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Neuro 1 - Exam 4 > TBI - Lecture 14 > Flashcards

TBI - Lecture 14 Flashcards

1
Q

acquired brain injury

A

injury to the brain at the cellular level resulting in a change in neuronal activity

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2
Q

what does injury to the brain affect

A

physical integrity

metabolic activity

fxnal ability of the neurons

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3
Q

ABI are

A

not hereditary, congenital, degenerative or induced by birth trauma

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4
Q

TBI is a _____ of ABI

A

subset

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5
Q

caused of ABI

A

TBI w/ or w/o skull fx

CVA

AVM

aneurysm

anoxic encephalopathy

intracranial tumors

meningitis, encephalitis

seizure disorders

toxic exposures

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6
Q

TBI is the

A

leading cause of neurologic disability in the US

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7
Q

incidence rate

A

highest

age 15-24

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8
Q

how often does someone sustain a TBI (US)

A

23 s

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9
Q

how many americans sustain a TBI/yr

A

1.4-1.5 mil

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10
Q

how many americans currently live with disabilities resulting from a TBI

A

estimated 5.3 americans

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11
Q

how many people die as a result of a TBI each year

A

> 50k

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12
Q

leading cause of death in children under 5

A

TBI

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13
Q

TBI

A

a non-degenerative, non-congenital insult to the brain from an external force

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14
Q

what can a TBI possibly lead to

A

permanent or temp impairments of cognitive, physical, and psychosocial fxns with an associated diminished or altered state of consciousness

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15
Q

which gender is more at risk for TBI

A

male

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16
Q

highest risk age

A

0-4 and 15-19

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17
Q

highest rates of TBI-related hospitalization and death

A

> age 75

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18
Q

certain military personel

A

at risk

IED exposure

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19
Q

elderly TBI

A

fastest growing group of TBI pts

anticoagulants

elder abuse

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20
Q

elderly –> high risk secondary to

A

medications

decreased balance

decreased strength

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21
Q

how many children sustain brain injuries a year

A

> 1 mill

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22
Q

TBI is the leading cause of death in children

A

<5

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23
Q

how many pediatric injuries are related to brain injuries

A

1/3

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24
Q

pediatric TBIs are often

A

misdiagnoses or misidentified

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25
if TBI occurs b4 attainment of development milestones
the child might never attain those milestones
26
TBI pathology
primary and secondary injury
27
primary injury
focal diffuse
28
focal
penetrating injury non-penetrating injury
29
penetrating injury
skull fxs lacerations gunshot/missile wounds
30
non-penetrating injuries
concussion contusion intracranial hemorrhage
31
diffuse
diffuse axonal injury (DIA)
32
skulls fxs
the more the severe the TBI, the more likely for skull fxs
33
skulls fractures have
higher risk of seizures and intracranial hemotoma
34
what is secondary to CSF leak --> skull fx
rhinorrhea or otorrhea
35
contusions
hemorrhage edema tissue distortion scarring
36
what do contusions produce
focal cognitive and sensori-motor deficits increased risk of seizures
37
types of intracranial hemorrhages
extra-axial intra-axial
38
extra-axial hemorrhages
epidural subdural subarachnoid
39
intra-axial hemorrhage
intra-parenchymal intra-ventricular
40
imaging --> intracranial hemorrhage
CT scan MRI
41
CT
preferred over MRI initially better at detecting bony fxs, hematomas, SAH easily accesible, faster, cheaper
42
MRI
more beneficial for detection of severe TBIs
43
epidural hematoma
mass effect associated with skull fx common
44
where does a EDH occur
b/w skull and dura mater
45
where is a EDH most common
middle meningeal artery
46
EDH enlarges
fairly slowly
47
EDH can be dangerous d/t
increase in ICP
48
subdural hematoma occurs
b/w dura and arachnoid
49
SDH onset
variable
50
SDH is most commonly
traumatic in nature
51
SDH is
rupture of vein that bridge the subdural space
52
SDH v. EDH
SDH is more common
53
morbidity and mortality
greater in SDH than EDH
54
SDH is more common in people w/
brain atrophy - tension on bridging veins higher risk of falls anticoagulants
55
anticoagulants --> SDH
increase risk of hemorrhage even with minor injuries
56
subarachnoid hemorrhage location
b/w the arachnoid and pia
57
SAH seen
to a degree in most serious brain injuries
58
SAH --> sudden onset of
loss of consciousness
59
SAH has
increased risk of vasospasm increased risk of hydrocephalus
60
SAH requires
immediate intervention dangerous
61
intra-parenchymal
IPH intracerebral or intracerebellar
62
intra-ventricular
IVH usually seen with SAH
63
diffuse axonal injury (DAI)
acute stretching and shearing of axons
64
what are DAI caused by
shearing injury and accelerating and decelerating forces to the brain
65
DAI is a
microscopic diagnosis
66
where is DAI most often seen
corpus callosum subcortical white matter cerebral peduncles brainstem
67
DAI in the midbrain
particularly repsonsible for initial LOC
68
DAI is associated with
shaken baby syndrome
69
DAI grading
mild moderate severe
70
mild DAI
coma lasting 6-24 hrs mild-mod memory impairment and disabilities
71
moderate DAI
coma > 24 hrs f/b confusion and long lasting amnesia w/drawl to purposeful mvts mod-severe memory, behavioral, cognitive and intellectual deficits
72
severe DAI
deep prolonged coma lasting months w/ flexion and extension posturing severe deficits in all areas
73
DAI diagnosis
may see nothing on radiologic exam petechial hemorrhages seen 20% of the time on CT scan MRI is more sensitive imaging
74
MRI --> DAI
diffusion weighted imaging FLAIR gradient ECHO diffusion tensor imaging
75
secondary injury
increased ICP cerebral edema hypoxia or anoxia ischemia hemorrhage, hematoma, herniation, mass effect hypotension neurochemical and cellular changes electrolyte imbalances
76
ICP levels
ideal abnormal likely to have neurological damage fatal
77
ideal
0-10
78
abnormal
20-40
79
likely to have neurological damage
>40
80
fatal
>60
81
increases ICP can cause
decreased cerebral BF decreased CPP herniations
82
interventions for increased ICP
surgical pharmacological
83
surgical interventions --> ICP
decompressive surgery CSF drainage decreased intracranial volume
84
decompressive surgery
craniotomy craniectomy
85
decreased intracranial volume
raise the HOB hyperventilation (temp)
86
pharmacological
mannitol barbiturate coma
87
hypoxia and edema
systemic brain damage intracranial brain damage
88
systemic brain damage
arterial hypoxemia d/t airway obstruction or trauma loss of brain's ability to autoregulate vasodilation --> decreased cerebral perfusion
89
intracranial brain damage
cytotoxic edema vasogenic edema
90
brain shift and hernitation
neurosurgical emergency
91
uncal herniation
temporal lobe gets pushed downward through the temporal notch compressing the brainstem
92
central herniation
diencephalon is at risk same as uncal herniation
93
cerebellar herniation
cerebellar edema pushes the cerebellar tonsils downward through the foramen magnum compressing the brainstem
94
subfascial herniation
caused by an expanding frontal lobe lesion

Neuro 1 - Exam 4 (12 decks)

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