conciousness despite bilateral jerking

73
Q

Preceded by lightheadedness, dizziness, sweating

whitening/graying out of vision

sweating/pallor

more rapid recovery

may have urinary incontinence

A

syncope

74
Q

During clinical evaluation after a seizure most will need a….

A

EEG and contrast brain MRI

note: 40% of epilepsy patients will have normal EEG

75
Q

generalized seizure activity lasting 5+ minutes or multiple seizures without return to conciousness of 5+ minutes

morbidity and mortality risk increases w/ duration

rapid diagnosis and treatment necessary

A

status epilepticus

76
Q

Risk of second seizure after first is ________

risk of third seizure after second?

A

33%

76%

note: treatment in adults after 1st seizure reduces risk of second by 35% over 2 years

77
Q

______ are more likely to be diagnosed with epilepsy syndrome

A

children

note: recommendation is to consider treating children after first seizure when risk of second outweighs risk of pharmacological side effects

78
Q

What is a common side effect of seizure medication?

A

suicidal ideation

note: also somnolence, nausea, ataxia, nystagmus, confusion, RASH

79
Q

Primary vs secondary headache disorders:

A

Primary- Migrane, tension HA, Cluster HA

Secondary- Brain tumor, increased intracranial pressure, meningitis, encephaliits, aneurysm, hypertension

note: more than 90% of headaches are primary

80
Q

How to differentiate primary from secondary headaches

A

neuro red flags and atypical features

81
Q

What are redflags of headaches?

A

SSNOOPPPP

  • Systemic Symptoms
  • Secondary Disease
  • Neurologic symptoms
  • Onset - sudden abrupt
  • Older - new onset and progressive in person over 50
  • Previous headache history- first headache or difference
  • Positional
  • Papilledema
  • Precipitants - cough, valsalva
82
Q

Migranes affect what sex more?

A

18% of women and only 6% of men

83
Q

What is the IHS criteria for migranes?

A

5 or more headaches lasting 4-72 hours

2 out of 4 of these symptoms:
- throbbing
- unilateral
- moderate to severe
- worse w/ activity

1 out of these 2:
- nausea and/or vomiting
- photophobia and phonophobia

84
Q

What is a migraine with an aura?

A

10% of all migranes
aura is a stereotyped prodromal symptoms

fortification spectra - visual illusion where you see things that look like layers of walls surrounding a castle

85
Q

What are the two types of migranes?

A

Migrane w/ an aura

migrane w/o aura

86
Q

When should a patient use prophylaxis to treat migranes

A

when the migranes significantly interfere w/ patients life

last 2-3 days 1-2 per week

patient cant use or overuses acute treatments

atypical migranes

87
Q

4 medication w/ A level evidence for migrane

A

Topirmate

Betablockers

CGRP antagonist

Valproic acid

88
Q

What is botulinum toxin

A

(botox)

31 injections to the head neck and shoulders

indicated for chronic migranes

inhibits central and peripheral nervous system

89
Q

Analgesic/withdrawal headache symptoms

A

Very common / underdiagnosed

worse in AM after not having medicine in system overnight

due to drop in blood levels

90
Q

Cluster headaches usually affects who at what age?

A
  • usual onset is in 20s
  • more commonly affects men
  • no association with migranes
  • 50x less common than migranes
91
Q

____________ are a major symptoms in 30% of patient’s w/ brain tumors

A

headaches

note: only 1% of brain tumor present w/ ONLY a headache, most will have neurological symptoms

92
Q

Headache w/ a tight band around head, sense of pressure, bursting

May be perceived as continuous for months or even years

A

Tension type headache

93
Q

Vertigo vs Opscillopsia

A

Vertigo- sensation that you’re spinning

Opscillopsia - sensation that the world is moving

94
Q

What is the goal when examining someone w/ vertigo

A

distinguish between central and peripheral

95
Q

What does a positive head impulse test mean?

A

Peripheral vertigo

96
Q

Most common reoccurent cause of vertigo?

A

BPPV

97
Q

What canal is most commonly affected by BPPV

A

85% in posterior semicircular canal

98
Q

how do you treat bppv?

A

dix hallpike

99
Q

How to distinguish vestibular neuritis from other problems?

A
  • (+) tinnitus
  • hearing loss

Veritgo is CONSTANT

100
Q

How does Ménière’s disease present

A
  • feeling of fullness of ear
  • tinnitus
  • hearing loss, often progressive
101
Q

What are the signs of vertigo due to posterior fossa mass or infarction?

A
  • (+) Brainstem signs
  • (+) intractable nausea/ vomiting
  • decreased level of conciousness
  • Acute severe vertigo (infarction) OR Progressive slow vertigo (mass)
102
Q

What are the accompanying signs for Vertigo d/t Brainstem Ischemia?

A
  • Diplopia
  • Cortical blindness
  • Dysarthria/Dysphagia
  • Quadriparesis
  • Tinnitus
  • Hearing Loss

Provacative maneuver shows nystagmus of long duration, NOT FATIGUABLE

to remember: 2 eyes, 2 mouth, 4 limb, 2 ear issues

103
Q

Chronic vestibular condition where patient has dizziness (not vertigo)

They do not fall

A

persistent postural perceptual dizziness

104
Q

how do PTs treat vertigo?

A

Vestibular rehabiliation ( balance gaze stabilization)

Neuromuscular management (19 decks)

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