TBI

Question 1

Normal pressure hydrocephalus definition

Answer 1

Abnormal amount of CSF in ventricles from blockage causing them to enlarge and put pressure on brain w/ little to no increase in ICP

Question 2

Causes

Answer 2

Age- most common in elderly
Can be unknown
Secondary to trauma such as hemorrhage, trauma, tumor

Question 3

s/s normal pressure hydrocephalus

Answer 3

Gait disturbances- wide gait, shuffling
Cognitive impairments- Memory loss/ loss of interests
Impaired bladder control- r/t gait

Question 4

DX for normal pressure hydrocephalus

Answer 4

CT/MRI, clinical exam, spinal tap to test fluid (csf pressure)

Question 5

Tx

Answer 5

Goal is to divert excess spinal fluid from ventricles

Question 6

2 types of tx

Answer 6

Shunt- permanent placement of shunt in brain to drain excess CSF into abdomen to be reabsorbed
Endoscopic third ventricular ostomy- bypass obstruction to drain fluid, less complications, less change of infection

Question 7

c/o…

Answer 7

Infection, complications, malfunction
s/s- cognitive impairment, urinary urgency, difficulty walking (similar to DX)
infection- swelling/redness along shunt tract.

Question 8

TBI

Answer 8

Traumatic brain injury, classified by Glasgow coma scale
mild 13-15, mod 9-12, severe 8>
Different types

Question 9

Direct v indirect

Answer 9

Direct- contact with head/brain (primary)

Indirect- bleed in brain caused by injury, seizure. (Usually secondary)

Question 10

Open v Closed

Answer 10

Open- the skull has been penetrated and exposed

Closed- Skull is not penetrated, cannot be seen however can palpate/visualize with MRI/CT

Question 11

Displaced vs non displaced

Answer 11

Non displaced- margins are well approximated

Displaced- margins have moved (depressed)

Question 12

Comminuted

Answer 12

Bone fragments present

Question 13

Basilar

Answer 13

@ Base of skull
s/s racoon eyes (bruising of the eyes)
Battle signs ( post auricular bruising)
c/o cranial nerve 4-6 (check eye movement)
fluid draining from ears/nose-is it CSF?
c/o hemorrhage of Cortaid artery
Glucose test, w/ blood halo sign
Usually resolves on its own, no NG tube

Question 14

Contusion

Answer 14

Bruising of brain tissue
Coup/counter coup injury, acceleration/deceleration
Brain impacts with front of skull causing first insult, then is projected towards back of skull where second impact occurs.
C/O hematoma formation

Question 15

Diffuse axonal injury

Answer 15

Widespread shearing and tearing causing damage to axons in cerebral hemispheres, corpus callosum, brainstem. Causes hypermetabolic state
s/s Tachycardia, Tachypnea, hyperThermia
Severe s/s coma, decorticate and decerebrate posturing and edema
DX- CT, MRI, Pet scan

Question 16

epidural hematoma

Answer 16

Location- between dura and skull
R/T- laceration of middle meningeal artery causing rapid accumulation of arterial blood
Neuro emergency!! c/o herniation
LOC @ time of insult, follower by lucid period, then rapid deteriation
This is because of compensation of CSF to accommodate rapidly accumulating arterial blood\hematoma
s/s of ICP- Vomiting, HA, restlessness–coma
s/s herniation- dilated and fixed pupils, deteriation of consciousness, decorticate/decerebrate posture
TX- rapid surgical intervention to evacuate hematoma, prevent herniation and manage ICP

Question 17

Subdural hematoma

Answer 17

Between dura mater and brain, most commonly from trauma and usually venous, rupture of small vessels that line the subdural space.
Actue- 24-48 hour post injury, S/S- change in LOC, pupillary, hemiparesis—coma. ^ BP, decrease HR, RR= enlarging, becomes emergent
Chronic- Duration is weeks-months, most common in older adults/alcoholic d/t atrophy, S/S ^ ICP, change in LOC, HA, N/V
Tx- watchful waiting, if enlarging need evacuation of hematoma, manage ICP

Question 18

Subarachnoid hemorrhage

Answer 18

Bleeding in space that surrounds brain, usually from aneurysm - poor prognosis in Pt’s with TBI
S/S Sudden HA, stiff neck, blood in CSF
TX w/ calcium channel blockers