Neuro- Class 2 - Trauma and injury Flashcards
Signs and symptoms of subdural hematoma?
– tenderness over hematoma – progressing dementia, generalized rigidity,
What is a transactions injury?
severing of spinal cord – most common when we think of spinal cord injury – total loss of function below injury – spinal coloum cut – not coming back
What can we see after the initial spinal shock injury is done?
We know that we lose everything due to spinal shock, but when the reflexes return then we can see the damage caused by the initial injury – similar to when secondary injury recovers – we may see some return of function
What kind of complication are post- traumatic seizures?
2-16% highest risk in open brain injuries – will develop seizures – start within days can last up to 2-5 years – not well understood, we do prophylactic treatments – use anti-seizure medications to prevent potential – can be short or long – not being diagnosed with epilepsy as we are expecting this to go away
Patho for autonomic dysreflexia?
1.) Noxious stimulus major SNS response: vasoconstriction
2.) Vasoconstriction below the injury causes increased blood volume above the injury
3.) Hypertension above the injury. Triggers parasympathetic response bradycardia and vasodilation
What happens over time with secondary spinal cord injuries?
– over time the tissue is replaced with collagenous tissue so within three to four weeks can have return of some function.
What can happen if autonomic dysreflexia goes untreated?
If left untreated – think about what is above the injury getting increased blood flow – below is not getting enough – seizures, pulmonary edema, renal insufficiency, MI, can cause cerebral edema can lead to brain injury or death
what is the patho behind the systemic and cerebral effects of a secondary brain injury?
First insult – inflammation – cerebral edema – increase intracranial pressure – compromises blood vessels -decreases cerebral blood flow – cerebral hypoxia & ischemia –
second insult which starts the circle over – ends up spiralling downwards
What is a TBI?
TBI – acquired injury – not born with
What is an aneurysm?
Spontaneous leakage of blood into brain tissue – in traumatic brain injury may have several intracerebral hematomas at the same time
What is autonomic dysreflexia?
noxious stimulus causes an exaggerated SNS response – causes vasoconstriction below injury – increased blood flow above injury
Primary Vs secondary brain injury?
Primary vs secondary – length of time is considered
Primary – immediate up to a few minutes to fully develop –
then we move into secondary injury phase – can start in minutes but can continue for days
What happens to supporting ligaments in spinal cord and vertebral injuries?
supporting ligaments are torn from spine – spine moves out of alignment – flection or extension or flexion rotation injury that results in dislocation
What is a blast primary brain trauma?
Brain injury caused by vibration through the brain
What is neurogenic shock?
Absence of sympathetic activity – parasympathetic is unopposed – vasodilation, Hypotension, bradycardia, poiklethermia
general signs and symptoms of Brian trauma?
loss of consciousness, other symptoms dependent on location
Severe diffuse axonal injury?
involving both hemisphere and brainstem – comatose state lasts days to months
What is a compressed vertebral fracture?
spine is pushed down on itself – no displacement – no other damage – loss of function or sensation – body will heal it’s self – sent home
Signs and symptoms of contusions?
S&S loss of consciousness, reflexes, may fall because of trauma
What is a focal injury brain trauma?
*It is a primary brain trauma
Focal injury – observable precise location – hit in the forehead or back of head – we can see where it was hit
What kind of spinal cord injury is a contusion/concussion?
– contusion or concussion similar to brain – results in temporary loss of function – bruising within neural tissue –
differentiate bleeding of neural tissue and bleeding into the neural tissue (hemorrhagic condition)
Brain trauma is defined as?
alteration of brain function caused by an external force
What is there a loss of in spinal shock?
complete loss of reflex, flaccid paralysis, loss of sensation, bowel and bladder control – may experience HTN poor venous circulation, hypothalamus can’t regulate temperature
Where on the spinal cord does autonomic dysreflexia occur?
someone with a spinal cord injury T6 or higher
Mild diffuse axonal injury?
decerebrate or decorticate posturing, prolonged stupor or restlessness
Ex of a primary brain trauma?
Something has come in contact with the brain:
1.) the head is hitting something like a wall or the ground
2.) the head is being hit with something like a bat
3.) shock waves are hitting the head – military trauma
Signs and symptoms of autonomic dysreflexia?
