managment of traumatic brain injury

Question 1

what does the Glasgow coma scale measure ?

Answer 1

responsiveness and consciousness of the patient depending on three main tested factors 
eye movement 4
verbal response 5
motor response 6
with a maximum score of 15

Question 2

what can diffuse injuries be classified into ?

Answer 2

simple concussions
diffuse axonal injuries
traumatic subarachnoid haemorrhages

Question 3

what are examples of focal injuries ?

Answer 3

penetrating injuries
contusions
hematoma

Question 4

what is the difference between coup and countercoup injuries ?

Answer 4

coup are at the site of contact

with countercoup shock waves travel and cause TBI away from the site of trauma

Question 5

what shape do epidural/extradural hematomas take ?

Answer 5

biconcave

Question 6

what shape do subdural hematomas take ?

Answer 6

concavoconvex

Question 7

what is a dangerous complication of traumatic subarachnoid hemorrhage ?

Answer 7

acute communicating hydrocephalus

Question 8

what may a patient with diffuse axonal injury present with ?

Answer 8

a comatose patient with minimal CT findings

Question 9

what are the types of acute hydrocephalus ?

Answer 9

communicating and non communicating

Question 10

what is the difference between primary and secondary brain injury ?

Answer 10

primary brain injury happens at time of effect and can be focal or diffuse
secondary brain injury is mainly due to the metabolic insult imposed after the initial injury

Question 11

what is the Monroe killie doctrine ?

Answer 11

it separates the components of a healthy skull into
80% brain
10% blood
10% CSF
sum of all the components is consistent and an increase in one should cause a decrease in another

Question 12

why is it important to monitor ICP ?

Answer 12

for early detection of evolving mass lesions

Question 13

what is the single most important secondary factor that influences outcome after TBI ?

Answer 13

cerebral ischemia

Question 14

what is an independent predictor of the outcome and prognosis in brain injury ?

Answer 14

ICP

Question 15

what is second impact syndrome ?

Answer 15

SIS is a fatal syndrome where the brain swells rapidly shortly after a person suffers a second concussion before symptoms from an earlier concussion have subsided

Question 16

what type of secondary injury does hypo perfusion and hyper perfusion cause ?

Answer 16

hypo perfusion - ischaemia

hyper perfusion - ICP

Question 17

what does herniation mean ?

Answer 17

Abnormal protrusion of tissue through an opening

Question 18

what are the types of brain herniation ?

Answer 18

supratentorial and infra tentorial

Question 19

what are the type of supratentorial herniation ?

Answer 19

uncal transtentorial
subfalcine
transcalavrine
central tentorial

Question 20

what are the type of infra tentorial herniation ?

Answer 20

upwards transtentorial

foraminal/tonsillar

Question 21

what is the initial management of traumatic brain injury ?

Answer 21

glasgow coma scale
exposure and wound examination 
ABC
give anticonvulsants if needed: IV phenytoin , carbamazepine 
osmotic diuretics - mannitol

Question 22

what is the surgical management in foreign body removal?

Answer 22

before surgery :
identify radiologically 
expose the wound
in the surgery :
remove the object under image guidance
small deeply seated particles can be left for follow up

Question 23

what is talk and die syndrome usually cause by ?

Answer 23

epidural/extradural hematoma

Question 24

what is decompressive craniotomy ?

Answer 24

temporary removal of a large portion of the skull used too deal with ICP after TBI

Question 25

what other procedure can help with ICP ?

Answer 25

external ventricular drain, temporarily remove the CSF

Question 26

what is the post operative management ?

Answer 26

ICP monitoring 
interval scanning looking for reversible neurological conditions 
wound drain and care 
diagnosis of brain stem death 
prognostic MRI for DAI

Question 27

what is used to diagnose brain stem death ?

Answer 27

EEG