TRAUMA Flashcards
implies a violent shaking or jarring of the brain and a
resulting transient functional impairment
concussion,
Even in immediately fatal head injuries,
autopsy reveals an intact skull in _______percent of cases
20 to 30
Overall, brain injury
is estimated to be_______ more frequent with skull
fractures than without them and perhaps 20 times more
frequent with severe and multiple fractures
5 to 10 times
Fracture of the
________ often deforms the external auditory
canal or tears the tympanic membrane, with resultant
leakage of CSF (otorrhea); or, blood may collect behind an
intact tympanic membrane and discolor it
petrous pyramid
If the fracture
extends more posteriorly, damaging the __________
the tissue behind the ear and over the mastoid process
becomes boggy and discolored _______
sigmoid sinus,
Battle sign
Basal fracture
of the ________ may also cause blood to leak
into the periorbital tissues, imparting a characteristic
“raccoon” or “panda bear” appearance.
anterior skull
The ______, ________ AND ______ are the ones most liable to injury, but any
one, including the twelfth, may be damaged
olfactory, facial, and
auditory nerves
A fracture in or near
the sella may tear the stalk of the pituitary gland with
resulting_______
diabetes insipidus.
A fracture of the sphenoid bone may lacerate the__________ with blindness from the beginning.
optic
nerve,
diplopia that is worse on looking down and compensatory
tilting of the head indicating a _________
trochlear nerve injury
Injury to the ________ AND ________ of the
trigeminal nerve may be the result of either a basal fracture across the middle cranial fossa or a direct extracranial injury to the branches of the nerves
ophthalmic and maxillary divisions
transverse fractures
through the petrous bone results in ______
immediate
facial palsy,
_____of the petrous bone, the facial palsy then
often being delayed for several days, a sequence that may be misinterpreted as progression of the intracranial traumatic lesion.
longitudinal
fractures
Injury to the eighth cranial nerve because of petrous
fractures results in a loss of hearing or in ________
and _________ coming on immediately after the trauma
postural vertigo
nystagmus
Deafness as a result of nerve injury must be distinguished
from the high-tone hearing loss due to ___________and
from deafness caused by bleeding into the middle ear
and disruption of the ossicular chain
cochlear injury
The rare condition of fracture through
the __________ causes weakness of one side of
the tongue.
hypoglossal canal
A basal fracture through the _______ may lacerate
the internal carotid artery or one of its intracavernous
branches where it lies in the cavernous sinus
sphenoid bone
In CCF, Also, there may be a loss of vision as a result of __________
ischemia of the optic nerve and retina
Some
_______ of fistulas resolve spontaneously, but the
remainder must be obliterated by interventional radiologic
means (by a detachable balloon inserted into the
carotid artery via a transfemoral catheter) or by a direct
surgical repair of the fistula
5 to 10 percent
How to test for CSF in CSF rhinorrhea?
by testing it for glucose with diabetic test tape (mucus has no glucose)
presence of fluorescein or radionuclide-labeled dye that
is injected into the lumbar subarachnoid space and then
absorbed by pledgets placed in the nasal cavity
detect tau protein in the discharge; it is
present only in CSF and not in mucus or blood
Tx of tension pneumocranium
Inhalation
of 100 percent oxygen has a slight salutary effect, but
aspiration of the air is required if the collection is causing
clinical signs.
Depressed skull fractures are of significance only
if the _________or the ________They then are surgically
elevated, preferably within the first 24 to 48 h.
underlying dura is lacerated
brain is compressed
by indentation of bone.
The duration of the
amnesic period, particularly of ______________, is
but one index of the severity of the concussive injury
anterograde amnesia
A majority of patients who
remain in a coma for more than 24 h after a head injury are found to have intracerebral______________
hematomas and contusions.
Blows to the front of the head may produce mainly __________lesions, whereas blows to the back of the head may cause mainly_________ lesions. Blows to the side of the head produce___________
coup
contrecoup
either coup or contrecoup lesions, or both.
Irrespective
of the site of the impact, the common sites of cerebral
contusions are in the_______
frontal and temporal lobes
Relative sparing of the occipital lobes in coupcontrecoup
injury has been explained by the __________and subadjacent tentorium,
smooth
inner surface of the occipital bones
In most cases of severe head injury, there is damage
to the __________by impact with the falx
corpus callosum
all brainstem
hemorrhages when there is mass effect that distorts
the brainstem
Duret hemorrhage
In addition to contusions and extradural, subdural,
subarachnoid, and intracerebral hemorrhages, closed head
injury induces variable degrees of vasogenic edema that
increases during the first ________
24 to 48 h
pulmonary symptoms is associated with a petechial rash
over the thorax, especially in the axillae and also in the
conjunctivea. what is this related to?
Ce re b ra l Fat E m bo l i s m
CEREBRAL FAT EMBOLISM CAUSES widespread ________________
involving both white and gray matter and a few larger
infarcts
petechial hemorrhages and small infarctions,
Most patients with fat embolism recover spontaneously
in ___________, although a mortality rate of up to
10 percent is cited
3 or 4 days
fracture
through the squamous bone and the groove of the middle
meningeal artery, which represents a risk for arterial
bleeding and ________
epidural hemorrhage.
indications of ct scan in head injury
prolonged loss of
consciousness (more than 1 min), severe and persisting
headache, nausea and vomiting, a confusional state, and
any new, objective neurologic signs,
T OR F
in children with head injury, it may be advisable to perform the scans more liberally
T
Canadian CT head rule
age above 60 years, intoxication, more than 30 min of retrograde amnesia, suspected skull fracture, seizure, anticoagulation, and dangerous mechanism of injury,
A concussion of the ______ of the spinal cord is
another potential mechanism of transient paraplegia
cervical portion
Among patients who
survived and remained vegetative until death, Adams
and colleagues (2000) found that 80 percent had _____________ and 71 percent had findings of ____________
thalamic damage
diffuse axonal
injury.
