neutrotrauma

Question 1

what is a life threatening pathology

Answer 1

Brain herniation

Question 2

what is a herniation

Answer 2

limited space - increased volume within the space - CSF displaced - changes in the cerebral blood flow/volume
compression of the flow of CSF can further increase ICP

Question 3

what is Cushing Triad

Answer 3

elevated ICP = Hypertension, Bradycardia, Irregular breathing

Question 4

what is it called when a patient reports with hypertension, bradycardia and irregular breathing

Answer 4

Cushing Triad

Question 5

what is an uncal transtentorial herniation

Answer 5

most common
uncus of temporal lobe is pushing inferiorly
through the tentorium
most common due to compression of temporal and lateral middle fossa
*COMPRESS CNIII (OCULOMOTOR) CAUSING IPSILATERAL FIXED DILATED PUPIL
needs immediate surgery - or death

Question 6

what is burr hole the treatment for

Answer 6

emergent release of uncontrolled bleed

Question 7

what is central transentorial herniation

Answer 7

bilateral pinpoint pupils
typically with midline lesion (frontal or occipital)
Babinksi sign
increased tone
hyperventilation
decorticate posturing

Question 8

what is decorticate posturing

Answer 8

arms flexed up and in and plantar flexion
first

Question 9

what is decerebrate posturing

Answer 9

arms extended and wrist flexed and plantar flexion
second

Question 10

what is Cerebellotonsilar herniation

Answer 10

cerebellar tonsils are pushing through the foramen magnum
pinpoint pupils
flaccid paralysis
death

Question 11

what are the layers of the Dura

Answer 11

Scalp
skull
periosteal dura matter
meningeal dura matter
arachnoid mater
subarachnoid space
pia matter
cerebral cortex

Question 12

what is an epidural hemorrhage

Answer 12

least common head bleed - most lethal
bleeding between skull and dura mater
most common in the temporal fossa
involves the middle meningeal artery
can result in herniation

Question 13

what are the common symptoms of epidural hemorrhage

Answer 13

N/V
HA
Stupor/coma
ipsilateral CNIII palsy
contralateral hemiparesis

Question 14

what is a subdural hemorrhage

Answer 14

most common traumatic intracranial mass
tearing of veins between the dura and arachnoid leading to collection of blood
often occurs in the elderly and ETOH abuse
may be acute, chronic or subacute
can cross suture lines

Question 15

what is the presentation of subdural hematoma

Answer 15

headache
drowsiness
agitation
slowing of cognition
confusion
LOC
respiratory changes
pupillary dilation
visual field defects
faze palsy (compression of the CN)

Question 16

what is a key presentation of an epidural bleed

Answer 16

lucid interval

Question 17

what is a chronic subdural hematoma

Answer 17

develops over weeks to months
presents with symptoms of expanding mass - increased ICP
can compress vessels - alteration in cerebral blood flow
can lead to herniation
over time, vascular membrane will form around the hematoma but area of bleeding may continue to increase

Question 18

what are intraparenchymal hematoma

Answer 18

bleeding within the tissue of the brain (not a dural space)
may have singular or multiple bleeds
most commonly in temporal or frontal lobes
may be from penetrating or shear trauma which break local vessels

Question 19

what is diffuse axonal injury

Answer 19

clinical diagnosis initially after trama (often coup, countrecoup injury)
shearing injury of axonal fibers - reduces conduction - would see physical tearing with electron microscope

Question 20

what are the types of diffuse axonal injury

Answer 20

mild coma: 6-24 hours
moderate: 24 hours without posturing
severe: >24 hours with brainstem impairment

Question 21

What is a cerebral contusion

Answer 21

edema at area of contusion
may have no imaging abnormalities
can be severe enough to have significant edema noted on imaging

Question 22

what is a secondary brain injury

Answer 22

initial insult leads to:
cerebral edema
increased ICP
decreased cerebral perfusion pressure
cerebral ischemia
disruption of the BBB and neuronal death
brain herniation

Question 23

Where are autonomic motor nuclei located within the spinal cord

Answer 23

grey matter

Question 24

what does the ventral root do

Answer 24

carry motor out of the cord

Question 25

what does the doral root do

Answer 25

carries sensory information to the cord

Question 26

what carries motor out of the cord

Answer 26

ventral/visceral efferent fibers

Question 27

what carries sensory information to the cord

Answer 27

dorsal root - somatic afferent fibers

Question 28

what is a complete spinal injury

Answer 28

traumatic disruption of the entire cord
insensate, areflexic and immobile distal to the site of the injury

Question 29

what is an incomplete spinal cord syndrome

Answer 29

only a section of the cord has been injured
may not only be associated with trauma but also malignancy or other compressive pathology

Question 30

Upper motor neurom defect

Answer 30

+ Babinski
hyperreflexia
NOT much atrophy
NO fasiculation/fibrillation
Spastic paralysis

Question 31

Lower motor neuron defect

Answer 31

NO babinksi
hyporeflexia
fasciculationa nd fibriltation
atrophy
flaccid paralysis

Question 32

what do patients with neurogenic shock present with

Answer 32

hypotension and bradycardia

Question 33

what is neurogenic shock

Answer 33

disruption of the autonomic pathway (sympathetic and parasympathetic)
hemodynamic compromise
circulatory failure due to loss of vascular resistance - can lead to multiorgan failure and mortality
typically resolves in 24-48 hours

Question 34

what is spinal shock

Answer 34

trauma to the cord itself leads to transient neurogenic upset
immediately after the cord injury patient will be areflexic and have flaccid paralysis
resolves within 24-72 hours