TBI

Question 1

TBI subtypes (spectrum)

Answer 1

concussion, contusion, intracranial hemorrhage/intracerebral hemorrhage…. death

Question 2

anywhere throughout the spectrum, it is possible to suffer from:

Answer 2

DAI: As tissue slides over tissue, a shearing injury occurs. This causes the lesions that are responsible for unconsciousness, as well as the vegetative state that occurs after a severe head injury. A diffuse axonal injury also causes brain cells to die, which cause swelling in the brain.

Question 3

primary biochemical force that induces concussion?

Answer 3

Rotation/angular acceleration (if I hit a wall, no concussion, if someone snaps my head around from being hit in the face, the rotation/angular acceleration will cause a concussion)

Question 4

characteristics of a concussion?

Answer 4

Zurich Consensus Guidlines 2012:

Question 5

the ZCC define concussion as:

Answer 5

1. Direct or impulsive force
2. Rapid onset
3. Functional
4. Clinical symptoms
5. No abnormality on standard imaging

Question 6

macro biomechanics: the places that we see the highest shear force:

Answer 6

corpus collosum, amygdala, hippocampus: all places you see the greatest change in clinical setting

Question 7

microscopic biomechanics

Answer 7

shearing axon

Question 8

when you twist a cell membrane:

Answer 8

the semipermeable membrane is fully open

Question 9

two ions that freely flow through the membrane upon concussion :

Answer 9

glutamate and Ca2+, glutamate is semi-toxic to the brain and Ca2+ causes a tidal wave of action potential

Question 10

concussion is a

Answer 10

mechanical injury that leads to a chemical change

Question 11

the mechanism for a concussion includes:

Answer 11

k/na pump dysfunction, ca influx, eaa release, spreading electrical depression, reversion to glycolysis for pump restoration, rely on glyscolysis for restarting system

Question 12

contusion:

Answer 12

this is concussion, PLUS, mainly in frontal and occipital

Question 13

on mri, contusion will show:

Answer 13

edema in front, occipital or parietal

Question 14

70 yr old woman falls, has pain in left occipital and feels out of it. What test is most appropriate?

Answer 14

concerned with bleeding in the brain so CT (sensitive for blood)

Question 15

subdural hemorrhage:

Answer 15

venous blood/low pressure, under dura, tearing of bridging veins: all the problems from before plus chemical changes (apoptosis) and “Mass effect”

Question 16

mnemonic for subdural hemorrhage:

Answer 16

ABCDE:
Alcoholics (brain shrinks and puts strain on bridging veins that run from the top of the skull to the brain)
Bridging veins
Crescent shaped on CT
Dura intact
Elderly (falls, atrophy of brain, and anti-coagulants like cumin)

Question 17

14 yr old takes line drive to temple, loss of consciousness, seems fine, then vomiting and is difficult to keep awake. What do you see on CT?

Answer 17

young (not as much of a subdural risk)

temple is thin, just above middle meningial artery

Question 18

high pressure bleed in brain:

Answer 18

epidural hemorrhage: arterial blood, high pressure, only place for the brain to go is down, presses on foramen magnum, crushes brain stem which is responsible for breathing

Question 19

epidural hematoma characteristics:

Answer 19

skull fracture, middle meningeal artery, mass effect

Question 20

epidural mnemonic:

Answer 20

FLAIR
Fracture (temporal)
Lens-shaped on CT
Arterial (middle meningeal)
Interval (lucid interval)
Ripped dura

Question 21

subarachnoid mnemonic:

Answer 21

Circle of Willis on CT
Headache (thunderclap)
Arterial blood/aneurysm
Nausea, neck stiffness
Trauma
Seizures or syncope

arterial blood, high pressure, severe (hypertension or dramatic trauma ( like being beaten by a lead pipe)

Question 22

TEST: which type of brain injury is most likely to cause seizures:

Answer 22

subarachnoid
the death star
Circle of Willis on CT
Headache (thunderclap)
Arterial blood/aneurysm
Nausea, neck stiffness
Trauma
Seizures or syncope

Question 23

intracerebral hemorrhage:

Answer 23

intraparenchymal and intraventricular, arterial and severe, from: trauma hypertension AVM and rapid bleeding

Question 24

4 areas to remember on assessment: history

Answer 24

thinking/remembering, physical, emotional mood, sleep disturbances, even 1 from each category is debillitating

Question 25

if someone suffers only a concussion, their strength and reflexes should be _____, if not, you should assume they have a more severe (spinal cord) injury until:

Answer 25

normal; you prove they don’t, get a non-contrast head ct

Question 26

TEST: the imaging modality of choice when in the ER with head trauma or suspected head injury:

Answer 26

with a noncontrast head ct

Question 27

test: Emergencies include symptoms include:

Answer 27

Increasing confusion
Drowsiness
Pupillary changes
Respiratory changes (Cheyne-Stokes)
Hypertension (with widened pulse pressure)
Bradycardia
The three in red, when seen in combination, are called Cushing’s Triad. This is bad news. This means you have an ICP problem and have impending herniation.

Question 28

TEST: what is a sign of an emergency situation?

Answer 28

cushing’s triad: Respiratory changes (Cheyne-Stokes)
Hypertension (with widened pulse pressure)
Bradycardia

Question 29

what is the equation to be concerned with in an emergency?

Answer 29

cpp=MAP-ICP

Question 30

how do you calculate CPP?

Answer 30

MAP-ICP measure of how much blood is getting to the brain

Question 31

in emergency situations, you want to :

Answer 31

reduce ICP (while permitting some HTN)
REDUCE ICP but permit some HTN
HOB to 30 degrees
Hyperventilate
Hypertonic saline (23.5%)
Sedation
EVD (extraventricular drain)

Question 32

whether or not to have surgery depends on:

Answer 32

volume of blood, location of blood, and symptoms

Question 33

TEST non-surgical treatment of a brain bleed incluides ______ because blood causes ______ when irritating the meningies

Answer 33

anti-epiletptics, seizures, for

subarachnoid hem, interperenchymal hemorrhages, interventricular hemmorhages