Neuro Trauma

Question 1

One of the most important factors in the
severity of head injury is a _____

Answer 1

scalp laceration

Question 2

Important Physical
Exam Findings for neurotrauma

Answer 2

○ Raccoon eyes (bilat orbital ecchymosis),
bleeding from the ear, and Battle Sign
(ecchymosis over the mastoid process) are
all signs of skull fracture, specifically a
basilar or temporal fracture

Question 3

If the patient is coherent, have them lean
forward a little for about 60 seconds,
watching for _____

Answer 3

watery otorrhea or rhinorrhea
■ Can be a sign of CSF leak, further
evidence of a Basilar Skull fracture

Question 4

Watch for signs of ______, which can indicate severe, irreversible brain or brainstem damage

Answer 4

abnormal posturing

Question 5

30% of skull fractures also have
_____

Answer 5

significant contrecoup findings,
such as contusions or SAH

Question 6

Diagnostic imaging modality of choice for skull fractures is ______

Answer 6

noncontrast CT

Question 7

If the fracture has more than ____ of depression, surgical intervention is recommended, even if no apparent bleed

Answer 7

0.5 cm

Question 8

Temporal bone fractures can cause damage to the _____ cranial nerves

Answer 8

7th and 8th

Question 9

______ may also present with raccoon
eyes, Battle sign, bleeding from the ear(s), or cranial nerve palsies

Answer 9

Basilar skull fractures

Question 10

A lab test called _____ is available at
most large facilities and can confirm whether or not the watery otorrhea/rhinorrhea is actually CSF.

Answer 10

Beta-2 Transferrin

Question 11

70% of EDHs are found in the _____

Answer 11

temporal or parietal area

Question 12

Epidural Hematoma

Answer 12

● EDHs are almost always associated with significant, severe head injury.
● 70% of EDHs are found in the temporal or parietal area.
Epidural Hematoma
● 90% are found with a skull fracture that has
lacerated or torn the underlying Middle
Meningeal Artery.
● Appearance is that of a lens (lenticular)

Question 13

“Classic” history for an epidural hematoma

Answer 13

LOC initially, followed by a “Lucid Interval,” and then neurologic decline

Question 14

Subdural Hematoma

Answer 14

● Acute SDH occurs in approximately 15% of severe head injuries
● Occurs secondary to shearing injury of
bridging dura-to-cortex veins.
● Symptomatic SDHs with mass effect or
midline shift should undergo surgery

Question 15

Traumatic Subarachnoid Hemorrhage

Answer 15

● Traumatic SAH (as opposed to the
aneurysmal type) usually occurs as part of
the contrecoup injury.
● The blood characteristically follows the sulci
in between the gyri.
● Can irritate the surface of the brain and may be a strong contributor to ongoing fatigue, headaches, nausea, vomiting, etc

Question 16

Traumatic SAH (as opposed to the
aneurysmal type) usually occurs as part of
the ______

Answer 16

contrecoup injury.

Question 17

Intraparenchymal/Cerebral Contusion

Answer 17

● Cerebral contusions are traumatic “bruises” of the intraparenchymal tissue of the brain.
● Most often a result of the contrecoup injury

Question 18

Patients with comorbidities or are on anti-clotting medications are at high risk of _____t contusions hat may require surgical intervention

Answer 18

“blooming” or expanding
contusions

Question 19

______ contusions are the most dangerous because of swelling into brainstem

Answer 19

Temporal lobe

Question 20

Intraventricular Hemorrhage

Answer 20

● Hemorrhage into the ventricular system occurs with approximately 2% of
minor-to-moderate head injuries, but as many as 35% of moderate-to-
severe head injuries, and is a poor prognostic indicator

Question 21

As many as 70% are actually an extension of another type of nearby
hemorrhage

Answer 21

Intraventricular Hemorrhage

Question 22

Blood can “clog” up the intraventricular ducts and the fourth ventricle, which leads to an _____

Answer 22

obstructive hydrocephalus

Question 23

Cerebral Perfusion Pressure (CPP) =

Answer 23

Mean Arterial Pressure (MAP) -
Intracranial Pressure (ICP)

Question 24

If ICP increases without MAP
______ , CPP decreases

Answer 24

increasing

Question 25

While injury to the spinal cord can occur secondary to whiplash (most
commonly central cord syndrome), most severe cord injuries are usually related to _____

Answer 25

fracture-dislocation injuries

Question 26

If the cord is only compressed and
not “cut,” severe and permanent
damage may still occur secondary to
_____ in the cord.

Answer 26

ischemia

Question 27

Total transection of the cord results in immediate _____

Answer 27

flaccid paralysis and full
loss of sensation below the level of the lesion

Question 28

What happens in the weeks following a total transection of the spinal cord?

Answer 28

● Reflexes are initially lost (absent), and urinary and fecal retention occur.
● Over the following days to weeks,
hyperreflexia, extensor plantar response (+Babinski), and spastic paraplegia or quadriplegia develops.

Question 29

Chronic or slowly-developing injury to the cord can occur with ______

Answer 29

Cervical Spondylosis with Myelopathy

Question 30

Degenerative changes in the spine result in _____ with cord compression

Answer 30

Cervical Spinal Stenosis

Question 31

Unilateral Hemitransection results in _____

Answer 31

ipsilateral loss of motor function and vibration sensation and proprioception, with contralateral loss of pain and temperature sensation
○ Also called Brown-Sequard Syndrome

Question 32

____ occurs often with whiplash injuries or a quick “punching” of the spinal cord at an unstable level.

Answer 32

Central Cord Syndrome

Question 33

Central cord syndrome often results from _____

Answer 33

a spinal cord contusion at the
level that suffered the impingement/assault

Question 34

If spinal fractures, dislocations, or spinal cord trauma is suspected, the entire
spinal axis should be imaged with ____

Answer 34

CT scan