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Neuro 4 (sam > TBI > Flashcards

TBI Flashcards

1
Q

What are the highest risk ages for TBI?

A

0-4, 15-19 and older adults

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2
Q

Who has the highest rate of hospitalization and death from TBI?

A

People over 75

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3
Q

What constitutes a mild brain injury on the GCS?

A

> =13.

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4
Q

What is a mild brain injury also referred to?

A

Concussion

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5
Q

What are the major complications with a mild brain injury?

A

No major complications such as hematoma

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6
Q

What are some symptoms of post concussive syndrome?

A

headaches, dizziness and mild mental slowing and fatigue

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7
Q

How long do post concussive symptoms last?

A

Improve over 1-3 months (60% may be symptomatic at 3 months)

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8
Q

What is considered a moderate brain injury on the GCS?

A

GCS 9-12
OR
GCS<=9, follows commands

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9
Q

What is a distinguishing feature of a moderate brain injury?

A

results in loss of consciousness lasting minutes to a few hours.
Followed by a few days or weeks of confusion

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10
Q

How long do impairments last for with moderate brain injury?

A

can last for many months or longer

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11
Q

What is recovery like for a moderate brain injury?

A

Treatment can result in nearly complete recovery but often there is a residual impairment.

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12
Q

What constitutes a severe brain injury with the GCS>

A

GCS <=8

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13
Q

What is a feature of a severe brain injury?

A

Prolonged unconsciousness or coma lasting days, weeks or longer

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14
Q

What is usually the outlook for a severe brain injury?

A

Very often results in permanent disability, including cognitive and motor losses

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15
Q

What is a depressed skull fracture and what is it a result from?

A

Result of a high velocity impact where part of the skull is pushed into the brain

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16
Q

What can a depressed skull fracture cause?

A

brain lacerations

lead to abscess or infection

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17
Q

What happens to the cranial cavity area?

A

Decreases area, can lead to increased ICP

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18
Q

What is a compound, depressed brain injury?

A

considered an open head injury

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19
Q

What is a linear skull fracture the rsult of?

A

Results from a low velocity impact

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20
Q

What are the two types of linear skull fracture?

A

Basal skull Fracture

Orbital skull fracture

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21
Q

What is the danger with a Basal skull fracture?

A

Risk of infection

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22
Q

What is battle’s signs?

A

Black and blue hematoma in area of mastoid

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23
Q

What are some symptoms of a Basal skull fracture?

A

CSF leaks out of ear (otorrhea)

Tympanich membrane hematoma

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24
Q

What is the danger of an orbital skull fracture?

A

danger of infection through mucus sinuses

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25
Q

What are Panda Bear/racoon signs?

A

Immediate black eyes associated with orbital skull fracture

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26
Q

What is Rhinorrhea?

A

Runny nose with CSF with an orbital skull fracture

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27
Q

What is a ontusion?

A

Bruising of the brain at the point of impact

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28
Q

Where area common sites for contusions?

A

Frontal, temporal and/or occipital poles (coup/contracoup)

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29
Q

What is a hematoma?

A

Localized collection of blood outside a vessel

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30
Q

What can hematomas lead to?

A

can cause increase in ICP and may cause ischemia

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31
Q

What are the most quickly developing hematomas?

A

Epidural hematomas

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32
Q

Where is an epidural hematoma located?

A

Between dura and inner skull usually caused by tearing of middle meningeal artery due to fx of temporal bone

33
Q

What is the mortality with an epidural hematoma?

A

20%

34
Q

What happens often with an epidural hematoma before consciousness is lost?

A

50% of the time, there is a lucid interval before consciousness is lost

35
Q

What is a subdural hematoma usually the result of?

A

Usually due to rotational injury

36
Q

What is a subdural hematoma the result of?

A

Bleeding from contused brain (frontal or temporal lobes)

Veins within the subdural space that are torn

37
Q

What is the mortality rate for a subdural hematoma?

A

80%

38
Q

What is a subarachnoid hemorrhage?

A

When abrasions and contusions of brain surface produce bleeding into the subarachnoid space

39
Q

What can a subarachnoid hemorrhage impede?

