Neurologic Trauma Flashcards
What are the most common causes of traumatic brain injury?
- falls
- motor vehicle accidents
- collisions w/stationary or moving objects
- assaults
Who is at the highest risk for traumatic brain injury?
- males 15-24 years
- very young
- very old
Primary Traumatic Brain Injury
initial damage to the brain that results from the traumatic event
Primary TBI’s may include what?
- contusions
- lacerations
- torn blood vessels from impact
- acceleration/deceleration
- penetration by foreign object
Secondary Traumatic Brain Injury
evolves over the ensuing hours/days after the initial injury
Secondary TBI’s can be due to what?
- cerebral edema
- ischemia
- seizures
- infection
- hyperthermia
- hypovolemia
- hypoxia
Increased intracranial pressure can cause what?
Herniation of the brain through or against the skull
Herniation of the brain causes what?
- ischemia
- infarction
- irreversible brain damage
- brain death
What are skull fractures?
a break in the skull caused by forceful trauma w/ or w/o brain damage
S/S of Traumatic Brain Injury
- altered LOC
- confusion
- pupillary abnormalities
- sudden onset of neuro deficits
- changes in vitals
- vision/hearing impairment
- headaches
- seizures
When does a Closed (blunt) brain injury occur?
when the head accelerates and then rapidly decelerates or collides w/ another object and brain tissue is damaged but there is no opening
When does an Open brain injury occur?
when an object penetrates the skull, enters the brain, and damages the soft brain tissue in its path or when blunt trauma is so severe it opens the scalp
What is a Concussion?
alteration in mental status that results from trauma and may or may not involve LOC
How long do symptoms of concussions typically last?
24 hours
S/S of Concussions
- headache
- N/V
- photophobia
- amnesia
- blurry vision
Treatment for Concussion
- observing patient for worsening symptoms for next 24 hours
- woken every 2 hours in order to detect changes
- advise to resume normal activities slowly
What is a Cerebral Contusion?
bruising of the brain, w/ possible surface hemorrhage and the patient is unconscious for more than a few seconds or minutes
S/S of a Cerebral Contusion depend on what?
The size of the contusion and the amount of associated swelling of the brain
S/S of Cerebral Contusion
- motionless
- faint pulse
- shallow respirations
- cool, pale skin
If patient recovers consciousness w/ a Cerebral Contusion they may enter a state of what?
Cerebral irritability
What is a state of Cerebral Irritability like?
Patient is easily disturbed by any form of stimulation such as noises, light, and voices; may be hyperactive at times
What are some after effects of Cerebral Contusions?
- residual headache
- vertigo
- impaired mental function
- seizures
Decorticate Posturing
abnormal flexion of the upper extremities and extension of the lower extremities
Decorticate Posturing indicates damage to what part of the brain?
Upper midbrain
Decerebrate Posturing
extreme extension of the upper and lower extremities
Decerebrate Posturing indicates damage to what part of the brain?
lower midbrain and upper pons
What are Hematomas?
Collections of blood that develop w/in the cranial vault
What are the most serious types of brain injury?
Hematomas
Symptoms of hematomas are frequently delayed until when?
The hematoma is large enough to cause distortion of the brain and increased ICP
Where are Epidural Hematomas found?
Space b/t skull and the dura
Epidural Hematomas can result from what?
Skull fracture that causes a rupture or laceration of the middle meningeal artery
Symptoms of Epidural Hematomas are caused by what?
the expanding hematoma
S/S of Epidural Hematoma
- Momentary loss of consciousness occurs at the time of injury followed by an interval of apparent recovery
- increased ICP
- signs of compression
- decreasing LOC
- dilation/fixation of pupils
- paralysis of extremity
Why is an Epidural Hematoma considered an extreme emergency?
B/c marked neurologic deficit and respiratory arrest can occur w/in minutes
Treatment of Epidural Hematoma
- burr holes into skull to decrease ICP, remove clot and control bleeding immediately
- Craniotomy
- drain may be inserted after either procedures to prevent reaccumulation of blood
Where is a Subdural Hematoma located?
Between the dura and the brain a space normally occupied by a thin cushion of CSF
What is the most common cause of Subdural Hematoma?
Trauma
- bleeding disorders
- ruptured aneurysm
Who is at an increased risk for Subdural Hematomas?
Elderly b/c of whole brain atrophy
Acute Subdural Hematoma’s are associated w/ what major head injuries?
Contusion or laceration
How long does it take S/S of acute subdural hematoma’s to develop?
24-48 hours
S/S of Acute Subdural Hematomas
- changes in LOC
- changes in reactivity of pupils
- hemiparesis