TBI Part 2

Question 1

common demog for TBI

Answer 1

M > F

0-4 yo - shaking baby

15-24 yo - MVA, sports

> 65 yo - falls

Question 2

object appears moving even when it is not

Answer 2

oscillopsia

Question 3

O exam of cerebrum is done if _____

Answer 3

there are S findings of cerebrum deficits

Question 4

level of consciousness common in TBI

Answer 4

RLA 1-3

Question 5

sequence of recovery after coma

Answer 5

1. eye opening - CN 3
2. brainstem function - sleep wake cycle
3. hypothalamus function - follow simple
4. able to talk and communicate - best indicator

Question 6

discuss persistent vegetative state

Answer 6

1 mo. unconscious

(+) sleep wake cycle
(+) PLR
(+) oculocephalic
(+) primitive behavior
(+) sponty response

Question 7

true or false

neurobehavioral deficits are more debilitating

Answer 7

true if long run

Question 8

classifications of TBI

Answer 8

primary and secondary

Question 9

primary injury TBI

Answer 9

brain tissue in contact c internal or external if penetrating

head prevented to move after blow

rapid acceleration and deceleration

Question 10

secondary injury TBI

Answer 10

damage p primary injury - hours to days p

treatable and preventable

Question 11

type of primary TBI

Answer 11

diffuse axonal injury

cerebral/cortical contusion

concussion

direct laceration

diaschisis

brain hematoma

Question 12

discuss diffuse axonal injury

Answer 12

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

Question 13

common sites and spared in DAI

Answer 13

common: corpus callosum, subcortical WM, brainstem

spared: upper medulla, CN 9 and 11

Question 14

discuss cerebral/cortical contusion

Answer 14

from translational acceleration - low velocity

elevated risk for seizures and more focal deficits

usually bilat by can be assym

Question 15

common areas of contusion

Answer 15

undersurface of frontal and ant temporal lobes

frontal: LTA
temporal: STA

Question 16

discuss the types of contusion

Answer 16

coup: under impact site

countercoup: opposite of impact site

coup-countercoup: combined

Question 17

discuss concussion

Answer 17

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

Question 18

in taking the GCS of a concussion pt what should be considered

Answer 18

absence of alcohol, drugs, sedatives

Question 19

discuss post concussional syndrome

Answer 19

3 mo. after concussion

loss of concentration
memory deficit
irritability
agitation
fatigue
HA

Question 20

discuss direct laceration

Answer 20

less common cause of parenchymal injury

caused by metallic or bony fragments
- GWS
- depressed skull fx
- blunt trauma
- penetrating

Question 21

discuss diaschisis

Answer 21

neurons remote from injury but anatomically connected are functionally depressed

crossed-cerebellar: dec BF in cerebellar hemisphere contra to cortical stroke

Question 22

discuss brain hematoma

Answer 22

epidural: arteries
- meningeal artery rupture

subdural: veins
- intracerebral hemorrhage; penetrating

Question 23

causes of secondary injury

Answer 23

dec BF
neurochemicals
cerebral edema
inc ICP
infection
hemorrhage
hypoxic ischemic injury

Question 24

discuss blast injury

Answer 24

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

Question 25

what is quaternary injury

Answer 25

asphaxia and exposure to toxic inhalants

Question 26

discuss PTA

Answer 26

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

Question 27

discuss retrograde and anterograde amnesia

Answer 27

retrograde: loss of previous; evocation

anterograde: inability to learn new; fixation

Question 28

true or false

if MAP is normal but BP is abnormal PT Mx can be continued

Answer 28

true

Question 29

what is dysautonomia

Answer 29

elevated SNS activity as response to trauma

Question 30

best indicator of perfusion in vital organs

Answer 30

MAP

Question 31

dec in CPP can lead to _____

Answer 31

brain ischemia

Question 32

racoon’s eyes and battle sign signify _____

Answer 32

basal skull fx

Question 33

compare decorticate and deceberate

Answer 33

decorticate - UE flexed while LE in ext

deceberate - UE, LE and trunk are ext