Neurological alterations pt 2 - Traumatic brain & spinal cord injuries

Question 1

(Traumatic Brain and Spinal Cord Injury)

Which term is the primary cause of death and disability in individuals under the age of 40 - twice as many men as women, causes massive mental health issues with the survivals, & prevention is key such as helmet in sports seatbelts, air bags, decreased transport times to hospital?

Answer 1

Brain trauma

Question 2

(Traumatic Brain and Spinal Cord Injury)

Which term refers to an alteration in brain function or other evidence of brain pathology caused by an external force, which can either be primary or secondary?

Which term refers to an injury that is caused by direct impact and involves __ injury, primary __ injury, and vascular responses; where they can be __ or diffuse, Open or __?

The severity of __ ___ __ can be either mild, moderate, or severe based on __ __ __, how long they were __ for, how much __

Answer 2

Traumatic brain injury (TBI)
- Primary brain injuries; neural; glial; focal; closed
- TBI; Glasgow coma scale; unconscious; amnesia

Question 3

(Traumatic Brain and Spinal Cord Injury)

Primary brain injury is caused by direct impact and can be ___, affecting one area of the brain, or ___ (___ axonal injury [___]), involving more than one area of the brain.

Which term refers to a more common injury & involves either the head striking a hard surface or a rapidly moving object striking the head, or by blast waves, where the dura remains intact, and brain tissues are not exposed to the environment, causing focal (local) or diffuse (general) brain injuries?

Which term refers to an injury that occurs with penetrating trauma or skull fracture, where a break in the dura results in exposure of the cranial contents to the environment?

Answer 3

• Focal; diffuse; DAI
• Closed (blunt) trauma
• Open (penetrating) trauma

Question 4

(Traumatic Brain and Spinal Cord Injury)

An example of an acquired injury that you are not born with is..?

Which term refers to some force was exerted outside of the skull?

Which term refers to a disease process occurring within the body causes the injury?

Answer 4

• TBI
• Traumatic brain injury
• Non-traumatic brain injury

Question 5

(Traumatic Brain and Spinal Cord Injury)

__ __ injury can be caused by closed (blunt) trauma or open (penetrating) trauma.
__ __ is more common.

Answer 5

Focal brain; Closed injury

Question 6

(Traumatic Brain)

Which term refers to observable brain lesion Including contusion, laceration, epidural (extradural) hematoma, subdural hematoma, intracerebral hematoma, & open brain injury?

Which term refers to aseveretraumatic brain injuryin which thebrainis damaged,unlike aconcussionwithno or minimalbraindamage, & like bruises in other tissues, they can be associated with multiple microhemorrhages, small blood vessel leaks into brain tissue, & thereis alwaysloss of consciousnessfor atleastfifteenminutes, and theloss of consciousnessisdeeperthan in case of aconcussion?

Answer 6

Focal brain injury
- Brain contusions

Question 7

(Brain trauma)

In __ __ brain edema forms around injury & increases __ __. Could have multiple hemorrhages, __, infarction, __ within the ___.

Answer 7

Brain contusions; intracranial pressure; edema; necrosis; contusion

Question 8

(Brain trauma)

The majority contusions in the …? Affecting

Affecting emotions, ___, speaking, & ___ ___

Answer 8

• Frontal lobe
• Judgement; voluntary movements

Question 9

(Brain Hematomas)

Which term refers to bleeding between the dura mater and the skull, in which an artery is the source of bleeding 85% of the time, usually accompanied by a skull fracture, where the temporal fossa is the most common site caused by an injury to the middle meningeal artery or vein?

Manifestations include: ___ _ __ at time of injury –headache, ___, ___ may develop. & __ possibly will decrease quickly if severe hematoma –__ dilation at the same side of trauma

Answer 9

• Epidural (extradural) hematomas
  -Loss of consciousness; vomiting; hemiparesis; LOC; pupil

Question 10

(Brain Hematomas)

Which term refers to bleeding between the dura mater and the brain where
10-20% with traumatic brain injury will have __ ___, most commonly develop on top of skull?