What is the hall mark symptom?
anxiety – bowel or bladder issues – blurry vision, dizzy, lightheaded, fever, diaphoretic above point of injury – all of this is happening in upper body –
profound hypertension – hall mark of autonomic dysreflex
Systemic Manifestations of a secondary brain injury?
Systemic - stroke, hypotension, anemia, hypoxia , hyper- or hypo- capnea
What area of the brain are contusions most common with? What does this control?
Majority contusions in frontal lobe, which controls our emotional, judgement, speaking, volunteer movements (review if needed what each area of the brain controls)
What are Patients with a primary injury are monitored for?
Patients with a primary injury are monitored for several days for secondary injury development
What can you get from a blast injury?
Vasospasms
With contusions the smaller the point of. impact the larger?
Smaller the point of impact = larger damage. consider larger object like a book at one speed vs hammer at same speed
What kind of spinal cord injury is a partial transaction?
Partial transection – may preserve some motor or sensory function below injury
Signs of a basal skull fracture?
– raccoon eyes or battle sign – blackened eyes - clear drainage from ears or nose -drainage has a halo sign characteristic outer circle around blood stain
-Patients will be bleeding behind their eyes, ears, CSF leaking
What is a primary closed focal TBI?
impact on the head without scalp breaking
What can a focal brain trauma result in?
can result in diffuse injury – long connecting fibers or our axons are sheared as the brain accelerates or decelerates
Traumatic Vs non traumatic brain injury?
Non Traumatic – disease process occurring within the body causes the injury
Traumatic – some force was exerted outside of the skull
What is post concussion syndrome?
have had a concussion – headache, dizziness, fatigue, nervousness, not normal feeling, anxious, irritable, sleep disrupted, depression, inability to concentration, ‘‘forgetfulness – weeks to months after concussion has occurred
Focal Vs diffuse brain injury?
Focal or diffuse – affecting only one area or affecting a larger portion of the brain – can you pinpoint where the injury is? Or is it all over?
What is a subdural hematoma? Where will it develop?
within the dura matter and brain – venous bleed – slow leaking bleed
10-20% with traumatic brain injury will have subdural hematoma – develops quickly – most common on top of skull
What is happening in autonomic dysreflexia?
Something is bothering you from below the injury – body is going into fight or filight and the parasympathetic isn’t responding
What are contusions?
– coup injury – compression at point of impact, oozing from blood vessel damaged at point of impact – brusing on the brain
Signs and symptoms of epidural hematoma?
– loss of consciousness at time of injury
1/3 lucid in a few minutes to days
2/3 Bleeding will continue to grow – headache vomiting, confusion, drowsiness, hemiparesis may develop
What will happen to LOC in a Epidural hematoma?
LOC will decrease quickly if severe hematoma – ipsilateral pupil dilation – same side of trauma – hit to right side – right pupil will dilate
Time frame for when autonomic dysrefelxia can occur?
Sudden onset – 1 month to 1 year after initial trauma – disconnect between SNS & PNS – message goes up to the brain, brain can’t get anything back down
Sympathetic – pushed into fight or flight response – parasympathetic is not responding properly
What is spinal shock?
It is the injury that happens immediately after injury – normal activity at or below the level of injury is completely gone
When there is a Laceration on face, inside mouth, around eye what do we need to investigate for?
investigate for potential skull fracture – something is going to be punctureing and pushing up into the bottom of the skull
Coup Vs countercoup brain trauma?
- Type of primary brain trauma
coup damage at site of impact
- contrecoup – bounce back injury - front of head is initial hit, bounce back on the back is the contrecoup injury – where our brain hit the skull?
- can have a coup/contrecoup injury where both sides are injured
Cerebral manifestations of a secondary brain injury?
Cerebral – inflammation, edema, Increased ICP, decreased cerebral perfusion pressure, ischemia, herniation
What are some long term cognitive complications with brain injuries?
long term complications that are cognitive – decrease in cognitive abilities – can have long term complications – pneumonia, recurrent infections – inability to ambulate – can lead to further brain injury and recovery
Most common region for a epidural hematoma?
