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IBSc PHEM Applied Science > Seizures And Surgical Aspects Of TBI > Flashcards

Seizures And Surgical Aspects Of TBI Flashcards

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1
Q

Types of diffuse TBI

A

Concussion
Diffuse axonal injury
Blast
Abusive head trauma/ shaken baby syndrome

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2
Q

Types of focal TBI

A

Contusion
Penetrating
Haematoma - EDH, SAG, SDH, intra ventricular, Intracerebral/intraparenchymal

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3
Q

Primary vs secondary TBI

A

Pri - caused at time of injury, vascular/neuronal
Sec - processes triggered by Pri brain injury

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4
Q

Secondary TBI examples

A

Hypotension
Hypoxia
Ischaemia
Pressure effects
Infection

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5
Q

Processes causing secondary TBI

A

Structural axonal injury
Excitotoxicity and calcium flux
Toxic proteins pathogens
Functional impairment
Cell autonomous death pathways
Neuro inflammation
Mitochondrial dysfunction
Autophagy, apoptosis, necrosis, pyroptosis
Cerebral bloodflow dysregulation
Cerebral oedema
Stroke

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6
Q

Aspects of focused neurological exam

A

ABCDE
Inspect for signs of craniofacial trauma or basal skull #
Eyes - acuity, pupils, fundoscopy, ocular movements
Moving 4 limbs
GCS
Breathing pattern
C SPINE

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7
Q

Possible Pupil abnormalities on examination

A

Anisocoria
RAPD
Mitosis
Mydriasis

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8
Q

Abnormal breathing patterns in TBI

A

Cheyne stokes (cerebral)
Apneustic (pons)
Ataxizpc (medullary)

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9
Q

What part of the brain is injured in a pt with cheyne stokes breathing

A

Cerebrum

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10
Q

What part of the brain is injured in a pt with apneusticbreathing

A

Pons

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11
Q

What part of the brain is injured in a pt with ataxic breathing

A

Medulla

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12
Q

Drawbacks of GCS

A

Skewed importance of motor score
Intubation
Facial/ocular trauma
Dysphasia
Inter-rated variability

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13
Q

Eyes scores in GCS

A

1 no opening
2 pain
3 voice
4 spontaneous

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14
Q

GCS verbal scores

A

1 none
2 incomprehensible
3 inappropriate words
4 confused
5 normal

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15
Q

GCS motor scores

A

1 none
2 extension (decerebrate)
3 abnormal flexion (decorticate)
4 withdraws from pain
5 localise to pain
6 obeys commands

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16
Q

GCS scores in mild mod and severe head injury

A

14/15 mild
9-13 mod
</=8 sev

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17
Q

Concussion

A

Alteration in consciousness without structural damage as a result of non penetrating TBI

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18
Q

Indications for head CT within 1 hour

A

GCS =/<8 on initial assessment
GCS <15 2 hrs after injury
Suspected open or depressed skull #
Any sign of basal skull #
Post traumatic seizure
Focus neuro deficit
More than 1 episode of vomiting

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19
Q

Indications for head CT within 8 hrs of injury (or within 1 hr if presenting >8hrs after injury)

A

LOC or amnesia since injury + 1 of:
- Age 65+
- any bleeding/clotting disorders or medications
- dangerous MOI (ped vs car, car ejection, fall from 1+m/5stairs, etc)
- >30mins retrograde amnesia of events immediately before injury

Consider if taking anticoagulants or anti platelets

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20
Q

Indications for immediate tube and vent in TBI

A

Coma / GCS<8
Loss of protective laryngeal reflexes
Ventilators insudpfficiency - hypoxaemia or hypercapnia
Irregular respirations

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21
Q

Indications for tube and vent before transfer to neurosurgery unit

A

Sig deteriorating consciousness level
Unstable facial skeleton #
Copious bleeding into mouth
Seizures

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22
Q

Which HI patients should be transferred to neurosurgery unit

A

Severe HI - GCS<8

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23
Q

Which HI pts should be admitted and observed

A

Clinically important abnormalities on imaging
GCS <15
Ongoing concerning sx (vomiting, headache, seizures)
Drug or alcohol use
Multiple injuries
No adult at home to supervise pt

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24
Q

Which HI pts should neurosurgery be involved

A

Sig abnormality on imaging
GCS </=8 after initial resus
Unexplained confusion >4hrs
Deterioration in GCS after admission
Progressive focal neuro signs
Seizure without full recovery
Definitive/suspected penetrating injury
CSF leak

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25
Q

Which type of brain injury is can have ‘talk and die’ presentation

A

EDH

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26
Q

Signs of brain herniation

A

Decr GCS
Anisocoria
Cushing’s reflex

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27
Q

Course of middle meningeal artery

A

Branches from maxillary artery -> passes through infra temporal fossa to foramen spinosum -> runs along squamous temporal bone -> anterior branch runs beneath pterion

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28
Q

Extradural haematoma locations

A

middle meningeal artery beneath pterion
Parietal
Convexity
Posterior fossa

29
Q

EDH surgical mx

A

Craniotomy

30
Q

Equation for estimating Intracerebral haemorrhage volume

A

(A x B x C) /2
A = greatest haemorrhage diameter on CT
B = haemorrgphage diameter at 90* to A
C = approx nbr CT slices w haemorrhage* slice thickness

