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N361: Pathophysiology II > Module 11 - Traumatic Brain Injury > Flashcards

Module 11 - Traumatic Brain Injury Flashcards

1
Q

Head Injury

A

term used to describe all structural damage to the head

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2
Q

Head Injury is synonymous with…

A

brain injury or traumatic brain injury (TBI)

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3
Q

The leading cause of death in ages 24+

A

Head Injury

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4
Q

Main causes of head Injury

A

road accidents

falls (biggest contributor)

assaults including violence and fire arms

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5
Q

Skull Fracture Types

A

Simple

Comminuted

Depressed

Basilar

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6
Q

Head Injury Types

A

Closed

Open

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7
Q

Main Diagnostic Tool for Skull Fractures

A

Skull X Ray

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8
Q

Simple Skull Fracture

A

linear break in the continuity of the bone

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9
Q

Comminuted Skull Fracture

A

refers to a splintered or multiple fracture line

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10
Q

Depressed Skull Fracture

A

when bone fragments are embedded into brain tissue

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11
Q

basilar skull fracture

A

fracture of the bones that form the base of the skull

this is an area of the skull that is more fragile

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12
Q

Basilar Area of the skull includes what areas

A

Include temporarily bone, occipital one, ethmoid bone, sphenoid bone

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13
Q

Ethmoid Cribriform Plate

A

Most fragile portion of the cranium

Is shattered in basal skull fractures

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14
Q

What 3 things occur with a Basilar Skull Fracture breaking the Ethmoid Cribriform Plate

A
  1. CSF leakage from nose or ear leading to potential source for infection of the meninges or brain
  2. Lacerations to the vessels of the dura leading to intracranial bleeding
  3. Damage to cranial nerves 1, 2, 3, 7, and 8 if the fracture is near the foramen magnum where the cranial nerves exit the skull
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15
Q

Rhinorrhea

A

CSF leakage out the nose

can test for high glucose since thats high in CSF and see if it tries in a yellow halo as CSF does

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16
Q

Ottorrhea

A

CSF leakage from the ear

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17
Q

Types of Brain Injuries

A

Primary

Secondary

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18
Q

Primary brain injury types

A

Concussion

post-concussion syndrome

contusion

laceration

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19
Q

Primary Brain Injury (Direct Brain Injury)

A

damage is caused by impact

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20
Q

Concussion

A

primary brain injury

Momentary interruption of brain function with or without loss of consciousness

Recovery usually within 24 hours

Cannot be visualized except microscopically (does not appear on CT)

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21
Q

Post Concussion Syndrome

A

primary brain injury

despite concussions being 24 hours, this can last months

HA, irritability, insomnia, poor concentration and memory issues persisting for months

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22
Q

Contusion

A

primary brain injury

bruising of the brain

CAN be seen on CT

often distributed along the rough irregular inner surface of the brain

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23
Q

Where are contusions more likely to occur

A

frontal or temporal lobes –> leads to cognitive and motor deficits

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24
Q

Secondary brain injury types

A

ischemia

increased ICP

cerebral edema

brain herniation

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25
Q

Secondary Brain Injuries

A

damage resulting from subsequent brain swelling

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26
Q

The most common cause of secondary brain injuries is…

A

ischemia

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27
Q

Classifications of brain injuries can be ___ or ___

A

focal or diffuse

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28
Q

Focal Brain injuries

A

pinpoint in one area like a knife wound

trauma and bleeding occurs from only one space

neurological deficits a function of the area injured

ex: contusion, laceration, hemorrhaging

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29
Q

Diffuse Brain Injury

A

widespread brain injury from something like whiplash, shaken baby syndrome, O2 deprivation

ex: Concussion, contusion, diffuse axonal injury (shearing lesion), hypoxic brain injury

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30
Q

Mild Brain Injury

A

Momentary LOC w/out demonstrating neuro symptoms or residual damage except for possible residual amnesia

Microscopic changes can be detected in neurons and glia within hours of injury

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31
Q

Moderate Brain Injury

A

longer period of unconsciousness

May be assoc. with focal manifestations such as hemiparesis, aphasia, cranial nerve palsy

many small hemorrhages occur along with some swelling of brain tissue

could be seen on CT

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32
Q

Severe Brain injury

A

more extensive damage to brain structures and a deeper level of coma

Primary damage to brain is often instantaneous and irreversible

Due to shearing and pressure forces causing diffuse axonal injury, disruption of blood vessels, and tissue damage

Often accompanied by neuro deficits like hemiplegia

often occurs with injury to other parts of the body

Whiplash or shaken baby can cause this

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33
Q

What is the mechanism of brain injury?

