TBI flashcards
Patients with ___ and ___ have been associated with doubling mortality
hypotension and hypoxia
what medication used for intubation does not increase ICP?
ketamine
what is hyperventilation used for in acute management of TBI
decrease ICP through hypocarbic vasoconstriction
when is surgical intervention appropriate for EDH?
EDH >30cm or GCS <9, clot thickness >15mm, midline shift >5mm or focal Neuro deficits
when is surgical intervention appropriate for SDH?
SDH >10mm or those associated with midline shift >5mm, GCS <8 with rapid decline or ICP <20mmHg
what positional changes can you do to help with intracranial hypertension
HOB >30 or reverse trendelenberg position to decrease ICP
when should ICP monitoring be used
patients with Severe TBI and abnormal CT scan to reduce 2-week and in-hospital mortality
what fluids are used to reduce ICP?
hypertonic saline 3% and mannitol 20%
what study indicated that corticosteroids should not be used in TBI?
CRASH trial
what is the equation for CPP
MAP - ICP
what are the secondary brain Injuries?
impaired CBF regulation and alteration in brain metabolism
what are the goals for ICP and CPP after Brain injury
ICP: <20
CPP between 50-70
what are the primary brain injuries?
DAI and cerebral contusion
where does DAI typically occur
axons of brainstem, parasagittal white matter of cerebral cortex, corpus callous and gray-white matter junctions of cerebral cortex
how do you classify DAI?
Adams classification
what is the most common cause of persistent coma after TBI?
DAI
what aphasia is not fluent, cannot comprehend and can repeat?
mixed transcortical
what aphasia is not fluent, can comprehend but cannot repeat
brocas
what aphasia is not fluent, can comprehend and can repeat
transcortical motor
what aphasia is fluent, cannot comprehend and can repeat
transcortical sensory
what aphasia is fluent, can comprehend but cannot repeat
conduction
most common abnormal hormone after brain injury?
growth hormone
how do you treat SIADH
fluid restriction and if moderate/severe= demeclocycline
most common cause of hypernatremia after brain injury?
Diabetes insipidus
how do you treat diabetes insipidus
free water replacement and more severe DDAVP
what are the Rancho levels (1-8)
1: no response
2. generalized response
3. localized response
4. confused agitated
5. confused inappropriate
6. confused-appropriate
7. automatic-appopriate
8. purposeful-appropriate
what are the levels of the agitated behavior scale
14-21: normal
22-28: mild
29-35: moderate
35+ severe
what score on CRSR means minimally conscious state
12 or higher
most common site for TBI
anterior inferior frontal and temporal lobes
most common brain tumor in childrens
astrocytomas and medulloblastomas
most common brain tumor in adults
metastatic
most common primary brain tumor in adults
GBM
what is the clinical presentation of supratentorial tumors
seizures, increased ICP and focal neurological deficits
what is the clinical presentation of infratentorial brain tumors
increased ICP, cranial nerve deficits and ataxia
what cancer is the most common to metastasize to the brain
small cell lung cancer
what is the second most common primary CNS neoplasm
meningioma
what is the most common intratentorial tumor in adults
acoustic neuroma/schwannoma
when does focal cerebral radiation necrosis typically occur
15-18 mints after XRT
when does diffuse cerebral radiation injury occur
6-18 months after XRT
what scale attempts to quantify outcome in quality of life in individuals with brain tumors
Karnofsky scale
what variables are related to good quality of life in individuals with Brain tumors
freedom from depression, active social life, greater energy, fewer symptoms
what complication of radiation for brain tumors is indistinguishable from recurrence of tumor on imaging and requires pathology for confirmation
FCRN
what is the incidence of HO after TBI
11-35%
what is the incidence of HO after SCI
16-53%
what is the incidence of HO after burns
0.1-3.1%
what is the peak occurrence for HO
2 months
where is HO most common with SCI
hip
where is HO most common in burn victims
elbow
why is indomethacin used in HO
inhibits prostaglandin synthetase; inhibits inflammatory response and suppresses mesenchymal cell proliferation
what are the gradings for HO around the him
0- no heterotopic bone
1- occupies less than 50% of the distance between femur and pelvis
2-occupies >50% of, but not bridging, the distance between the femur and the pelvis
3- formation of bridging heterotopic bone
surgical timing for HO
traumatic HO can be resected at 6 months
SCI HO at 1 year
TBI HO at 1.5 years
what is the major cause of post-TBI NPH
SAH
what is the most important acute predictor of TBI outcome
ICP
what are the cutoffs for ICP for not good vs fatal
> 40 is not good
>60 is fatal
what things make someone more prone to developing both NPH and seizures
SAH, depressed skull fracture, meningitis
what is the most common cause of TBI in the USA
falls
what is the most common cause of TBI world-wide
MVCs
what age demographics are most likely to develop TBi
15-19 yo, >75 yo (falls) and 0-4yo
where is CSF produced
at the choroid plexus in the lateral ventricles
what is the most common cause of communicating NPH
TBI
what are the CT findings for post-traumatic hydrocephalus
distended appearance of anterior horns of the lateral ventricles
enlargement of the temporal horns of the 3rd ventricles
normal or absent sulci
enlargement of the basal cisterns or 4th ventricles
periventricular lucency
lifetime incidence of TBI is ____ greater in alcoholics
4x
what percentage of TBIs occurred while the person was drunk
~50%
how much more likely are TBI survivors to have another TBI
3-8 times higher risk
how common is depression within the first year of a TBI
8 times more common
what are the CAGE screening questions
C- cut back
A-annoyed
G-guilty
E-eye-opener
what are the most significant prognostic indicators after TBI
PTA duration and age
how do you know if someone is out of PTA
GOAT >75 for 2 consecutive days or
O-log 25+ for 2 straight days
what are the areas of scoring for CRSR
auditory (0-4), visual (0-5), motor (0-6), promoter (0-3), communication (0-2), arousal (0-3)
coma lasting longer than ____ is very unlikely to have good outcome
2 weeks
PTA less than ____ usually has good outcome
<2 weeks
define coma
deep sustained pathologic unresponsiveness in which eyes remain closed and the patient cannot be aroused
define vegetative state
condition in which awareness of self and environment is presumed to be absent and there is an inability to interact with others, although the capacity for spontaneous or stimulus-induced arousal (wakefulness) is preserved
when does vegetative state become persistent
after 1 month
mechanism of amantadine (most supported)
weak, non-competitive antagonist of the NMDA receptor, which increases dopamine release and prevents dopamine reuptake
what is the primary thing found in SIADH
low sodium
diagnostic labs for SIADH
low sodium, low serum. osmolarity, urine osmolarity> serum osmolarity, high urine sodium
what happens with rapid correction of low sodium
central pontine myelinosis
what is the primary symptom of DI
elevated sodium
