MIDTERMS: TBI

Question 1

What is the definition of Traumatic Brain Injury (TBI)?

Answer 1

Physical injury to the brain caused by an external mechanical force or projectile, resulting in loss of consciousness, post-traumatic amnesia, and neurological deficits.

Question 2

What are the three primary results of TBI?

Answer 2

Loss of consciousness, post-traumatic amnesia, and neurological deficits.

Question 3

What are the most common causes of TBI?

Answer 3

ransportation-related incidents, falls, violence, and suicide attempts.

Question 3

Which age groups are most affected by TBI?

Answer 3

15-24 years old and 65-75 years old.

Question 4

What are some risk factors for TBI?

Answer 4

Alcohol intake, pre-injury personality disturbances, family discord, and antisocial behavior.

Question 4

What is the male to female ratio in TBI cases?

Answer 4

2:1, with more severe injuries observed in males.

Question 5

What are secondary mechanisms of injury in TBI?

Answer 5

Intracranial hemorrhage, brain swelling, excitotoxicity, oxidant injury, and hypoxia.

Question 5

What is a concussion?

Answer 5

The mildest form of TBI characterized by a state of unconsciousness due to minor diffuse axonal injury.

Question 5

What are the primary mechanisms of injury in TBI?

Answer 5

Diffuse axonal injury (DAI), multiple petechial hemorrhages, contusions, and cranial nerve injuries.

Question 6

What are cerebral contusions?

Answer 6

Bruises on the cortex, commonly located in the inferior frontal lobe and anterior temporal lobe, associated with seizures and focal deficits.

Question 7

What types of hemorrhages are associated with secondary brain damage?

Answer 7

Subarachnoid hemorrhage (SAH), subdural hematoma (SDH), epidural hematoma, and intracerebral hemorrhage (ICH).

Question 8

What are the types of herniation that can occur in TBI?

Answer 8

Subfalcine, central, transtentorial (uncal), and tonsillar herniation.

Question 9

What is the difference between tangential and penetrating cranial wounds?

Answer 9

Tangential wounds involve scalp lacerations and depressed skull fractures, while penetrating wounds involve objects like metal particles or bone fragments entering the skull.

Question 10

What are the main surgical concerns for gunshot wounds to the brain?

Answer 10

revention of infection, control of intracranial pressure (ICP), and management of potential complications like CSF leaks and seizures.

Question 11

(4)If there is also edema or hemorrhage causing swelling in the cerebellum, the tonsil (or tonsils) of the cerebellum herniates downward into the foramen magnum.

Answer 11

Tonsillar Herniation:

Question 12

Due to the cerebral edema, the uncus of the temporal lobe (medial temporal lobe) herniates downward into the posterior fossa.

Answer 12

Transtentorial (Uncal) Herniation:

Question 13

occurs when there is downward pressure centrally and can result in?

Answer 13

Central herniation

Question 14

The cingulate gyrus is pushed laterally away from the expanding mass and herniates beneath the falx cerebri.

Answer 14

Subfalcine
Herniation:

Question 15

Which cranial nerves are most commonly injured in basal skull fractures?

Answer 15

Olfactory nerve, facial nerve, and auditory nerve.

Question 16

What is a clinical sign of olfactory nerve injury?

Answer 16

Anosmia (loss of smell) and apparent loss of taste.

Question 16

What are common signs of a fracture of the petrous pyramid?

Answer 16

Otorrhea (ear drainage) and blood behind the tympanic membrane (TM).

Question 16

What is “Battle Sign”?

Answer 16

A bruising behind the ear indicating a possible skull fracture.

Question 16

Which cranial nerve injury can lead to diabetes insipidus?

Answer 16

: Injury to the sella (pituitary gland).

Question 16

What does Raccoon Eyes indicate?

Answer 16

Periorbital ecchymosis associated with basal skull fractures.

Question 17

What indicates a trochlear nerve injury?

Answer 17

Diplopia worse when looking down and compensatory head tilting

Question 17

What are signs of optic nerve injury due to sphenoid bone fracture?

Answer 17

Blindness, unreactive pupils to direct light, and partial vision loss (scotoma).

Question 17

What are the signs of oculomotor nerve injury?

Answer 17

Ptosis, divergent globes, loss of medial and vertical movements, diplopia, and fixed dilated pupil.

Question 17

What is a carotid-cavernous fistula and its signs?

Answer 17

A laceration of the internal carotid artery causing pulsating exophthalmos, cranial nerve palsies (CN VI > III > IV), loss of vision, and glaucoma.

Question 17

What symptoms are associated with trigeminal nerve injury?

Answer 17

Numbness, paresthesias, and neuralgia from basal fracture.

Question 17

What are coup and contrecoup lesions?

Answer 17

Coup lesions occur at the site of impact; contrecoup lesions occur on the opposite side of the brain.