__ hematomas are not as common

Which term refers to bleeding commonly found in older adults and persons who abuse alcohol and have some degree of brain atrophy with a subsequent increase in extradural space, & develops over weeks to months, also where the existing subdural space gradually fills with blood?

Manifestations include:

__, tenderness over hematoma, ___ ___, & generalized rigidity

Answer 10

Subdural hematoma
- Bilateral
- Chronic subdural hematomas
- Headaches; progressive dementia;

Question 11

(Brain Hematomas)

Which term refers to bleeding within the tissues of the brain due to traumatized ruptured blood vessels, where aneurysms are the main cause, but it can also be due to birth defects, hypertension, & tumours?

Answer 11

Intracerebral Hematoma

Question 12

(Brain injury)

How are potential compound skill fractures investigated?

For a basal fracture you should also investigate anywhere on the __ ___ or __ __ __ __ (Roof of mouth).

Signs of a basal skull fracture include:

(1) __ __ (blackened eyes) ; (2) ___ ___ (bruising behind the ears) 3) ___ __ from __ or __ - drainage has a halo sign characteristic outer circle of fluid has slight discoloration (CSF)

Answer 12

• Laceration on face, inside mouth, around eye
• Cranial vault; Base of the skull
• Racoon eyes; battle sign; clear drainage from ears or nose;

Question 13

(Brain injury)

General signs & symptoms of an open brain injury is..?

Basillar skull fractures can cause leakage of …?

Answer 13

• Loss of consciousness, & other symptoms dependent on the location
• CSF from meninges

Question 14

(Brain injury)

Which term involves widespread areas of the brain, where mechanical effects from high levels of acceleration and deceleration, such as whiplash, or rotational forces cause
shearing of delicate axonal fibres and white matter tracts that project to the cerebral cortex; Ranging from mild concussion to severe ___?

Answer 14

Diffuse brain injury (diffuse axonal injury [DAI])
- DAI

Question 15

(Brain injury)

Which term refers to an injury directly below the point of impact?

Which term refers to an injury from brain rebounding and hitting opposite side of skull (Injury on the side opposite the site of impact
)?

Answer 15

• Croup injury
• Contrecoup injury

Question 16

(Brain injury) —>Diffuse Brain Injury Categories:

Which term refers to a mild traumatic brain injury, with immediate but transitory clinical manifestations, where confusion lasts for 1 to several minutes, possibly with transient amnesia?

Which term refers to any
loss of consciousness lasting <6 hours accompanied by retrograde & anterograde amnesia with a confusional state lasting for hours to days; &
transient cessation of respiration can occur but will resolve quickly?

Which term refers to manifestations such as : Headaches; Dizziness; Fatigue; Irritability; Anxiety; Insomnia; Loss of concentration and memory; Ringing in the ears.

DAI severity corresponds to the amount of shearing force applied to the ___ & Coma that lasts longer than __ hours – caused by axonal destruction

Which term refers to when coma lasts 6 to 24 hours with 30% of persons displaying decerebrate or decorticate posturing, where they may experience prolonged periods of stupor or restlessness?

Which term refers to an injuey where the score on the Glasgow Coma Scale is 4 to 8 initially and 6 to 8 by 24 hours; decerebrate or decorticate posturing which may last days or weeks, &
when out of coma they are confused, post-traumatic retrograde amnesia, antegrade amnesia from point of trauma to now, may develop permanent deficits in speech, memory, attention, reasoning, vision, problem solving, language – change in mood, affect ?Also, 100% of children lose their friend group due to that much of a change in their behaviour/mood/affect.

Which term refers to an injury that involves both hemispheres and the brainstem, where the coma may last days to months?

