S3_L6: Traumatic Brain Injury Flashcards
The sole reference of this flashcard deck is Merritt's Neurology, 14th ed.
Linear skull fractures occur most commonly in what region, where the skull is thinnest?
temporoparietal
Source: Merritt 14th ed
It is a skull fracture where one or more fragments of bone are displaced inward, compressing the underlying brain
Depressed skull fracture
It is a skull fracture where there are multiple, shattered bone fragments, which may or may not be displaced.
Comminuted skull fractures
It is a mild TBI without obvious structural abnormality identified on standard neuroimaging. Loss of consciousness is a result.
Cerebral concussion
It is considered the single most important cause of persistent disability after traumatic brain damage.
Diffuse axonal injury (DAI)
Axonal shearing injury tends to be most severe in specific brain regions that are anatomically predisposed to maximal stress from what type of force?
Rotational forces
Small hemorrhages that are sometimes associated with focal-shearing lesions
Traumatic microbleeds
It is a focal parenchymal hemorrhage that result from scraping and bruising of the brain as it moves across the inner surface of the skull.
Cerebral contusion
Where are the most common sites of traumatic contusion as brain tissue in these areas come in contact with irregular protuberances at the base of the skull?
Inferior frontal and temporal lobes
These are linear tears of the meninges or cerebral tissue, usually a result of cuts from the sharp edges of depressed skull fragments.
Lacerations
These are focal collections of blood clots that displace the brain, in contrast to contusions, which resemble bruised and bloodied brain tissue.
Hematomas
TRUE OR FALSE: Contusions are found in cortical areas while most parenchymal hematomas are located in the deep white matter.
True
Subdural hematomas usually arise from what source?
Venous source
In subdural hematomas, blood fills the potential space between which membranes of the brain?
Dural and arachnoid membranes
Where are most subdural hematomas located?
Over the lateral cerebral convexities
Note: Subdural blood may also collect along the medial surface of the hemisphere, between the tentorium and occipital lobe, between the temporal lobe and the base of the skull, or in the posterior fossa
The Glasgow Coma Scale is based what three individual components?
- Eye opening
- Patient’s best verbal responses
- Patient’s best motor responses
It is a widely used as a semiquantitative clinical measure of the severity of brain injury. It also provides a guide to the prognosis.
Glasgow Coma Scale
A patient is in the comatose state. What is their Glasgow Coma Scale score?
Less than or equal to 8
An epidural hematoma, or bleeding into the epidural space, is usually caused by a tear in the wall of what artery?
Middle meningeal artery
TRUE OR FALSE: Elderly or alcoholic patients with cerebral atrophy are particularly prone to subdural bleeding.
True
In a subdural hematoma, the CT scan usually reveals a high-density, ____ collection across the entire hemispheric convexity
Crescentic / Cresent-shaped
You suspect a patient of yours to have a basilar skull fracture. Standard skull x-rays have not catched anything. What test and setting can you use to better identify structures in the brain?
CT bone windows
Brain injuries occur at all ages, but the peak between what age range?
15-24 years old
Head injury is the leading cause of death among people younger than the age of?
24 years
Traumatic brain injury is more prevalent in which sex?
Men are affected 3 or 4 times as often as women
A fracture wherein the scalp was lacerated over it is considered as?
Open or compound fracture
Match the risk category with its corresponding characteristics
- Focal neurologic signs
- May complain of headache and dizziness
- Posttraumatic amnesia
- May have scalp abrasion, laceration, or hematoma
- Alcohol or drug intoxication
A. Mild
B. Moderate
C. Severe
- C
- A
- B
- A
- B
Match the risk category with its corresponding characteristics
- Normal neurologic examination
- Glasgow Coma Scale score of 3-8
- Penetrating skull injury or palpable depressed skull fracture
- No drug or alcohol intoxication
- Concussion, vomiting, seizure
A. Mild
B. Moderate
C. Severe
- A
- C
- C
- A
- B
Match the risk category with its corresponding characteristics
- Progressive decline in level of consciousness
- Glasgow Coma Scale score of 9-14
- No concussion
- Comatose
- Unreliable or no hx of injury
A. Mild
B. Moderate
C. Severe
- C
- B
- A
- C
- B
Match the risk category with its corresponding characteristics
- Age <2 y/o, >65 y/o
- Signs of possible basilar or depressed skull fracture of serious facial injury
- “talked and deteriorated”
- Confused, lethargic, stuporous
A. Mild
B. Moderate
C. Severe
- B
- B
- C
- B
Most epidural hematomas are located over the convexity of the hemisphere in which cranial fossa?
