TBI/Near Drowning/Tumors Flashcards
external mechanical force applied to head/skull
traumatic brain injury
what is the leading cause of death in children aged 1-18
TBI
MOI for TBI
- falls
- MVA (pedestrian, passenger, bicyclists)
- gunshot wounds
- sports/concussions
- abuse/assault
what age is TBI most common from falls
0-12 m/o
80% of head trauma deaths under the age of 2 are caused by
child abuse
signs and sx of abusive head trauma
- unexplained apnea
- retinal hemorrhages
- seizures
- head/neck bruising
types of brain injury associated with abuse
- subdural hematoma
- hypoxia/ischemic injury
- cerebral edema
- shaken baby impact syndrome
occurs when infant is inconsolable and the caregiver shakes them usually to get them to stop crying and then often in combination with dropping/throwing infant against an object
shaken baby impact syndrome
moving head hits a fixed object such as ground, dashboard or back of seat
accerelation/deceleration MOI
head displaced, hits object, then lateral displacement of brain; coup impact in the direction opposite the original impact (countercoup –> brain decelerates against bones in the skull)
translational injury
blunt object hits the head
impression injury
skull rotates, brain stays stationary; angular force on brain
rotational injury
can you typically see brain changes on imaging following a concussion
no
neurochemical injury
concussion
sx of concussion
headache, dizziness, sensitivity to light/sound, difficulty falling asleep, memory changes, behavioral changes
bruising/hemorrhage, will be able to see on MRI
contusion
common causes of contusion
blunt force trauma, also seen with acceleration/decelereation injuries
what lobes are contusions common in
frontal and temporal
fracture caused from low velocity objects
linear comminuted fracture
fracture caused from higher velocity objects
depressed skull fractures
what can depressed fractures lead to
contusions, lacerations, and CN damage due to indentation
skin is broken and bone is seen
compound fx
involves fracture in floor of skull near eyes/ears/nose or in the back/base of skull
basal/basilar skull fx
what types of sx/signs can be seen with basal/basilar skull fx
blood in ear canal, leakage of CSF from nose/ears, raccoon eyes
injury with or without loss of consciousness and the depth of injury may not be readily recognized
intracranial hemorrhages
what are the two main types of intracranial hemorrhages
extradural (epidural) and intradural hematoma
commonly seen with skull fx
extradural hematoma
what artery is torn with extradural hematoma
middle meningeal artery
unilateral extradural hematoma can lead to herniation to which lobe
temporal
types of intradural hematoma
subdural and intracerebral hematomas
what causes intradural hemotoma and where is it commonly seen
injury to veins in subdural space
- seen in temporal and frontal lobes
type of hematoma with increased mortality rate and poorer long term outcomes
subdural hematoma
what does DAI stand for
diffuse axonal injury
what type of injury is DAI associated with
rotational injury and shearing forces (diffuse changes in cellular structures t/o the brain)
what matter does DAI affect
white
common sx associated with DAI
sudden LOC and extensor posturing
occurs hours to days after initial brain injury
secondary brain damage
in conjunction with increased ICP, can lead to infarctions, herniation, necrosis of brain tissue
cerebral edema
treatment for secondary brain injury
medical sedation, neuromuscular paralysis, diuretics
can cause obstructive hydrocephalus, the brain shifts past midline leading to changes in LOC, increased tone and decorticate posturing
herniation syndromes
what tries to handle an increase in intracranial pressure
ventricular system
how to tell if infant has increased ICP
bulging fontanels
series of events following increased ICP
contents in cranial vault pushed down –> brainstem compression —> cardiorespiratory arrest
what is the normal ICP in kids
7-15 mmHg
monitors ICP and drains CSF
external ventricular drain
ANS malfunction that leads to hypertension, diaphoresis, fatigue, heart rate changes, sweating/lack of sweating
dysautonomia
what are factors that can predict the outcome following pediatric TBI
- location and severity of injury
- complications
- age at time of injury
- length of coma
- premorbid level of cognition
unconscious state; no eye opening, no command following and no reaction to painful stimuli
coma
what does the glasgow coma scale (GCS) measure
response to motor activity, verbal responses and eye opening
what age in the pediatric coma scale (PCS) used for
9-72 m/o
score range for GCS
3-15
score range for PCS
3-14
scores that predict poor and good outcomes following coma
- poor: 3 or 4
- good: > 7
what test is used to assess orientation/amnesia
children’s orientation and amnesia test (COAT)
age for COAT and what does it assess
- 4-15
- orientation, temporal orientation, memory
a descriptive scale used to assess cognitive/behavioral functioning and is used in inpatient settings
rancho los amigos level of cognitive functioning
state the levels of the rancho scale
- I: no response
- II: generalized response (inconsistent/non-purposeful)
- III: localized response (specific but inconsistent)
- IV: confused-agitated (heightened state of activity and agitation)
- V: confused-inappropriate (simple commands, distractible, memory impaited)
- VI: confused-appropriate (needs input/direction for activities, responses are appropriate for stimulation, still with memory deficits)
- VII: automatic/appropriate (robot like with daily routine, decreased judgement and problem solving)
- VIII: purposeful/appropriate (recall past, aware of environment, learns new tasks, no supervision needed)
age range for pediatric rancho scale
infancy to 7 y/o
scores of pediatric rancho scale
- V: no response to stimuli
- IV: generalized response to stimuli
- III: localized response to stimuli
- II: responsive to environment (alert/responds to name, highly distractible, agitation)
- I: patient oriented to self and surroundings (provides accurate information about self, participates in tx program, shows interest in toys, knows where their room is/PT gym)
survival for at least 24 hours following submersion incident
near drowning
highest age range for near drowning
1-4 y/o
sources of near drowning
bathtubs, pools, washing machines
wet drowning
aspiration of water
dry drowning
laryngospasm
areas most commonly affected by ischemia in near drowning
hippocampus, insular cortex and basal ganglia
tumor involving cerebellum and brainstem
astrocystomas
what does astrocytoma arise from
brain cells, astrocytes or glial cells (glioma)
most common pediatric brain tumor
astrocytoma
common locations of astrocytoma
cerebellum, cerebral hemispheres, thalamus, hypothalamus
most common malignant tumor in the cerebellum
medulloblastoma
what does medulloblastoma arise from
primitive neuronal cells (PNET)
intracerebral tumor commonly found in 4th ventrile
ependymomas
high grade ependymomas are prone to spread via
subarchnoid and intraventricular fluid pathways
congenital tumors, can cause compression of optic N and can block 3rd ventricle causing hydrocephalus’ usually benign
craniopharyngiomas
s/s of brain tumors
seizures, visual disturbances, headaches, vomiting, gait disorders, loss of coordination
what can cause low arousal
damage to frontal lobe and brainstem; medications
damage where can lead to decreased attention to stimuli, decreased ability to learn or relearn a motor task
frontal lobe injury
trauma where will lead to memory deficits
temporal lobe
damage where can lead to deficits in executive functions
prefrontal cortex
tone commonly seen in UE and LE
- UE: flexor tone
- LE: extensor tone
ataxia occurs due to damage where
cerebellar and basal ganglia
what is a good position for tone inhibition
sidelying