A
  1. Brain suffer injury and swells or bleeds thus increasing ICP
  2. Rigid cranium doesn’t allow expansion of contents so ICP increases more
  3. More pressure on blood vessels within the brain causes blood flow to brain to slow and cerebral hypoxia and ischemia to occur
  4. ICP continues to rise and the brain may herniate
  5. Cerebral blood flow ceases
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34
Q

Locations for Hemorrhage

A

Subdural Hematoma

Intracerebral Hematoma

Epidural Hematoma

35
Q

Subdural Hematoma area

A

Bleeding below the dura

36
Q

Epidural Hematoma area

A

Bleeding above the dura

37
Q

Intracerebral Hematoma area

A

Bleeding below the pia - brain tissue is bleeding

38
Q

Dura

A

what connects to the skull’s wall (inside the skull)

39
Q

Coup-Contrecoup Injury

A

When the brain hits a rough surface of the cranial vault leading to blood vessels, nerve tracts, and other structures to bruise and tear

40
Q

Why can Coup-Contrecoup injury occur

A

because the brain floats freely in the CSF BUT the brain stem is stable (like florets on a broccoli)

41
Q

Coup

A

The initial throwing of the brain against one side of the skull in a continuous motion –> causes damage immediately below site of impact

42
Q

Contrecoup

A

brain rebounds and strikes the opposite side of the skull –> injures regions in the brain opposite the side of impact

43
Q

Hematoma

A

Ruptured vessel resulting from vascular injury and bleeding but not necessarily a clot

Can occur in any compartment lie epidural, subdural, subarachnoid space, brain

44
Q

Epidural (Extradural) Hematoma

A

usually from head injury where skull is fractured

develops between the inner table of the bones of the skull and the dura

Immediate compression occurs

45
Q

There is a strong association between epidural hematoma and…

A

skull fractures

46
Q

Usually, epidural hematomas occur from what?

A

a tear in an artery leading to rapid compression of the brain

Arteries bleeding faster as they are under pressure but venous bleeding is slowed and insidious

47
Q

Most common area of the head for an epidural hematoma?

A

middle meningeal membrane located under the thin temporal bone

48
Q

What age group is more common for epidural hematoma?

A

in young b/c the dura is not as firmly attached to the skull surface and is easily stripped away allowing hematoma to form

this can mean shaken baby syndrome can lead to this

49
Q

When looking at a hematoma it is important to distinguish what

A

whether the bleeding is arterial or venous

50
Q

What is the presentation for an epidural hematoma?

A

Hx of head injury, a brief period of LOC followed by a lucid period with regained consciousness

This is then followed by a rapid progression to LOC again

51
Q

If an epidural hematoma is not removed…

A

increased ICP occurs –> tentorial herniation –> death

52
Q

What makes an epidural hematoma prognosis excellent

A

removal before loss of consciousness

53
Q

Epidural Hematoma Lucid Interval

A

does not always occur, but when it does its of diagnostic value

its a period of improvement followed by rapid decline again

54
Q

LOC, Lucid Period, Rapid LOC is pathonomic for…

A

epidural hematoma

55
Q

What causes the initial LOC and then the rapid LOC in epidural hematoma?

A

Initial LOC is from the injury

The second rapid LOC is from arterial blood loss

56
Q

Focal symptoms of epidural hematoma are related to …

A

area of the brain involved in injury

ex: Ipsilateral pupil dilation if pressure on optic nerve same side as injury

ex: Contralateral hemiparesis - opposite side effect since motor nerves cross at medulla oblongata

57
Q

Subdural Hematoma

A

Develops in the area between the dura and arachnoid space - the subdural space

Usually comes from a tear in the small bridging veins that connect veins on the surface of the cortex to the Dural sinuses - VENOUS TEAR = slower bleeding

58
Q

Where can bleeding for a subdural hematoma occur?