Middle cranial fossa
Note: Occasionally, hemorrhages may be confined to the anterior fossa, possibly as a result of tearing of anterior meningeal arteries.
TRUE OR FALSE: Coagulopathy and oral anticoagulants are important risk factors for subdural hematoma and is associated with increased mortality.
True
In the neurologic assessment, the skull should be palpated for fractures, hematomas, and lacerations. A step-off or palpable bony shelf may indicate?
A depressed skull fracture
The patient is conversant and disoriented. What score is given to this patient according to the Glasgow Coma Scale?
4
The patient opens the eyes to hearing a voice. What score is given to this patient according to the Glasgow Coma Scale?
3
The patient’s best motor response is extensor posturing. What score is given to this patient according to the Glasgow Coma Scale?
2
The patient’s best motor response is localizes to pain. What score is given to this patient according to the Glasgow Coma Scale?
5
The patient’s best verbal response is incomprehensible sounds. What score is given to this patient according to the Glasgow Coma Scale?
2
The patient’s eyes open spontaneously. What score is given to this patient according to the Glasgow Coma Scale?
4
The patient’s best motor response is withdrawing to pain. What score is given to this patient according to the Glasgow Coma Scale?
4
The patient’s best motor response is flexor posturing. What score is given to this patient according to the Glasgow Coma Scale?
3
TRUE OR FALSE: Among older adults, the most prevalent TBI mechanism of injury is falls, and TBIs occur more commonly in women.
True
TRUE OR FALSE: Skull fractures are important markers of a possibly serious injury but rarely cause problems by themselves
True
Most common skull fracture
Linear skull fracture
TRUE OR FALSE: In most cases, depressed fractures are open (or “compound”) and liable to become infected or leak cerebrospinal fluid (CSF).
True
TRUE OR FALSE: Most patients with concussion have normal CT or magnetic resonance imaging (MRI) findings because concussion results from physiologic, rather than structural, injury to the brain.
True
What is the term for a traumatic coma lasting more than 6 hours?
Diffuse axonal injury
Determine whether the DAI is mild or moderate or severe
- Coma lasting more than 24 hours
- Coma of 6 to 24 hours duration
A. Mild DAI
B. Moderate or severe DAI
- B
- A
Hypertension, hyperhidrosis, and hyperpyrexia are autonomic dysfunctions common in patients with acute severe DAI. These may reflect injury to which two structures?
Injury to the brainstem or hypothalamus
Fill in the blanks of the Criteria for hospital admission after head injury.
- Intracranial blood or fracture identified on (1)___
- Confusion, agitation, or depressed level of (2)___
- (3)___ neurologic signs or symptoms
- Posttraumatic (4)___
- Alcohol or drug intoxication
- Significant (5)___ medical illness
- Lack of a reliable home environment for observation
- Head CT
- Consciousness
- Focal
- Seizure
- Comorbid
What is the possible treatment for large, parenchymal hematomas with mass effect?
Surgical evacuation
Post-traumatic brain swelling may result from (1)___, an increase in cerebral blood volume (CBV) resulting from abnormal (2)___, or both.
- cerebral edema
- vasodilatation
TRUE OR FALSE: Brain swelling may follow any type of head injury
True
Due to lateral forces, a contusion may occur at the site of the blow to the head, known as?
Coup lesion
Due to lateral forces, a contusion may occur at the opposite pole as the brain impacts on the inner table of the skull, known as?
Contrecoup lesion
When rotational forces lead to tearing of small- or medium-sized vessels within the parenchyma, what may occur?
Intracerebral hematoma
Acute subdural hematomas are symptomatic within (1)___ of injury, while chronic subdural hematomas become symptomatic after (2)___.
- 72 hours
- 21 days
What are the most common focal neurologic signs after an acute subdural hematoma?
Hemiparesis and pupillary abnormalities
Note: The usual picture is ipsilateral pupillary dilation and contralateral hemiparesis
Extradural hemorrhage in the posterior fossa may occur when what structure has been torn?
Torcular herophili
TRUE OR FALSE: Epidural hematoma is primarily a problem of young adults.
True
Note: It is rarely seen in the elderly because the dura becomes increasingly adherent to the skull with advanced age.
