MIDTERMS: TBI Flashcards
What is the definition of Traumatic Brain Injury (TBI)?
Physical injury to the brain caused by an external mechanical force or projectile, resulting in loss of consciousness, post-traumatic amnesia, and neurological deficits.
What are the three primary results of TBI?
Loss of consciousness, post-traumatic amnesia, and neurological deficits.
What are the most common causes of TBI?
ransportation-related incidents, falls, violence, and suicide attempts.
Which age groups are most affected by TBI?
15-24 years old and 65-75 years old.
What are some risk factors for TBI?
Alcohol intake, pre-injury personality disturbances, family discord, and antisocial behavior.
What is the male to female ratio in TBI cases?
2:1, with more severe injuries observed in males.
What are secondary mechanisms of injury in TBI?
Intracranial hemorrhage, brain swelling, excitotoxicity, oxidant injury, and hypoxia.
What is a concussion?
The mildest form of TBI characterized by a state of unconsciousness due to minor diffuse axonal injury.
What are the primary mechanisms of injury in TBI?
Diffuse axonal injury (DAI), multiple petechial hemorrhages, contusions, and cranial nerve injuries.
What are cerebral contusions?
Bruises on the cortex, commonly located in the inferior frontal lobe and anterior temporal lobe, associated with seizures and focal deficits.
What types of hemorrhages are associated with secondary brain damage?
Subarachnoid hemorrhage (SAH), subdural hematoma (SDH), epidural hematoma, and intracerebral hemorrhage (ICH).
What are the types of herniation that can occur in TBI?
Subfalcine, central, transtentorial (uncal), and tonsillar herniation.
What is the difference between tangential and penetrating cranial wounds?
Tangential wounds involve scalp lacerations and depressed skull fractures, while penetrating wounds involve objects like metal particles or bone fragments entering the skull.
What are the main surgical concerns for gunshot wounds to the brain?
revention of infection, control of intracranial pressure (ICP), and management of potential complications like CSF leaks and seizures.
(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.
Tonsillar Herniation:
Due to the cerebral edema, the uncus of the temporal lobe (medial temporal lobe) herniates downward into the posterior fossa.
Transtentorial (Uncal) Herniation:
occurs when there is downward pressure centrally and can result in?
Central herniation
The cingulate gyrus is pushed laterally away from the expanding mass and herniates beneath the falx cerebri.
Subfalcine
Herniation:
Which cranial nerves are most commonly injured in basal skull fractures?
Olfactory nerve, facial nerve, and auditory nerve.
What is a clinical sign of olfactory nerve injury?
Anosmia (loss of smell) and apparent loss of taste.
What are common signs of a fracture of the petrous pyramid?
Otorrhea (ear drainage) and blood behind the tympanic membrane (TM).
What is “Battle Sign”?
A bruising behind the ear indicating a possible skull fracture.
Which cranial nerve injury can lead to diabetes insipidus?
: Injury to the sella (pituitary gland).
What does Raccoon Eyes indicate?
Periorbital ecchymosis associated with basal skull fractures.
What indicates a trochlear nerve injury?
Diplopia worse when looking down and compensatory head tilting
What are signs of optic nerve injury due to sphenoid bone fracture?
Blindness, unreactive pupils to direct light, and partial vision loss (scotoma).
What are the signs of oculomotor nerve injury?
Ptosis, divergent globes, loss of medial and vertical movements, diplopia, and fixed dilated pupil.
What is a carotid-cavernous fistula and its signs?
A laceration of the internal carotid artery causing pulsating exophthalmos, cranial nerve palsies (CN VI > III > IV), loss of vision, and glaucoma.
What symptoms are associated with trigeminal nerve injury?
Numbness, paresthesias, and neuralgia from basal fracture.
What are coup and contrecoup lesions?
Coup lesions occur at the site of impact; contrecoup lesions occur on the opposite side of the brain.
