Pathology of NS 2 Flashcards
TBI peaks at three points across the lifespan
Childhood at age 1-2 y
Ages 15-24 y
75 y or more (death is more likely)
TBI Incidence in sports
female > male
The Glasgow Coma Scale score is a quick and reliable test of neurologic function
Assess the level of consciousness
Scores eye opening, motor response, and verbal output to obtain a score between 3 and15
3-8
3-8 (severe TBI, loss of consciousness)
9-12
moderately abnormal
13-15
mild abnormality
Eye opening response
- No response
- To pain
- To speech
- Spontaneously
Verbal response
- No response
- incomprehensible sounds
- inappropriate words
- confused
- oriented to time, person and place
Motor Response
- no response
- abnormal extension
- abnormal flexion
- flex to withdraw from pain
- moves to localised pain
- obeys command
Neurological testing
Observation for signs
Basilar skull fracture
Battle’s sign (blood over the mastoid process)
Raccoon eyes
Pupillary examination
Tests the optic and oculomotor nerves
Corneal Reflex
Tests the trigeminal and facial nerves
Gag Reflex
Tests for glossopharyngeal and vagus nerves
Isolated lower extremity weakness could indicate a
SC injury
When quadriplegia is present, a
cervical spine injury must be suspected
Rectal Tone
S2-4
Rectal tone will be diminished in cases of spinal cord injury
Cognitive & Behavioral Impairments
Common
Confusion and disorientation
Difficulty problem solving
Delayed processing, motor and verbal disinhibition and lack of initiation
Combativeness and agitation
Poor social behavior and erratic wondering
Motor and sensory perseveration or restlessness
Motor Deficits
Flaccidity, spasticity, rigidity
Decorticate or decerebrate posturing
Hemiparesis
Loss of selective motor control
Abnormal balance reactions
Sensory loss
Cerebellar and basal ganglia dysfunction
Heterotopic Ossification
Abnormal bone growth outside of the skeleton
Around a joint
Cause unknown
Onset 4-12 weeks post injury
Heterotopic Ossification presents with
Loss of ROM
Local tenderness and palpable mass
Erythema, swelling, pain with movements
Poor Prognosis
<7 glasgow coma score
subdural hematoma
old age
pupil remains dilated (Light relfex)
eyes do not deviate (Caloric testing)
decerebrate rigidity
Better Prognosis
> 7 glasgow coma score
normal CT scan
youth age
pupil constricts (Light reflex)
eyes deviate to irrigated side (caloric testing)
localizes (defensive gesture) (noxious stimuli)
