TBI & CVA (16) EXAM 4 Flashcards
What is an insult to the brain caused by external physical force? (Not of degenerative or congenital nature)
Traumatic Brain Injury
What is the prognosis in a TBI dependent on?
- Age
- Length of time in coma
- Length of time of post-traumatic amnesia
- Size of brain injury
- Location of brain injury
- Cause of injury (i.e. fall vs. gun)
What is a closed TBI?
Closed head injury
Skull is intact; no penetration of the skull
What is an open TBI?
Open head injury
penetration of the skull with direct injury to the brain
What is the most common type of TBI?
Focal (damage confined to a specific area)
What is a Focal Injury (TBI)?
Direct impact of short duration. typically related to acceleration/deceleration forces
What is coup-contra-coup and what classification of TBI is it seen in?
Brain is hurled against the skull; then it ricochets in the opposite direction (force may fracture skull)
Seen in Focal Injury
In coup-contra-coup, what lobes are most often damaged?
Frontal and temporal loves
What do focal injuries cause to happen?
Conusions (bruises) and hematomas (collections of blood - usually clotted)
What kind of TBI is diffuse and impacts several areas of the brain?
Diffuse Injury (actually multifocal because damage is not symmetrical)
What can diffuse injury (TBI) occur from?
Hypoxia, damage to blood vessels, rotational forces
What is the secondary damage in diffuse TBI?
Increased intracranial pressure, swelling, hemorrhage, oxygen deprivation
What is a stretch injury to the membrane of an axon, ultimately leading to axon breakage?
Diffuse axonal injury
What is a localized collection of blood, usually clotted, in a tissue or organ?
Hematoma
Epidural hematoma
Above dura (collection of blood)
Subdural hematoma
Below dura (collection of blood)
Intracerebral hematoma
In brain (collection of blood)
Contusion
Brusing brain
T or F: Impairments resulting from TBI are unpredictable; each outcome is unique?
True, symptoms can range from:
Loss of consciousness
Cognitive impairment
Communication, memory, neuromuscular, Personality/emotional, perceptual, sensory or visual
A state in which a person makes no purposeful response to the environment and from which he/she can not be aroused
Coma
How long does coma usually last?
What follows it?
Hours or days and usually followed by semi-coma (confusion)
Glasgow coma scale:
Way to record the conscious state of a person
Vegetative state
Unconscious with eyes open (TBIs)
A state of inconsistent, erratic responsiveness, generally unable to communicate with outside world
Minimally conscious state
Communication problems with TBI
Dysarthria (Slurred speech)
Aphasia (Deficit in language)
Memory problems with TBI
Anterograde vs retrograde
seen in severe injuries usually
Neuromuscular problems with TBI
- Spasticity, atypical (hyper reflexia) (UMN)
- Poor balance and equilibrium
- Abnormal posture
- Difficulty swallowing
- Extraneous Movements (tremors)
- Paresis/paralysis
With neuromuscular problems in TBI’s, how are the reflexes?
Atypical, spasticity (hyperreflexia) due to UMN damage
Personality/Emotional Changes with TBI:
- Impulsive and poor judgement
- Irritable
- Apathy
- Altered sex drive
- Decrease in goal-directed behavior
- Impaired social skills
- Limited self-awareness
Perceptual problems with TBI
- Visual spatial
- Poor body awareness
- Apraxia
- Unilateral neglect (R PTO)
- Agnosias (R PTO)
Somatosensory problems with TBI
- Feeling
- Discriminative touch
- Vibration
- Temperature
- Pain
Visual problems with TBI
- Diplopia (double vision)
- Visual field loss
- Acuity loss
- Poor eye movements
How much total blood volume circulates to the brain?
15-18% (even though brain is only about 2% of our body weight)
Arterial Supply of the brain:
- Internal Carotid (anterior)
2. Vertebral-Basilar (posterior)
Internal Carotid Artery supplies:
Majority of cerebral hemispheres
Vertebral-Basilar Supplies:
Brainstem, cerebellum and some of the cerebral hemispheres
Which artery merges at the brainstem to form the basilar artery?
Vertebral-Basilar artery
What makes up the circle of Willis?
The branches of the internal carotid and basilar arteries (posterior, anterior and middle cerebral arteries)
(they form a circle)
Anastomosis
Ring of nine arteries that supply ALL the blood the the brain
What are the nine arteries that supply all the blood to the brain?
- 6 large arteries (2 posterior/anterior and middle) (each has a cortical and a deep branch)
- 3 small communicating arteries
What does the internal carotid branch into?
Anterior cerebral (medial) Middle cerebral (lateral)
What do the vertebral arteries join together to form?
Basilar artery
What does the basilar artery branch into?
Posterior cerebral artery (PCA)
What does the middle cerebral artery supply on the surface?