Temporal fossa most common location – medial meningeal artery or vein – skull fracture
What does the severity of a TBI refer to?
mild/moderate/severe based on GCS, how long they were unconscious for, how much amnesia
What will babies have with shaken baby syndrome?
: Permanent vision & hearing loss, seizure disorder, developmental delays, cerebral palsy, subdural hematoma – can also have vertebrae damage – can crush spinal cord
What is there a loss of in burst or dislocation vertebral injuries?
in burst or dislocation there is loss of protection for spinal column – results from direct or indirect trauma
What is happening in a diffuse axonal injury?
there is damage being done to the neruons – can have it when somone goes hypoix
What kind of complication is chronic traumatic encephalopathy?
example - Mohamed Ali – recurrent traumatic brain injury – presents as progressive amnesia – strongly related to sports, also in blast injuries so seen in soldiers, also in work related head trauma – trips, slips, & falls – construction workers
What kind of injury us shaken baby syndrome?
This is a diffuse axonal injury
-Repeated coup injury as brain comes in contact with skull - causes diffuse axonal injury – getting banging back and fourth
Open Vs closed TBI?
Open or closed – penetrating wound – cranium opened up – or closed with no loss of skin integrity
What is a primary brain injury?
It is the point of contact, we start at looking if it is a open, closed or focal trauma
What is a epidural hematoma?
Epidural hematoma – artery is source of bleed – 80% accompanied by scull fracture which causes bleeding
What is a secondary spinal cord injury?
Similar to secondary brain injury
Cascade of vascular, cellular, biochemical events that starts within minutes of initial events but carries on for potential weeks causing further damage
Signs and symptoms of a moderate diffuse axonal injury?
when out of coma – confused, retrograde amnesia, antegrade amnesia, and may develop permanent deficits in speech, memory, attention, reasoning, vision, problem solving, language – change in mood, affect
In spinal cord injuries where does bleeding/bruising of neural tissue occur?
Bleeding/bruising of neural tissue occurs in contusion
Signs and symptoms of a mild concussion?
– potential amnesia – transient as well, headache, not feeling themselves for a few days
Signs and symptoms of a severe diffuse axonal injury?
-What injury will develop?
Autonomic dysfunction will subside in weeks, caused by increased intracranial pressure for over 6 days
Will develop pulmonary complications due to profound sensory/motor/cognitive deficits
What is a closed brain trauma?
Closed - Brain dura intact – no external exposure
What is a concussion?
Concussion is a mild traumatic brain injury – immediate transitory (memory suddenly disappears) – GCS 15 or a bit confused – lasts for only minutes
Chronic hematomas?
develop slowly, alcoholics due to brain atrophy which causes an increase in extra dura space
can develop bleed over weeks or months – extra space will slowly build up with blood
What is a cerebral concussion?
loss of consciousness lasts longer than a few minutes, but less than 6 hours
What do open traumatic brain injuries occur with? What kind of injuries can they be?
Open – traumatic brain injury occurs with penetrating trauma or with skull fracture
Can include focal and diffuse, compound skull fractures & missile type injuries – baseball bat vs bullet wound
simple vertebral fracture Vs Burst vertebral fracture?
simple fracture – no dislocation – no other damage – stable
burst fracture – one vertebrae – disintegration of vertebrae – damage to spinal column
What is a intracerebral hematoma?
– bleeding within the tissues of the brain – trauma, ruptured blood vessels
Looking at a ruptured aneurysm
What is a closed brain trauma?
Closed - Brain dura intact – no external exposure
Where on the spinal cord does autonomic dysreflexia occur?
someone with a spinal cord injury T6 or higher
What is shaken baby syndrome?
Shaken baby injury – brain injury caused by forceful shaking – occurs quickly, within 5 seconds
What kind of spinal cord injury is a compression injury?
pressure can cause ischemia – TX – decompress quickly to prevent damage – swelling, bleeding, and hypoix tissue is whats going to do the damage
What do secondary spinal cord injuries mask? what do they impair?
– impairs micro circulation results in inflammation, increases dysfunction
– can mask permanent damage