Answer 16

• Mild concussion
• Classic cerebral concussion
• Post concussive syndrome
• Brainstem; 6
• Mild diffuse axonal injury
• Moderate diffuse axonal injury
• Severe diffuse axonal injury

Question 17

(Brain injury) –> Diffuse Axonal Injury

Which term refers to brain injury caused by forceful shaking that occurs quickly, within 5 seconds, where person experiences repeated coup injury as brain comes in contact with skull causing diffuse axonal injury? More common under 2 years – up to 5 years, most common 6-8 weeks

Which can cause permanent __ & __ loss, seizure disorder, developmental delays, __ __, subdural hematoma – can also have vertebrae damage

Manifestations include: Difficulty staying awake, __, abnormal RR, poor eating, ___, discolored skin, seizures, & __ __

Answer 17

• Shaken baby syndrome
• Vision; hearing; cerebral palsy
• Tremors; vomiting; coma paralysis

Question 18

(Brain injury)

Which term refers to an indirect result of primary brain injury, including trauma & stroke syndromes, where systemic & cerebral processes are contributing factors?

Systemic processes include: hypotension, __, anemia, __ or hypocapnia & signs of __

Cerebral contributions include: ___, cerebral edema, __ ___, decreased cerebral perfusion pressure, __ ___, & brain herniation.

Answer 18

Secondary brain injury
- Hypoxia; hypercapnia; stroke
- Inflammation; increased ICP; cerebral ischemia

Question 19

(Brain injury) –> Secondary brain injury cycle

Integral consequence of primary injury:
First insult, then inflammation & __ __, which ___ ___ pressure, thus ___ blood vessels, which decreases __ __ __, causing cerebral hypoxia & ___. The second insult which starts the circle over – ends up spiralling downwards

Thats why…Patients with a primary injury are monitored for several days for secondary injury development

Answer 19

• Cerebral edema; increases intracranial; compressing; cerebral blood flow; ischemia

Question 20

(Complications of Brain Injury)

Which term includes headache, dizziness, fatigue, nervousness or anxiety, irritability, insomnia, depression, inability to concentrate, and forgetfulness, may last for weeks to months after a concussion?

Which term occur in about 2 to 16% of TBIs, with the highest risk among open brain injuries, where seizures can occur early, within days, and up to 2 to 5 years or longer after the trauma, also the person experiences a Hyperexcitable state related to injury & repair?

Which term refers to a progressive dementing disease that develops with repeated brain injury associated with sporting events, blast injuries in soldiers, or work-related head trauma; & long term complications include decreases in cognitive abilities & an inability to ambulate?

Answer 20

• Post concussion syndrome
• Post-traumatic seizures
• Chronic traumatic encephalopathy

Question 21

(Spinal cord and vertebral injury)

Which term includes risk factor, such as age 20-39 years, 75% occur in males, with the leading causes being: Motor Vehicle Accidents, sports, & violence? & Risks with people over the age of 70 due to falls related to increase in degenerative disorders

Answer 21

Spinal cord and vertebral injury

Question 22

(Spinal cord and vertebral injury)

Which term refers to the initial mechanism that causes the trauma & immediate tissue destruction
due to contusion or concussion similar to the brain & results in temporary loss of function & bruising within neural tissue; It may occur in absence of vertebral fracture or dislocation?

Answer 22

Primary spinal cord injury

Question 23

(Spinal cord and vertebral injury)

Which type of spinal cord where pressure on cord causes ischemia to tissues; must be relieved (decompressed) to prevent permanent damage to spinal cord?

Which type of spinal cord injury includes tearing of neural tissue & may be reversable dependent on what part of the spinal column is affected?

Which type of spinal cord injury includes severing of spinal cord, & is the most common when we think of spinal cord injury with total loss of function below injury?

Which type of spinal cord injury may preserve some motor or sensory function below injury?

Answer 23

• Compression
• Laceration
• Transection
• Partial transection

Question 24

(Spinal cord and vertebral injury)

Which term results from forces of acceleration or deceleration and sudden reduction in anteroposterior diameter of spinal cord?

Which term results from sudden and excessive force that propels neck forward or causes an exaggerated lateral movement of neck to one side?

Which term results from a force applied along an axis from top of cranium through vertebral bodies?

Which term results from adding shearing force to acceleration forces?

Answer 24

• Hyperextension injury
• Hyperflexion injury
• Compression injury
• Flexion-rotation injury

Question 25

(Spinal cord and vertebral injury)

Which term results from acceleration, deceleration, or deformation forces occurring at impact?

