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Pathophysiology > TBI > Flashcards

TBI Flashcards

1
Q

What is a traumatic brain injury?

A

Alteration in brain function, or other evidence of brain pathology

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2
Q

What are the four main causes of brain injury?

A
  1. external forces hitting the head (or vice versa)
  2. severe acceleration and deceleration of head (without hitting anything
  3. blast injuries
  4. penetrating objects
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3
Q

What is primary brain damage?

A

the direct result of the external force and occurs at the time of the injury

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4
Q

What is secondary brain damage?

A

occurs over time (hour to day) after the injury occurred

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5
Q

What are examples of secondary brain damage?

A

Increased intracranial pressure
cerebral hypoxia or ischemia
electrolyte imbalance
infection - from open wounds
seizures

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6
Q

What is an open head injury?

A

HI with skull fracture

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7
Q

What is a closed head injury?

A

HI without skull fracture

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8
Q

What kind of acceleration causes the most damage to the brain?

A

rotational

linear is often negligible

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9
Q

Diffuse axonal injury tends to occur with __________ acceleration injuries.

A

rotational

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10
Q

Open head injuries are more at risk for __________.

A

Infection

due to the meninges being breached and exposure of brain

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11
Q

How can injuries to the face and neck from penetrating objects cause head injury?

A

If the blood supply to the brain was damaged

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12
Q

What is a contusion?

A

bruise or bleeding on the brain

laceration with or without skull fracture

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13
Q

Where are the typical brain surfaces affected by contusions?

A

inferior surface of temporal lobe (because skull is thin here)
frontal lobe because it’s where you hit your head typically

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14
Q

What is an epidural hematoma?

A

occurs in adults when meningeal arteries are torn and there is a collection of blood between the skull and the dura

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15
Q

90% of epidural hematoma have an associated ___________.

A

Skull fracture

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16
Q

Where do epidural hematomas typically develop?

A

temporal and parietal regions

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17
Q

How must a epidural hematoma be treated upon discovery?

A

emergency surgical evacuation

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18
Q

Subdural hematoma often occurs secondary to _____________.

A

acceleration/deceleration injury

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19
Q

How must a subdural hematoma be removed?

A

With a craniotomy

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20
Q

Why is a subdural hematoma associated with poor outcomes?

A

It takes a while to occur, so a pt may be sent home and it develops after the fall asleep so they die in their sleep.

Additionally brain gets pushed downward and BS is effected.

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21
Q

What is a diffuse axonal injury (DAI)?

A

shearing injury to nerves caused by angular rotation

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22
Q

How is DAI detected?

A

On the microscopic level after the brain has been stained–so the pt is dead

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23
Q

What are the three hallmarks of DAI?

A

common in high speed MVA
initial CT is unremarkable
edema begins within 48-72 hours

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24
Q

_____________ structures are more at risk for DAI.

A

Deep

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25
Q

What is the most common type of primary damage?

A

DAI

although there’s no test we make assumptions

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26
Q

What is secondary brain daamage?

A

occurs over time in reaction to primary damage

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27
Q

What are examples of secondary damage?

A

increased intracranial pressure
cerebral hypoxia
intracranial hemorrhage
electrolyte imbalance
infection from open wounds
seizures
secondary and tertiary blast injuries

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28
Q

What is one consequence of increased ICP?

A

swelling causes distortion of the brain and herniation

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29
Q

What is acute hydrocephalus?

A

blood accumulates in the ventricular system expanding the size of the ventricles and increasing ICP

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30
Q

What are signs and symptoms of herniation?

A

coma
miosis
hemiparesis
HTN & bradycardia
PCA or ACA infarction

31
Q

What are signs of a herniated brainstem?

A

papillary dilation
lateral gaze palsy
decerebrate posturing
abnormal RR

32
Q

What is cerebral hypoxia?

A

lack of blood to the brain or lack of O2 in the secondary to airway obstruction or chest injuries

33
Q

Cerebral hypoxia can lead to ____________ in later stages.

A

intracranial hypertension

34
Q

What are common causes of cerebral hypoxia?

A

drowning
head injury without quick discovery
failed suicide by hanging

35
Q

What structures are the most susceptible to cerebral hypoxia?

A

cerebellum
retina
basal ganglia

36
Q

What are possible impairments from cerebral hypoxia?

A

cortical blindness
ataxia

37
Q

Why does cell death occur after DAI?

