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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
What is the most common type of primary damage?
DAI although there's no test we make assumptions
26
What is secondary brain daamage?
occurs over time in reaction to primary damage
27
What are examples of secondary damage?
increased intracranial pressure cerebral hypoxia intracranial hemorrhage electrolyte imbalance infection from open wounds seizures secondary and tertiary blast injuries
28
What is one consequence of increased ICP?
swelling causes distortion of the brain and herniation
29
What is acute hydrocephalus?
blood accumulates in the ventricular system expanding the size of the ventricles and increasing ICP
30
What are signs and symptoms of herniation?
coma miosis hemiparesis HTN & bradycardia PCA or ACA infarction
31
What are signs of a herniated brainstem?
papillary dilation lateral gaze palsy decerebrate posturing abnormal RR
32
What is cerebral hypoxia?
lack of blood to the brain or lack of O2 in the secondary to airway obstruction or chest injuries
33
Cerebral hypoxia can lead to ____________ in later stages.
intracranial hypertension
34
What are common causes of cerebral hypoxia?
drowning head injury without quick discovery failed suicide by hanging
35
What structures are the most susceptible to cerebral hypoxia?
cerebellum retina basal ganglia
36
What are possible impairments from cerebral hypoxia?
cortical blindness ataxia
37
Why does cell death occur after DAI?
if one neuron shears the neurons it communicates with begin to die because they aren't being used
38
Why would seizures occur in pts with TBI?
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
What is a direct blast injury due to?
rapid shifts in air pressure usually effects lungs, organs and brain
40
What is an indirect blast injury due to?
fragments and objects propelled by the blast
41
What is consciousness?
State of being awake and alert
42
What is a coma?
no eye opening and no response to pain lowest level of consciousness
43
What is a vegetative state?
emergence from coma will often be signaled by eye opening wakefulness without awareness return of sleep/awake cycles
44
What is a minimally conscious state?
ability to demonstrate clear awareness of self but lack of consistent, functional means of communication begin inconsistent yes/no responses
45
What is post traumatic amnesia?
the time between the injury and the time the patient consistently remembers events
46
What is the difficulty with the GCS?
it has a low ceiling
47
What from the GCS would indicate poor prognosis?
low initial scores particularly motor scores and pupillary reaction
48
What are the levels of RLA?
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
RLA gives __________ functioning only.
cognitive
50
What are some deficits not included on the GCS or RLA that indicate decreased arousal?
trouble swallowing or constant drooling olfactory function
51
What is dys-autonomia?
sympathetic nervous system becomes overstimulated
52
What are characteristics of dys-autonomia?
increased HR V-tach and/or supraventricular tachycardia diaphoresis hyperthermia HTN
53
What should be done with a patient with dys-autonomia?
minimize distractions stop and give the pt a choice expect that tasks are not going to get done
54
What are severe symptoms of dys-autonomia?
posturing hypertonia teeth grinding
55
With what RLA rating would you see abnormal posturing?
1 or 2
56
True or False: TBI can have a CVA syndrome presentation including hemiparesis, abnormal synergy, and movement disorders.
True
57
What are potential cardiopulmonary complications with TBI pts?
aspiration pneumonia respiratory complications PE DVT risk of infections complications from meds used
58
What are potential orthopedic risks for TBI pts?
multiple massive or small injuries heterotopic ossification
59
In order for heterotopic ossification to occur there must be an injury to ___________.
the CNS
60
What are signs of heterotopic ossification?
loss of ROM edema palpable lump pain heat over spot
61
What is a GCS of <8?
severe head injury
62
GCS of 9-12?
moderate head injury
63
GCS of >13?
mild head injury
64
What is the hallmark of a concussion or mTBI?
neurological signs and symptoms after biomechanical force to the brain **without** macroscopic evidence of injury
65
Why is a concussion unable to be detected on CT or MRI?
dysfunction is cellular
66
What are risk factors for concussion?
history of migraine learning disability ADHD repetitive concussion male gender
67
What are acute physical symptoms of concussion?
headache nausea/vomiting balance problems dizziness
68
What are acute cognitive symptoms of concussion?
difficulty remembering difficulty concentrating confusion feeling "slow" dazed, in a fog
69
What is protracted recovery?
symptoms of concussion resolve in longer than 3 weeks about 20% of concussions
70
What is one of the biggest problems in concussion?
insomnia
71
What are risk factors for having protracted recovery?
hx of previous concussion hx of headaches/migraines hx of ADHD/ADD or learning disorders psychiatric hx of depression/anxiety
72
What are most common persistent concussion symptoms?
**headache** sleep disorder persistent mental health disorders-depression, anxiety, PTSD
73
The initial rest period after a concussion should be ____________.
24 - 48 hours must include no screens
74
What are the primary symptoms to treat in concussion?
depression sleep disorder headache

Pathophysiology (10 decks)

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