How can facial nerve injury manifest after a skull fracture?
Immediate facial palsy with transverse fractures and delayed facial palsy with longitudinal fractures.
What are common symptoms of vestibulocochlear nerve injury?
Hearing loss, postural vertigo, and nystagmus.
What is the Glasgow Coma Scale (GCS)?
: A scale used to measure consciousness, with a score range from 3 (unresponsive) to 15 (fully alert).
What is the prognosis for regaining consciousness after PVS?
50% chance of regaining consciousness within a year; 28% chance of achieving independence.
How is cognition demonstrated in patients recovering from coma?
By the ability to communicate.
What are the immediate clinical manifestations of a cerebral concussion?
Loss of consciousness, suppression of reflexes, transient respiratory arrest, and brief bradycardia.
What is an acute epidural hemorrhage?
Hemorrhage usually caused by meningeal arteries, leading to immediate loss of consciousness, lucid interval, and potential brainstem herniation.
: What is a subdural hematoma and its CT appearance?
: What is a subdural hematoma and its CT appearance?
What is the recovery pattern in coma?
Eye-opening and sleep-wake cycles ➔ following commands ➔ speaking.
What is the management goal for intracranial pressure (ICP)?
Maintain ICP < 20 mmHg and cerebral perfusion pressure (CPP) > 60 mmHg.
What causes coma and unconsciousness?
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.
What pharmacologic agents are used to increase arousal and facilitate recovery of consciousness?
Methylphenidate, Amantadine, and Bromocriptine
Define Persistent Vegetative State (PVS).
A condition where the patient is unresponsive for more than 2-4 weeks, has spontaneous sleep-wake cycles, but lacks cortical activity.
What factors indicate a positive prognosis for emergence from unconsciousness?
Young age, reactive pupils, decorticate posturing, early spontaneous eye opening, and absence of ventilator dependence.
What are management strategies for MCS?
Electrical stimulation, dopaminergic agents, and multimodal sensory stimulation.
What is Posttraumatic Amnesia (PTA)?
The period during which the patient’s ability to learn new information is minimal or non-existent, often accompanied by retrograde amnesia.
What are the main goals in the rehabilitation of patients with impaired consciousness?
Remove obstacles to recovery, treat medical complications, and provide education and support to family members.
What is the GOAT and what does it measure?
The Galveston Orientation and Amnesia Test, measuring orientation and memory in PTA, with scores over 75 indicating the patient is out of PTA.
Describe agitation in the context of brain injury.
A neurobehavioral syndrome with cognitive confusion, extreme emotional lability, motor overactivity, and potential aggression.
What medications are used to manage agitation in brain injury patients?
Beta-blockers, anti-epileptics, dopamine agonists, TCAs, and benzodiazepines.
What is heterotopic ossification (HO)?
Formation of lamellar bone in soft tissue and periarticular areas, often seen in patients with prolonged coma or limb spasticity.
What characterizes a Minimally Conscious State (MCS)?
Evidence of awareness with visual tracking and nonreflexive motor behavior, but inconsistent following of commands or intelligible communication.
: What are the symptoms and management of posttraumatic epilepsy?
Late seizures may occur, and risk factors include penetrating injuries and early seizures. Carbamazepine is the drug of choice for management.
What complications are associated with brain injury?
Spasticity, posttraumatic epilepsy, hydrocephalus, cranial nerve damage, pulmonary complications, and nutritional complications.
What nutritional strategies are used in brain injury rehabilitation?
Total enteral nutrition (TEN) and total parenteral nutrition (TPN) to manage metabolic responses and achieve positive nitrogen balance.
What are common pulmonary complications following brain injury?
Pneumothorax, hemothorax, atelectasis, pneumonia, and neurogenic pulmonary edema.
A neurological disorder caused by repeated blows to the head, characterized by dementia and symptoms of Parkinson’s disease.
dementia pugilistica
