TBI pathology/management

Question 1

What is a contusion?

Answer 1

swollen brain tissue with vascular and tissue damage
countercoup is injury to opposite side
blood is intermixed with tissue (seen on CT scan)

Question 2

What is a hematoma?

Answer 2

damage to major blood vessels or heavy bleeding into/around brain

1. epidural- between skull and dura
2. subdural- between dura and arachnoid
3. subarachnoid- into brain

Question 3

What is a diffuse axonal injury?

Answer 3

torsion or shearing of axons
happens at gray/white matter junction
Not always diffuse (focal or multifocal)
Not seen on CT

Question 4

What are the four types of blast injuries?

Answer 4

1. primary- shock wave
2. secondary- fragments
3. tertiary- bone fractures/amputation
4. quaternary- respiratory, burns

Question 5

What is a typical ICP and CPP? excessive ICP?

Answer 5

10-15 mmHG, 60-70 mmHG

excessive is >20-25

Question 6

What are signs/symptoms that ICP is too high?

Answer 6

decreased pulse
change in consciousness
agitation
coma

Question 7

What are the Cushing’s Triad signs?

Answer 7

increase systolic BP
decreased pulse
decreased respiration
(opposite of shock)

Question 8

What types of injury do X-ray, CT, and MRI identify?

Answer 8

x-ray: fracture
CT: hematoma, contusion
MRI: DAI

Question 9

What are the surgical procedures done for a hematoma?

Answer 9

epidural: craniotomy and evacuation
Subdural: burr holes

Question 10

What value must the ICP be under to treat the patient?

Answer 10

less than 22 mmHg