Question 17

How can facial nerve injury manifest after a skull fracture?

Answer 17

Immediate facial palsy with transverse fractures and delayed facial palsy with longitudinal fractures.

Question 17

What are common symptoms of vestibulocochlear nerve injury?

Answer 17

Hearing loss, postural vertigo, and nystagmus.

Question 17

What is the Glasgow Coma Scale (GCS)?

Answer 17

: A scale used to measure consciousness, with a score range from 3 (unresponsive) to 15 (fully alert).

Question 17

What is the prognosis for regaining consciousness after PVS?

Answer 17

50% chance of regaining consciousness within a year; 28% chance of achieving independence.

Question 18

How is cognition demonstrated in patients recovering from coma?

Answer 18

By the ability to communicate.

Question 18

What are the immediate clinical manifestations of a cerebral concussion?

Answer 18

Loss of consciousness, suppression of reflexes, transient respiratory arrest, and brief bradycardia.

Question 18

What is an acute epidural hemorrhage?

Answer 18

Hemorrhage usually caused by meningeal arteries, leading to immediate loss of consciousness, lucid interval, and potential brainstem herniation.

Question 18

: What is a subdural hematoma and its CT appearance?

Answer 18

: What is a subdural hematoma and its CT appearance?

Question 18

What is the recovery pattern in coma?

Answer 18

Eye-opening and sleep-wake cycles ➔ following commands ➔ speaking.

Question 18

What is the management goal for intracranial pressure (ICP)?

Answer 18

Maintain ICP < 20 mmHg and cerebral perfusion pressure (CPP) > 60 mmHg.

Question 18

What causes coma and unconsciousness?

Answer 18

Disruption of input to surface brain structures from deeper structures that subserve arousal and wakefulness, due to factors like diffuse axonal injury or brainstem compression.

Question 18

What pharmacologic agents are used to increase arousal and facilitate recovery of consciousness?

Answer 18

Methylphenidate, Amantadine, and Bromocriptine

Question 18

Define Persistent Vegetative State (PVS).

Answer 18

A condition where the patient is unresponsive for more than 2-4 weeks, has spontaneous sleep-wake cycles, but lacks cortical activity.

Question 19

What factors indicate a positive prognosis for emergence from unconsciousness?

Answer 19

Young age, reactive pupils, decorticate posturing, early spontaneous eye opening, and absence of ventilator dependence.

Question 20

What are management strategies for MCS?

Answer 20

Electrical stimulation, dopaminergic agents, and multimodal sensory stimulation.

Question 21

What is Posttraumatic Amnesia (PTA)?

Answer 21

The period during which the patient’s ability to learn new information is minimal or non-existent, often accompanied by retrograde amnesia.

Question 21

What are the main goals in the rehabilitation of patients with impaired consciousness?

Answer 21

Remove obstacles to recovery, treat medical complications, and provide education and support to family members.

Question 22

What is the GOAT and what does it measure?

Answer 22

The Galveston Orientation and Amnesia Test, measuring orientation and memory in PTA, with scores over 75 indicating the patient is out of PTA.

Question 23

Describe agitation in the context of brain injury.

Answer 23

A neurobehavioral syndrome with cognitive confusion, extreme emotional lability, motor overactivity, and potential aggression.

Question 23

What medications are used to manage agitation in brain injury patients?

Answer 23

Beta-blockers, anti-epileptics, dopamine agonists, TCAs, and benzodiazepines.

Question 24

What is heterotopic ossification (HO)?

Answer 24

Formation of lamellar bone in soft tissue and periarticular areas, often seen in patients with prolonged coma or limb spasticity.

Question 25

What characterizes a Minimally Conscious State (MCS)?

Answer 25

Evidence of awareness with visual tracking and nonreflexive motor behavior, but inconsistent following of commands or intelligible communication.

Question 26

: What are the symptoms and management of posttraumatic epilepsy?

Answer 26

Late seizures may occur, and risk factors include penetrating injuries and early seizures. Carbamazepine is the drug of choice for management.

Question 27

What complications are associated with brain injury?

Answer 27

Spasticity, posttraumatic epilepsy, hydrocephalus, cranial nerve damage, pulmonary complications, and nutritional complications.

Question 28

What nutritional strategies are used in brain injury rehabilitation?

Answer 28

Total enteral nutrition (TEN) and total parenteral nutrition (TPN) to manage metabolic responses and achieve positive nitrogen balance.

Question 29

What are common pulmonary complications following brain injury?

Answer 29

Pneumothorax, hemothorax, atelectasis, pneumonia, and neurogenic pulmonary edema.

Question 29

A neurological disorder caused by repeated blows to the head, characterized by dementia and symptoms of Parkinson’s disease.

Answer 29

dementia pugilistica