Answer 25

Vertebral injuries

Question 26

(Spinal cord and vertebral injury) —> Fracture of vertebrae:

Which type of vertebrae fracture has no dislocation, no other damage, & it’s stable?

Which type of vertebrae fracture is when the spine is pushed down on itself, with no displacement – loss of function or sensation?

Which type of vertebrae fracture where one vertebrae is disintegrated & there is damage to spinal column?

Which type of vertebrae fracture caused by flection or extension or flexion rotation injury, which is a fracture that no longer supports the spinal column, & supporting ligaments are torn from spine; spine moves out of alignment & may damage sensory motor function?

Answer 26

• Simple fracture
• Compressed (wedged) vertebral fracture
• Burst fracture
• Dislocation

Question 27

(Spinal cord and vertebral injury)

Which term refers to a pathophysiological cascade of vascular, cellular, biochemical events that starts within minutes of initial events but carries on for potential weeks causing further damage, with microscopic ___ in grey matter that continues until all grey matter is ___ in that area, which can become necrotic which leads to edema In the white matter?

It also impairs micro circulation results in __ & edema which increases dysfunction.
However, over time the tissue is replaced with __ tissue so within three to four weeks can have return of some function.

Answer 27

Secondary spinal cord injury
- Hemorrhage; hemorrhagic; edema
- Inflammation; collagenous

Question 28

(Clinical Manifestations of Spinal Cord Injury)

Vertebral injuries in adults occur most often at vertebrae __ to __ (“Hang” man fracture),
__ to __, & T10 (thoracic) to __ (__), are the most __ __ of the vertebral column.

Answer 28

• C1 to C2; C4 to C7; L2 (lumbar); mobile portions

Question 29

(Clinical Manifestations of Spinal Cord Injury)

Which term refers to symptoms related to level of injury, where paralysis of the lower half of the body with both legs involved is called __; Paralysis involving all four extremities is called __.
; lose of bowel & bladder functions?

Which term includes the possibility of seeing asymmetrical loss – may see partial … but not complete, less severe bowel and bladder issues, may have some sensory perception below level of injury?

Answer 29

• Complete cord transection; paraplegia; quadriplegia
• Partial cord transection

Question 30

(Clinical Manifestations of Spinal Cord Injury)

Which term is caused by a spinal cord injury with cessation of all motor, sensory, reflex, & autonomic functions below the transected area, where loss of motor and sensory function depends on the level of injury?

It lasts about 1 – 2 weeks, & can be as short as a few days or up to 3 months, & when we have return of reflexes then we know __ ___ has ended then we can see the damage caused by the initial injury

Answer 30

Spinal shock

Question 31

(Clinical Manifestations of Spinal Cord Injury)

Which term occurs with cervical or upper thoracic cord injury (above __) and can occur concurrently with spinal shock, and is caused by the absence of __ activity=> parasympathetic is unopposed => manifesting into hypotension, __, and __ __, & hypothermia?

Answer 31

Neurogenic shock
- T5; sympathetic; bradycardia; peripheral vasodilation

Question 32

(Clinical Manifestations of Spinal Cord Injury)

Which term refers to a syndrome of sudden, massive reflex sympathetic discharge associated with spinal cord injury at level __ or above where ___ inhibition is blocked, it can happen during 1 month to 1 year after initial trauma due to a disconnect between SNS & PNS where the message goes up to the brain, but brain can’t get anything back down? (Bascially its massive, uncompensated cardiovascular response to a noxious stimulus (pain, distention in hallow organs such as bladder and intestine ) below the level of the cord lesion?

Manifestations include..?

& if left untreated can result seizures, __ hemorrhage, __ edema, renal insufficiency, __ __, ___ hemorrhage, &, ultimately, death

Answer 32

Autonomic dysreflexia
- T6; descending
- High BP, low Heart rate, sweating & blushing above point of injury, & anxiety
- Retinal; pulmonary; myocardial infarction; cerebral