TBI Flashcards
1
Q
TBI
A
- Rapid injury to brain: stroke, external inflicted trauma, infection, parasite etc.
- Typical cause: MVA, falls, sports, violence, knife wounds, blunt force trauma
2
Q
Types of TBI (2)
A
- Force inflicted wounds
- Closed head wound (most common)
- Open Head wound: penetrating/ crushing (least common)
- Encephalopathey
- Anoxic
- Metabolic
3
Q
Concussion
A
- Closed head wound
- Mild TBI
- Causes: blunt force, deceleration, angular rotation
4
Q
Pathophysiology of Concussion
(what happens)
A
- Brain bounces inside cranium rubbing dura mater and bone, causing hematoma (blood collection like bruise) and swelling.
- Brain stretches from base,cause tissue to rub together. Axons become distended (mild DAI)
- Brain presses down or streches brainstem, temp shutting it down.
5
Q
Symptoms of Concussion
A
- Headache
- Nausea
- Sleepiness
- Vomitting
- Loss of orientation (more disoriented the worse)
- Glas Coma Scale of 12 and up
- LoC for less than 30
- Amnesia for less than 24 hr
- normal pupillary response less than 5 mm more than 3 mm
6
Q
Tx for Concussion
A
- Usually no treat as long as no focal injury non CT
- ice on contusions
- monitor vital signs for 24 hr
7
Q
Prognosis for Concussion
A
- Excellent prog
- multiple concussions can lead to lasting impairment
- one concussion cause permanent impairment in short term mem, attention, encoding, recall, concentration.
8
Q
Closed head Wounds
Epidural
A
- Blunt force: smack to skull, on sides, cause epidural or subdural hematoma
- Epidural: blood collects btwn skull & dura mater. Convex blood collection on CT
9
Q
Closed Head Wounds
Subdural Hematoma
A
- blood collects btwn skull & arachnoid mater
- often venous bleed
- crescent shape on CT
- more common
10
Q
Deceleration Injury
A
- Head moving in 1 direction, quickly stopped, sent in other direction
- Causes: MVA, falls, blunt force
- Coup-contre coup=Brain travelling in direction of inertia, bounces back against skull to hit opposite side
- common in frontal/occipital, temporal/temporal
11
Q
Rotational Injury
A
- Head twisted by impact, parts of brain/skull rub against each other
- Brain rubs against skull/meninges: veins in arachnoid mater rupture, causing subdural/subarachnoid hemorrhage
- Shearing injury: Brain rub against itself: Axons get stretched/torn (DAI), causing petechial/intraparenchymal hemorrhage
12
Q
Diffuse Axonal Injury
A
- Neurons stretched by deceleration/ abraded by shearing
- Damage from DAI can occur after initial injury when broken axons release apoptic factors (cell suicide)
- very difficult to see in brain scan bc microscopic
- POOR prognosis
- predictive of coma
- more evident DAI on brain scan=higher mortality
13
Q
Open Head Wounds
A
-
Penetrating
* cranium penetrated-by skull, blunt or piercing object (bullet) - Crushing
- Skull crushed btwn objects causing widespread fracture/ brain visibility
- symptoms same as closed w/ higher risk of infectoin & pneumocephalus (air entering brain cavity disrupting pressure)
14
Q
Extra Axial Bleed
A
Bleed occuring inside skull but outside brain tissue
15
Q
Herniation
A
- Occurs during Extra axial bleeds
- ICP inc, brain swell, blood/meninges push brain in places it souldn’t go.
- Tentorium=area of dura mater seperating cerebellum/cerebrum
- Uncus=inferior medial temporal lobe
- Cingulate gyrus=medialportion of cerebrum (around corpus cal)
- Foramen magnum=big hole at bottom of cranium where spinal cord/brainstem meet
19
Q
Fencing Posture
A
- Arm flies out as a tonic response to disruption of neurochemistry, with vestibular function involved
- often in contusion leading to unconsciousness
20
Q
Opisthotonus Posture
A
- severe muscle spasms caused by compression of corticoreticular tracts in midbrain
- Back and head arch back
- not common in TBI
21
Q
Decorticate Posture
A
- arms fold into “prayer” position, legs extended and feet turned inwards
- muscles rigid
- Indicative of pressure or damage to brainstem, especially motor tracts going through medulla
- Bad