A

Between the dura and arachnoid

OR

into the CSF filled subarachnoid space

59
Q

Where does the tear usually occur for a subdural hematoma

A

usually in the small bridging veins that connect veins on the surface of the cortex to the Dural sinuses

These are readily snapped in head injuries when the brain moves suddenly in relation to the cranium

60
Q

Subdural Hematoma are classified based on …

A

time interval before appearance of symptoms

Acute, Sub acute, Chronic

61
Q

Acute, Sub Acute, and Chronic Subdural Hematoma occur within what time frames?

A

Acute - within 24 hours of injury

Sub acute - 2-10 days post injury - more dangerous than acute due to how slow it is

Chronic - several weeks after injury - can become recurrent problem

62
Q

Acute Subdural Hematoma

A

Progresses rapidly (within 24 hours) due to a larger venous bleed

High mortality rate from severe secondary injuries from increased ICP

Similar to an epidural hematoma clinically, but lacks lucid period

63
Q

The quicker the development of hematoma symptoms…

A

the quicker the treatment and the better the prognosis - subacute and chronic can be more dangerous than acute !

64
Q

What may occur due to increased ICP in an acute subdural hematoma

A

uncontrolled increase in ICP

loss of consciousness

decerebrate posturing

delay in surgical removal of the hematoma

65
Q

How does Acute Subdural hematoma differ from epidural hematoma?

A

They are clinically similar but there is no lucid period

So once they go unconscious they stay unconscious and do not wake up

66
Q

Subacute Subdural hematoma

A

There is a reasonable level of consciousness and are often sent home

However, after 2-10 days there is deterioration and by the time the bleed is found there is already extensive damage if it was not caught early

67
Q

Chronic Subdural Hematoma

A

Develops weeks after a head injury and the individual may not even remember the injury (especially elders)

Blood into the subdural space occurs very slowly

The blood is not absorbed and becomes encapsulated

Higher morbidity and mortality than with epidural and intracerebral hematoma

68
Q

What occurs to cause the symptoms and mortality/morbidity of a chronic subdural hematoma?

A

bleed cells slowly lysed as they bleed slowly –> fluid with high osmotic pressure forms –> this pulls in fluid from surrounding subarachnoid spaces –> increases in mass size –> Increased ICP occurs –> Decreased LOC, drowsiness, confusion, apathy, and HA ensue

Acts similarly to a tumor

69
Q

The earliest sign of increased ICP is…

A

loss of consciousness

70
Q

Intracerebral Hematoma

A

bleeding occurring in the brain tissue itself, and this often leaks into the CSF

bleeding is rapid and arterial in origin

can occur in any lobe but more common in frontal and temporal

can be one hematoma or more at once

71
Q

What groups more commonly have intracerebral hematoma? Why?

A

Elders and Alcoholics

Their brain vessels are more easily friable

72
Q

What lobes most commonly have intracerebral hematoma?

A

It can occur in any lobe, but most commonly its the frontal and temporal lobe

73
Q

S/S of Intracerebral Hematoma depend on …

A

size and location of the bleed

signs of increased ICP if large and encroaching on vital structures

74
Q

What location of an intracerebral hematoma leaves the potential for lateral herniation?

A

temporal lobe location

75
Q

What is the treatment for a rapidly developing versus a neurologically stable intracerebral hematoma?

A

Rapidly developing –> surgical evacuation of clot

Neurologically stable –> observation, gradual resolution

76
Q

When the location of an intracerebral hematoma is in the frontal lobe, where will the brain herniate

A

downward away - so opposite the direction of the frontal lobe

77
Q

Monitor blood pressure in hematomas because…

A

it can affect cerebral perfusion (lower it)

78
Q

Epidural hematomas are __ in origin

A

arterial

79
Q

Subdural hematomas are __ in origin

A

venous

80
Q

Intracerebral hematomas are __ in origin

A

arterial

81
Q

Burr Holes

A

4 holes made into the skull to remove a plate of bone and refrigerate it or put in another body part like the abdomen

Allows ICP pressure release and is important to keep ICP down

Once healed the bone is replaced

82
Q

Intraventricular Cerebral Bleeds occur into ventricles, and if this bleeds into the 3rd ventricle…

A

this is where the choroid plexus is and that is responsible for making CSF

83
Q

A cerebellar hemorrhage may impact…

A

gait and balance

84
Q

Basal Ganglia hemorrhage may impact…

A

a lot of movement control so it impacts voluntary motor control, cognition, emotions, eye movement, decision making, and dopamine creation

N361: Pathophysiology II (20 decks)

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