31
Q

Cause of DAI

A

Rotational acceleration or deceleration causing axonal and shearing stress

32
Q

DAI

A

Microscopic white matter haemorrhage including brainstem/ CC

33
Q

DAI signs on Ct

A

Usually normal

34
Q

Which imaging is best for DAI

A

FLAIR or SWI MRI

35
Q

DAI tx

A

Supporti e

36
Q

DAI grades

A

1 - microscopic axonal damage in WM
2 - + focal lesion in CC
3 - + focal lesion in Cc and brainstem

37
Q

Cerebral perfusion pressure equation

A

CPP = MAP - ICP

38
Q

Cerebral bloodflow equation

A

CBF = CPP/CVR

39
Q

ICP monitoring methods

A

Subarachnoid
Intra ventricular
Intraparenchymal
Epidural

40
Q

Processes of compensation to ICP rise

A

Decr venous volume in brain
CSF egress into spinal column lumbar theca
Stretching of falx cerebri/tentorium cerebelli

41
Q

What is causes by sustained uncompensated ICP rise

A

Brain Herniation

42
Q

Herniation syndromes

A

Subfalcine herniation - ACA infarct, hydrocephalus
Uncal herniation - ipsilateral CN3 palsy, PCA infarction
Central herniation - decr consciousness dorsal midbrain pressure pressure on reticular formation, parinauds syndrome, basilar artery stretching
CN4 palsy
Cushing’s triad

43
Q

Cushing’s triad

A

Hypertension
Bradycardia
Respiratory irregularity

44
Q

Parinauds syndrome and durets haemorrhage causes

A

Perinauds - dorsal midbrain pressure
Durets - basilar artery stretching
Both caused by central herniation

45
Q

Indication for ICP monitoring

A

Severe TBI
Hydrocephalus
Craniosynostosis

46
Q

ICP monitoring contraindications

A

Intracranial haematoma
Extra axial location

47
Q

What is shown by P1 P2 and P3 on ICP monitoring trace

A

P1 percussion wave
P2 tidal wave (brain compliance)
P3 dicrotic (aortic valve closure)
P2>p1 = non compliant brain

48
Q

Conservative/1st line Raised ICP mx

A

Head up 30*
Straighten neck
Remove c spine collar
Normocarbia
Avoid temp rise
- AVP time cooling if 39*+
- paracetamol
Avoid coughing/straining

49
Q

2nd and 3rd line raised ICP mx

A

2nd - optimise sedation (decr pain+agitation), neuromuscular blockade, Hyperosmolar therapy, intra ventricular drainage
3rd - barbituate coma (decr CMRO2), Decompressive craniectomy

50
Q

Is normal brain electrical activity synchronous or non synchronous

A

Non synchronous

51
Q

Main inhibitory and excitatory NT in the brain

A

Inhib GABA
Excite glutamate

52
Q

What causes a seizure

A

Cortical neurones firing in a hypersynchronous manner
Paroxysmal depolarising shift causes spreading wave as neurones adjacent to abnormally firing neurones start firing abnormally

53
Q

What process causes abnormal neurone firing to spread across the brain in a seizure

A

Paroxysmal depolarising shift

54
Q

Fit

A

Colloquial term for seizure
3/4 fits are not epileptic

55
Q

What causes post ictal periods

A

Neurotransmitter imbalance

56
Q

Factors that lower seizure threshold

A

Alcohol
Electrolyte imbalance
Inter current illness

57
Q

How long does a person need to be seizure free to be eligible to drive in the UK

A

12 months

58
Q

Seizure subtypes

A

Tonic clonic
Atonic
Absence
Myoclonic

59
Q

Which type of seizure pt often presents with a head injury sustained from sudden fall

A

Atonic seizure

60
Q

Which type of seizure is characterised by repetitive movements

A

Myoclonic

61
Q

Where do epileptic seizures (almost always) originate from

A

Supercentorial
Cerebellar epilepsy reported but very rare

62
Q

Focal seizure onset

A

Onset within 1 hemisphere
Usually in temporal lobe

63
Q

Focal seizure characteristics

A

Aura, motor, or autonomic
Awareness may be retained or altered
May stare blankly, automatisms, grunting
Often progresses to bilateral convulsive seizures in adults

64
Q

Focal seizure characteristics

A

Aura, motor, or autonomic
Awareness may be retained or altered
May stare blankly, automatisms, grunting
Often progresses to bilateral convulsive seizures in adults

65
Q

Do head versions turn towards or away from the lesion in a seizure

A

Away

66
Q

Are eye movements and motor sx ipsi or Contralateral in a focal seizure

A

Contralateral

67
Q

How can hyperventilation bring on a seizure

A

Hyperventilation -> hypercapnia -> cerebral vasoconstriction -> cerebral hypoperfusion -> brain cell dysfunction/transporter dysfunction -> seizure

68
Q

Todd’s paresis

A

Unable to move 1/both sides after waking from seizure
Usually after focal seizure
No changes on imaging

69
Q

What causes post traumatic epilepsy

A

Cortical irritation from SAH

IBSc PHEM Applied Science (21 decks)

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