Lateral surface of most of the lateral hemispheres: frontal, parietal and temporal lobes (not inferior temporal lobes though)
What does the middle cerebral artery supply deep?
Deep structures of the internal capsule, basal ganglia, indirectly optic tract and radiations
What does the anterior cerebral artery supply?
Medial aspect of frontal and parietal lobes
What part of brain do the branches of the anterior cerebral artery reach?
Diencephalon, limbic, caudate, internal capsule, undersurface of parietal lobe and part of frontal
What is the anterior cerebral artery formed from?
Internal carotid
What is the posterior cerebral artery formed from?
basilar artery
Posterior Cerebral Artery supplies what?
Supplies undersurface and posterior surface of the temporal lobes and occipital lobes
Where is the basilar artery?
Runs along the posterior surface of brainstem at level of pons
Where do the branches of the Basilar Artery wrap around to?
Cerebellum and internal auditory artery
Is there one or two basilar arteries?
ONE
Complete occlusion of Basilar Artery:
Death due to ischemia of brainstem nuclei and tracts that control vital functions
Partial occlusion of Basilar Artery:
Tetraplegia, loss of sensation, coma, CN signs (bilateral)
Severe partial occlusion of Basilar Artery:
Locked-in syndrome
Damage to cerebellar arteries (not getting into specific names)
Bad balance, lack of coordination, nystagmus, dizziness
Anterior Supply of arteries:
Internal Carotid System
Middle cerebral artery (MCA)
Anterior Cerebral Artery (ACA)
Posterior Supply of arteries:
Vertebral-Basilar system
Posterior cerebral artery (PCA)
Cerebellar Arteries
Ischemia
Local, temporary loss of blood supply
(lose consciousness after about 10 seconds)
(electrical signal ceases after about 20 seconds)
Infarct:
Area of tissue death due to loss of blood supply
Cerebrovascular Accident (CVA): What is it?
Focal neurological disorder of relatively abrupt onset due to a pathological process in a blood vessel, usually within one hemisphere of the brain
CVA: Aka?
Stroke or brain attack
CVA: Transient Ischemic Attack (TIA)
Brief, focal loss of brain function
Usually full recovery w/in 24 hours
Sign of risk for stroke
What is the leading cause of serious long-term disability?
Stroke
CVA: Completed Stroke:
Neurologic deficits from vascular disorders that persist more than 1 day and are stable
CVA: Progressive Stroke:
Deficits increase intermittently over time
Types of Strokes: Brain Infarction - Caused by??
Ischemic/non-hemorrhagic/Occlusive
Blockage of blood vessel producing ischemia, resulting in infarct
What % of strokes are ischemic?
90%
What causes blockage in Brain Infarction stroke?
Thrombus
Embolism
Thrombus (Thrombotic Stroke)
Formation of blood clot within an artery (it stays there and doesnt travel)
Embolism (Embolic stroke)
Blood clot formed, was dislodged, traveled in the blood stream and then became trapped in arteries closer to the brain
Which type of stroke is a rupture of blood vessel, with bleeding into or around cerebral tissue?
Hemorrhagic Stroke
bleeding irritates brain tissue, causing swelling
What displaces normal brain tissue in a hemorrhagic stroke?
swelling and hematoma compressing
What causes hemorrhagic stroke?
High blood pressure
Aneurysm:
Weak spot in an artery wall
Eventually it can burst and cause serious harm
Amyloid Protein in hemorrhagic stroke:
Who is it commonly seen in?
Makes vessels more prone to bursting
Seen in elderly
Stroke Symptoms
Face (uneven smile)
Arm (weakness or inability to move)
Speech (Slurred)
Time (call 911)
Prognosis of Stroke: If neuronal cell death occurs
If neuronal cell death occurs, permanent impairment
Prognosis of Stroke: After edema (swelling) subsides
Spontaneous recovery
likely to take place within 6 months
Stroke: Common deficits:
Motor
UMNs affected
- Flaccidity first (cerebral shock) then spasticity (b/c UMN not turning reflex arc off)
- Paresis/paralysis
- Hemiplegia (paralysis one side of body)
- Apraxia
Stroke: Common deficits:
Sensory
- Rarely in isolation (usually associated w motor)
2. Depends on where lesion is
Stroke: Common deficits:
Visual
Contralateral homonymous hemianopia
Stroke: Common deficits:
Emotional
- Depression
- Fear/Anxiety
- Emotional changes
- Apathy
Stroke: Common deficits:
Perception
- Agnosia
- Body Schema
- Visual-spatial
- Constructional Praxis
Stroke: Common deficits:
Cognition
Various
Stroke: Common deficits:
Language
- Aphasia (loss of ability to understand or express speech)
2. Dysarthria (slurred speech)
