TBI Flashcards
What are the highest risk ages for TBI?
0-4, 15-19 and older adults
Who has the highest rate of hospitalization and death from TBI?
People over 75
What constitutes a mild brain injury on the GCS?
> =13.
What is a mild brain injury also referred to?
Concussion
What are the major complications with a mild brain injury?
No major complications such as hematoma
What are some symptoms of post concussive syndrome?
headaches, dizziness and mild mental slowing and fatigue
How long do post concussive symptoms last?
Improve over 1-3 months (60% may be symptomatic at 3 months)
What is considered a moderate brain injury on the GCS?
GCS 9-12
OR
GCS<=9, follows commands
What is a distinguishing feature of a moderate brain injury?
results in loss of consciousness lasting minutes to a few hours.
Followed by a few days or weeks of confusion
How long do impairments last for with moderate brain injury?
can last for many months or longer
What is recovery like for a moderate brain injury?
Treatment can result in nearly complete recovery but often there is a residual impairment.
What constitutes a severe brain injury with the GCS>
GCS <=8
What is a feature of a severe brain injury?
Prolonged unconsciousness or coma lasting days, weeks or longer
What is usually the outlook for a severe brain injury?
Very often results in permanent disability, including cognitive and motor losses
What is a depressed skull fracture and what is it a result from?
Result of a high velocity impact where part of the skull is pushed into the brain
What can a depressed skull fracture cause?
brain lacerations
lead to abscess or infection
What happens to the cranial cavity area?
Decreases area, can lead to increased ICP
What is a compound, depressed brain injury?
considered an open head injury
What is a linear skull fracture the rsult of?
Results from a low velocity impact
What are the two types of linear skull fracture?
Basal skull Fracture
Orbital skull fracture
What is the danger with a Basal skull fracture?
Risk of infection
What is battle’s signs?
Black and blue hematoma in area of mastoid
What are some symptoms of a Basal skull fracture?
CSF leaks out of ear (otorrhea)
Tympanich membrane hematoma
What is the danger of an orbital skull fracture?
danger of infection through mucus sinuses
What are Panda Bear/racoon signs?
Immediate black eyes associated with orbital skull fracture
What is Rhinorrhea?
Runny nose with CSF with an orbital skull fracture
What is a ontusion?
Bruising of the brain at the point of impact
Where area common sites for contusions?
Frontal, temporal and/or occipital poles (coup/contracoup)
What is a hematoma?
Localized collection of blood outside a vessel
What can hematomas lead to?
can cause increase in ICP and may cause ischemia
What are the most quickly developing hematomas?
Epidural hematomas
Where is an epidural hematoma located?
Between dura and inner skull usually caused by tearing of middle meningeal artery due to fx of temporal bone
What is the mortality with an epidural hematoma?
20%
What happens often with an epidural hematoma before consciousness is lost?
50% of the time, there is a lucid interval before consciousness is lost
What is a subdural hematoma usually the result of?
Usually due to rotational injury
What is a subdural hematoma the result of?
Bleeding from contused brain (frontal or temporal lobes)
Veins within the subdural space that are torn
What is the mortality rate for a subdural hematoma?
80%
What is a subarachnoid hemorrhage?
When abrasions and contusions of brain surface produce bleeding into the subarachnoid space
What can a subarachnoid hemorrhage impede?
May impede CSF flow and cause hydrocephalus`
What is a deep cerebral hemorrhage (intracerebral)?
Bleeds within the substance of the brain
What is a petichial hemorrhage?
Small bleeds within the substance of the brain
What is a laceration?
Tearing of brain tissue or blood vessels on ridges of the skull
What is a DAI?
a diffuse axonal injury, which is a shearing injury to the long axons in the brain
What can cause a DAI?
edema, causing herniation of parts of the brain
How long does it take for axotomy to occur?
delayed, usually 24-48 hours
What does DOI usually present with immediately?
loss of consciousneess
what do you call indirect damage as a result of trauma?
Secondary damage
What is cerebral edema the result of?
damage from the O2 free radicals to the BBB, so it becomes “leakay”
Aso contributed to by an initial rise in BP following trauma and loss of autonomic control of BP
What does an intracranial hematoma expose the brain to?
Free iron, which is very damaging by its formation of a hydroxyl ion
What is primary cerebral ischemia due to?
damage to blood vessels
What is secondary cerebral ischemia due to?
pressure on vessels due to heamtoma formation and edema
decreased systolic pressure resulting in hypoperfusion
What is perfusion inversely related to?
inversely related to intracerebral pressure
What happens to vessels immediately following hypoxic events?
Vessels dilated, petichial hemorrhages form, BBB leaks
What can ischemia and hypoxia trigger?
can trigger apoptosis
What areas are affected by cerebral hypoxia/ischemia?
grey matter (high metabolic rate) Basal ganglia and hippocampus esp. vunerable
What does herniation of brain tissue occur 2ndary to?
2ndary to some space occupying lesion (hematoma)
What happens to tissues that herniate?
become ischemic
Where do tissues sometimes herniate?
under corpus callosum or relative to tentorial notch
When does ICP go up?
in response to space occupying blood or edema
What is the purpose of the examination of someone with a coma?
help localize the area of damage
contribute information to the formation of a prognosis
What could lack of a pupillary light reflex be due to?
damage anywhere along the circuit (optic nerve, chiasm, tract, post. thalamus, Edinger-Westphal nucleus to sphincter pupillate mus. via CN III
May indicate pressure on midbrain at tentorium cerebelli
Problems with horizontal gaze could help localize damage to where?
cortex or pons
If vertical gaze is impaired, what area might be involved?
midbrain
Smooth pursuit always involves what area of the brian?
cortex
What is the Oculocephalic response AKA?
dolls head maneuver, checking VOR
The dolls head maneuver is positive unless there is damage to what area?
lower brainstem damage eliminates reflex
What happens to the caloric response in a deep coma?
the fast component is not seen so eyes tonically deviate
What happens to the caloric response with damage to pons or medulla?
may be absent
What is decotricate posturing?
UE flexed adducted, LE extended, INT ROT, PF
What is decerebrate Posturing? What area of the brain is damaged
LE and UE extension
Mid brain lesion
this is a poorer prognostic sign
What is Cheyne-Stokes breathing pattern?
Periods of hyperventilation alternating with periods of apnea
What is Cheyne-Stokes breathing pattern due to?
due to abnormal response of CO2-sensitive areas of the brain. May only be seen during sleep
What level is responsible for Central Neurogenic Hyperventilation?
Midbrain and upper pons
What is Central Neurogenic Hyperventilation?
Continuous, regular rapid respirations with lowered CO2 levels
What is Apneustic Respiration?
Prolonged inspiration with a pause before expiration
What level is resopnsible for Aneurstic respiration?
Lower pons
What is ataxic respirations?
Breathing is chaotic with irregular phases, usually leading to cessation of breathing
What level is responsible for ataxic respirations?
Medulla
What type of breathing is an indication for endotracheal tubing?
Ataxic respirations