A

if one neuron shears the neurons it communicates with begin to die because they aren’t being used

38
Q

Why would seizures occur in pts with TBI?

A

scars can’t conduct electricity and seizures occur as a result

they may cause additional brain damage due to high O2 and glucose requirements

39
Q

What is a direct blast injury due to?

A

rapid shifts in air pressure

usually effects lungs, organs and brain

40
Q

What is an indirect blast injury due to?

A

fragments and objects propelled by the blast

41
Q

What is consciousness?

A

State of being awake and alert

42
Q

What is a coma?

A

no eye opening and no response to pain

lowest level of consciousness

43
Q

What is a vegetative state?

A

emergence from coma will often be signaled by eye opening

wakefulness without awareness

return of sleep/awake cycles

44
Q

What is a minimally conscious state?

A

ability to demonstrate clear awareness of self but lack of consistent, functional means of communication

begin inconsistent yes/no responses

45
Q

What is post traumatic amnesia?

A

the time between the injury and the time the patient consistently remembers events

46
Q

What is the difficulty with the GCS?

A

it has a low ceiling

47
Q

What from the GCS would indicate poor prognosis?

A

low initial scores particularly motor scores and pupillary reaction

48
Q

What are the levels of RLA?

A
  1. no response
  2. generalized response
  3. localized response
  4. confused agitated
  5. confused inappropriate
  6. confused appropriate
  7. automatic appropriate
  8. purposeful appropriate
49
Q

RLA gives __________ functioning only.

A

cognitive

50
Q

What are some deficits not included on the GCS or RLA that indicate decreased arousal?

A

trouble swallowing or constant drooling
olfactory function

51
Q

What is dys-autonomia?

A

sympathetic nervous system becomes overstimulated

52
Q

What are characteristics of dys-autonomia?

A

increased HR
V-tach and/or supraventricular tachycardia
diaphoresis
hyperthermia
HTN

53
Q

What should be done with a patient with dys-autonomia?

A

minimize distractions
stop and give the pt a choice
expect that tasks are not going to get done

54
Q

What are severe symptoms of dys-autonomia?

A

posturing
hypertonia
teeth grinding

55
Q

With what RLA rating would you see abnormal posturing?

A

1 or 2

56
Q

True or False: TBI can have a CVA syndrome presentation including hemiparesis, abnormal synergy, and movement disorders.

A

True

57
Q

What are potential cardiopulmonary complications with TBI pts?

A

aspiration pneumonia
respiratory complications
PE
DVT
risk of infections
complications from meds used

58
Q

What are potential orthopedic risks for TBI pts?

A

multiple massive or small injuries
heterotopic ossification

59
Q

In order for heterotopic ossification to occur there must be an injury to ___________.

A

the CNS

60
Q

What are signs of heterotopic ossification?

A

loss of ROM
edema
palpable lump
pain
heat over spot

61
Q

What is a GCS of <8?

A

severe head injury

62
Q

GCS of 9-12?

A

moderate head injury

63
Q

GCS of >13?

A

mild head injury

64
Q

What is the hallmark of a concussion or mTBI?

A

neurological signs and symptoms after biomechanical force to the brain without macroscopic evidence of injury

65
Q

Why is a concussion unable to be detected on CT or MRI?

A

dysfunction is cellular

66
Q

What are risk factors for concussion?

A

history of migraine
learning disability
ADHD
repetitive concussion
male gender

67
Q

What are acute physical symptoms of concussion?

A

headache
nausea/vomiting
balance problems
dizziness

68
Q

What are acute cognitive symptoms of concussion?

A

difficulty remembering
difficulty concentrating
confusion
feeling “slow” dazed, in a fog

69
Q

What is protracted recovery?

A

symptoms of concussion resolve in longer than 3 weeks

about 20% of concussions

70
Q

What is one of the biggest problems in concussion?

A

insomnia

71
Q

What are risk factors for having protracted recovery?

A

hx of previous concussion
hx of headaches/migraines
hx of ADHD/ADD or learning disorders
psychiatric hx of depression/anxiety

72
Q

What are most common persistent concussion symptoms?

A

headache
sleep disorder
persistent mental health disorders-depression, anxiety, PTSD

73
Q

The initial rest period after a concussion should be ____________.

A

24 - 48 hours
must include no screens

74
Q

What are the primary symptoms to treat in concussion?

A

depression
sleep disorder
headache

Pathophysiology (10 decks)

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