TBI Part 2 Flashcards
common demog for TBI
M > F
0-4 yo - shaking baby
15-24 yo - MVA, sports
> 65 yo - falls
object appears moving even when it is not
oscillopsia
O exam of cerebrum is done if _____
there are S findings of cerebrum deficits
level of consciousness common in TBI
RLA 1-3
sequence of recovery after coma
- eye opening - CN 3
- brainstem function - sleep wake cycle
- hypothalamus function - follow simple
- able to talk and communicate - best indicator
discuss persistent vegetative state
1 mo. unconscious
(+) sleep wake cycle
(+) PLR
(+) oculocephalic
(+) primitive behavior
(+) sponty response
true or false
neurobehavioral deficits are more debilitating
true if long run
classifications of TBI
primary and secondary
primary injury TBI
brain tissue in contact c internal or external if penetrating
head prevented to move after blow
rapid acceleration and deceleration
secondary injury TBI
damage p primary injury - hours to days p
treatable and preventable
type of primary TBI
diffuse axonal injury
cerebral/cortical contusion
concussion
direct laceration
diaschisis
brain hematoma
discuss diffuse axonal injury
disruption of axons and small BV from angular acceleration
d/t MVA - high velocity
LOC —-> coma is common and recovery is gradual
more generalized deficits
common sites and spared in DAI
common: corpus callosum, subcortical WM, brainstem
spared: upper medulla, CN 9 and 11
discuss cerebral/cortical contusion
from translational acceleration - low velocity
elevated risk for seizures and more focal deficits
usually bilat by can be assym
common areas of contusion
undersurface of frontal and ant temporal lobes
frontal: LTA
temporal: STA
discuss the types of contusion
coup: under impact site
countercoup: opposite of impact site
coup-countercoup: combined
discuss concussion
mild TBI
sx should be present 3-12 mo. for persistent deficits
GCS score 13-15 after 30 mins
at least one:
- confusion
- disorientation
- LOC for < 30 mins
- PTA for < 24 hrs
- transient focal neuro deficits
in taking the GCS of a concussion pt what should be considered
absence of alcohol, drugs, sedatives
discuss post concussional syndrome
3 mo. after concussion
loss of concentration
memory deficit
irritability
agitation
fatigue
HA
discuss direct laceration
less common cause of parenchymal injury
caused by metallic or bony fragments
- GWS
- depressed skull fx
- blunt trauma
- penetrating
discuss diaschisis
neurons remote from injury but anatomically connected are functionally depressed
crossed-cerebellar: dec BF in cerebellar hemisphere contra to cortical stroke
discuss brain hematoma
epidural: arteries
- meningeal artery rupture
subdural: veins
- intracerebral hemorrhage; penetrating
causes of secondary injury
dec BF
neurochemicals
cerebral edema
inc ICP
infection
hemorrhage
hypoxic ischemic injury
discuss blast injury
military or police
primary - oscillations of blast inc CSF or venous psi; compression of thorax and abdoment
secondary - shrapnel or other objects
tertiary - victim flung backwards and hits head
what is quaternary injury
asphaxia and exposure to toxic inhalants
discuss PTA
time bet injury and time pt is able to remember
mild: 0-1 day
mod: more than 1 but less than 7 days
severe: > 7 days
discuss retrograde and anterograde amnesia
retrograde: loss of previous; evocation
anterograde: inability to learn new; fixation
true or false
if MAP is normal but BP is abnormal PT Mx can be continued
true
what is dysautonomia
elevated SNS activity as response to trauma
best indicator of perfusion in vital organs
MAP
dec in CPP can lead to _____
brain ischemia
racoon’s eyes and battle sign signify _____
basal skull fx
compare decorticate and deceberate
decorticate - UE flexed while LE in ext
deceberate - UE, LE and trunk are ext
