Pathophysiology - Final Flashcards
What is a TBI?
Trauma to brain, neck, SC causing many types of disabilities and even death
What does ICP stand for?
intercranial pressure
Loss of consciousness for more than 30 minutes and memory loss after the injury lasting more than 24 hours is indicative of:
severe brain injury
Paralysis results from injury to what?
The brain and SC
How does a primary injury TBI occur?
Brain tissue comes in contact with object or rapid acceleration/deceleration of brain
What are contact injuries?
Contusions, lacerations, intracerebral hematomas.
Coup/contracoup/focal
How does a secondary injury TBI occur?
Secondary cell death bc of cellular events following tissue damage
What is the term for head trauma that does not physically bruise the brain tissue?
Concussion
What is the term for head trauma that is more serious, and is a physical bruising of the brain tissue and often occurs when the skull is fractures?
Contusion
Area of bruised lesions is called a…
coup
Area of a bruised lesion and injury on opposite side of brain…
contracoup lesion
Post concussion syndrome
refers to symptoms that may occur for weeks following a concussion including headache, difficulty sleeping, fatigue, short term memory issues, sensitivity to light or noise
What is a contusion termed if the blow to the head results in brain tissue being torn?
Cerebral laceration
Can a cerebral laceration increase in size over hours/days causing deteriorations in brain function?
YES
What is more common? Contusions or concussions?
Concussions
Contusions are 20-30% of head injuries
What are some sx’s of concussions and contusions?
Unconsciousness, amnesia, blurred vision, headache, vomiting, irritability
What is the main symptom of both concussions and contusions?
Unconsciousness
How is a concussion and contusion diagnosed?
Hx, head x-ray, neuro exam, CT, MRI, Glasgow coma scale, ranchos los amigos scale
T or F?
Better outcomes are achieved with PT occurs in familiar settings with a pt who has had a TBI
True
What is tx for a concussion?
Rest/sleep under direct supervision, waking the pt every 2-4 hrs to check for consciousness changes, mood, pupil size
What is a tx for a contusion?
Hospitalization and continuous monitoring
Should pts with head injuries take analgesics, sedatives, or stimulants? Why?
No - you do not want to alter how they feel or their sx’s so that you can correctly gauge their progress
How can skull fractures occur and what is a big risk here?
Skull fractures can occur from MVA, fall, blow to the head, etc.
The risk is that fragments of bone may cut the brain and its vessels, resulting in a hematoma
Fractures near the base of the skull can cause injury to what part of the brain?
They can cause injury to the respiratory center of the brain, resulting in cessation of breathing.
What is performed if increased ICP occurs?
Craniotomy
What is the term for a collection of blood between the skull and dura mater?
Epidural hematoma
What is the term for collection of blood between the dura mater and arachnid layer?
Subdural hematoma
Which is more common? Epidural or subdural hematoma
Subdural hematoma
What causes an epidural hematoma?
Blow to the head like a bat
What causes a subdural hematoma?
Caused by head striking an immobile object like falling to the ground
What are the sx’s of an epidural hematoma?
Dilated pupils, headaches, dizziness, nausea and vomiting, increased ICP, loss of consciousness
What are sx’s of a subdural hematoma?
Increased ICP, hemiparesis, nausea, vomiting, convulsions, dizziness, loss of consciousness
What can be done to drain blood from the brain and cauterize tissue to stop further bleeding in an epidural or subdural hematoma?
Burr holes
What is the term for bleeding into the subarachnoid space between the Pia mater and arachnoid mater?
Subarachnoid hematoma
What is a subarachnoid hematoma caused by?
Usually caused by rupture of an aneurysm in an artery resulting in a sudden and severe headache and short period of unconsciousness
What is the term for sudden loss of neurological function caused by an interruption in blood flow to the brain?
Stroke
What kind of stroke is most common, affecting 80% of people and results from thrombosis, embolism, and hypo perfusion?
Ischemia stroke
What kind of stroke occurs when blood vessels, rupture causing leakage of blood in or around the brain?
Hemorrhagic stroke
A stroke can be classified as one if neurological deficits persist for at least how many hours?
24 hrs
Under 34 hrs is a TIA (transient ischemic attack)
What is the term for paralysis?
Hemiplegia
What is the term for weakness?
Hemiparesis
In a stroke, is the affected side usually opposite of the side of the brain that has the lesion?
Yes
Stokes are classified by what? (3)
- Etiology (hemorrhage, thrombus, embolism)
- Which artery is involved (anterior cerebral artery, middle cerebral artery, etc)
- Management categories (TIA, minor stroke, young stroke, deteriorating stroke, etc)
Do women or men have a higher prevalence of strokes?
Men, and then it switches around 85 years old
Survival rates of strokes are lessened by what?
Increased age, htn, heart disease, dm
What are some risk factors for strokes?
htn, dm, hld, smoking, heart disease, CKD, sleep apnea, women’s early menopause, preeclampsia, pregnancy and 6 wks ppm, use of estrogen or estrogen + progestin
What is the acronym for spotting a stroke?
BEFAST - balance, eyes, face, arms, speech, time
Within minutes of blood flow stopping during a stroke, what dies?
Neurons die in ischemia core tissue (neurons need 20-25% blood flow to survive)
In a stroke, what can occur that can elevate ICP leadings to herniation of the brain stem and is the most common cause of death in an acute stroke
Cerebral edema
What is the most common site of occlusion of a stroke?
Middle Cerebral Artery (MCA)