A

May impede CSF flow and cause hydrocephalus`

40
Q

What is a deep cerebral hemorrhage (intracerebral)?

A

Bleeds within the substance of the brain

41
Q

What is a petichial hemorrhage?

A

Small bleeds within the substance of the brain

42
Q

What is a laceration?

A

Tearing of brain tissue or blood vessels on ridges of the skull

43
Q

What is a DAI?

A

a diffuse axonal injury, which is a shearing injury to the long axons in the brain

44
Q

What can cause a DAI?

A

edema, causing herniation of parts of the brain

45
Q

How long does it take for axotomy to occur?

A

delayed, usually 24-48 hours

46
Q

What does DOI usually present with immediately?

A

loss of consciousneess

47
Q

what do you call indirect damage as a result of trauma?

A

Secondary damage

48
Q

What is cerebral edema the result of?

A

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

49
Q

What does an intracranial hematoma expose the brain to?

A

Free iron, which is very damaging by its formation of a hydroxyl ion

50
Q

What is primary cerebral ischemia due to?

A

damage to blood vessels

51
Q

What is secondary cerebral ischemia due to?

A

pressure on vessels due to heamtoma formation and edema

decreased systolic pressure resulting in hypoperfusion

52
Q

What is perfusion inversely related to?

A

inversely related to intracerebral pressure

53
Q

What happens to vessels immediately following hypoxic events?

A

Vessels dilated, petichial hemorrhages form, BBB leaks

54
Q

What can ischemia and hypoxia trigger?

A

can trigger apoptosis

55
Q

What areas are affected by cerebral hypoxia/ischemia?

A 
grey matter (high metabolic rate)
Basal ganglia and hippocampus esp. vunerable
56
Q

What does herniation of brain tissue occur 2ndary to?

A

2ndary to some space occupying lesion (hematoma)

57
Q

What happens to tissues that herniate?

A

become ischemic

58
Q

Where do tissues sometimes herniate?

A

under corpus callosum or relative to tentorial notch

59
Q

When does ICP go up?

A

in response to space occupying blood or edema

60
Q

What is the purpose of the examination of someone with a coma?

A

help localize the area of damage

contribute information to the formation of a prognosis

61
Q

What could lack of a pupillary light reflex be due to?

A

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

62
Q

Problems with horizontal gaze could help localize damage to where?

A

cortex or pons

63
Q

If vertical gaze is impaired, what area might be involved?

A

midbrain

64
Q

Smooth pursuit always involves what area of the brian?

A

cortex

65
Q

What is the Oculocephalic response AKA?

A

dolls head maneuver, checking VOR

66
Q

The dolls head maneuver is positive unless there is damage to what area?

A

lower brainstem damage eliminates reflex

67
Q

What happens to the caloric response in a deep coma?

A

the fast component is not seen so eyes tonically deviate

68
Q

What happens to the caloric response with damage to pons or medulla?

A

may be absent

69
Q

What is decotricate posturing?

A

UE flexed adducted, LE extended, INT ROT, PF

70
Q

What is decerebrate Posturing? What area of the brain is damaged

A

LE and UE extension
Mid brain lesion
this is a poorer prognostic sign

71
Q

What is Cheyne-Stokes breathing pattern?

A

Periods of hyperventilation alternating with periods of apnea

72
Q

What is Cheyne-Stokes breathing pattern due to?

A

due to abnormal response of CO2-sensitive areas of the brain. May only be seen during sleep

73
Q

What level is responsible for Central Neurogenic Hyperventilation?

A

Midbrain and upper pons

74
Q

What is Central Neurogenic Hyperventilation?

A

Continuous, regular rapid respirations with lowered CO2 levels

75
Q

What is Apneustic Respiration?

A

Prolonged inspiration with a pause before expiration

76
Q

What level is resopnsible for Aneurstic respiration?

A

Lower pons

77
Q

What is ataxic respirations?

A

Breathing is chaotic with irregular phases, usually leading to cessation of breathing

78
Q

What level is responsible for ataxic respirations?

A

Medulla

79
Q

What type of breathing is an indication for endotracheal tubing?

A

Ataxic respirations

Neuro 4 (sam (7 decks)

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