_________ accelerated
slightly the emergence from the vegetative or minimally
conscious state; it was given for 4 weeks between the
fourth and twelfth weeks after injury, 100 mg twice per
day and increasing to 200 mg twice per day
Amantadine
epidural hematoma arises with _____________fracture and laceration of the middle meningeal
artery or vein. Less often, there is a tear in a ______
a temporal or parietal
dural venous sinus.
Poor prognosticating factors after surgery of EDH
extended fractures and laceration of the dural
venous sinuses,
In _______________ which may be
unilateral or bilateral, there may be a brief lucid interval
between the blow to the head and the advent of coma
acute s ubdural hematoma,
Unlike epidural arterial hemorrhage, which is
steadily progressive, the ____________usually
arrests the venous bleeding
rising intracranial pressure
IN SDH, On CT scans, the
acute clot is initially hyperdense but becomes slowly more isodense after a period of ________
Over the subsequent weeks,
all image sequences show it as hyperintense as a result
of ____________ formation
1 or more weeks
methemoglobin
The acute clot is
hypointense on T2-weighted images, reflecting the presence
of _______
deoxyhemoglobin
In SDH, With contrast infusion, both imaging procedures usually reveal the _________
vascular and reactive border surrounding the
clot.
Usually, by the fourth week, sometimes later, the
hematoma becomes very hypodense, giving rise to a
___________
chronic subdural hygroma
The chronic subdural hematoma becomes gradually
encysted by fibrous membranes _________
that grow from the dura
(pseudomembranes)
the most important factor in the expansion
of subdural fluid is a pathologic___________
permeability of the
developing capillaries in the outer pseudomembrane
of the hematoma
In most cases of
acute hematoma it is sufficient to place ________ and
evacuate the clot before coma has developed
burr holes
the interval between__________________ is
perhaps the most important determinant of outcome in
serious cases
loss
of consciousness and the surgical drainage of the clot
To remove the more chronic hematomas a _______
must be performed and an attempt made to strip the
membranes that surround the clot
craniotomy
This i s a thinly encapsulated collection o f clear o r slightly xanthochromic fluid in the subdural space; such collections form after an injury, as well as after meningitis
subdural hygroma
Occasionally a hygroma originates from a tear
in an _________.
Another cause is from _________
arachnoidal cyst
IC hypotension
In contusion hematoma, the swelling in the
region of an acute contusion is precipitated by _______
excessive
administration of intravenous fluids
basal ganglia
hemorrhages were prone to enlarge in the day or two
after closed head injury and that those greater than ____________
in volume were fatal in 9 of 10 cases
25 mL
The diagnosis is suspected from the combination
of subdural hematomas and retinal hemorrhages,
Shaken baby syndrome
In most penetrating injuries from high-velocity missiles,
the object (such as a bullet) causes a _____________that is sterile and does not require
surgery if the projectile exits the skull
high-temperature
coagulative lesion
Cx of penetrating injuries
In these instances,
the main considerations are the development of infection
or CSF leaks or, in the long term, epilepsy or aneurysms
in distal blood vessels
factors leading to coma in penetrating injuries
cerebral necrosis, edema, and hemorrhage
The shock wave o f a n explosive device such a s bomb
can propel objects into the cranium but there is also a
direct form of organ damage from the dissipation of
energy that occurs at the interfaces of tissues of different
densities
blast injury
Seizures are the most common delayed sequela of
craniocerebral trauma, with an overall incidence of
approximately ________in patients with closed head
injuries and ________ in those who had sustained a
compound skull fracture and direct wounds of the brain.
5 percent
50 percent
risk of seizures after severe head injury
was 7 percent within 1 year and 1 1 .5 percent
in 5 years.
Some _________percent of
hospitalized head-injured individuals are said to have
one or more seizures within the first week of their injury
___________
4 to 5
(early epilepsy) .
The______________have a good prognosis
and we tend not to treat them as if they represented
epilepsy; on the other hand, ______________ are significantly more frequent in patients who had experienced epilepsy in the first week after injury
immediate seizures
late seizures
seizures that develop several weeks or
months after closed head injury (1 to 3 months in most
cases).
posttraumatic epilepsy
Approximately 6 months after injury, half the
patients who will develop epilepsy have had their first
episode; by the end of 2 years, the figure rises to _____________
80 percent
T OR F
Individuals who have early
attacks (within a week of injury) are more likely to have
a complete remission of their seizures than those whose
attacks begin a year or so after injury
T
An extensive randomized
study by Temkin and colleagues demonstrated that when
administered within a day of injury and continuing for 2
years,____________ reduced the incidence of seizures in the
first week, but not thereafter.
phenytoin
A worrisome consequence of severe head injury, which is
observed in some comatose patients and particularly in
the vegetative state, is a syndrome of episodic vigorous
extensor posturing, profuse diaphoresis, hypertension,
and tachycardia lasting minutes to an hour.
“diencephalic epilepsy”
in “diencephalic epilepsy”
Narcotics such as morphine and benzodiazepines
have a slightly beneficial effect but__________which
may be used in combination with sedatives or with small
doses of morphine, has been most effective
bromocriptine,
When cerebellar ataxia is caused
by the trauma itself, it is frequently unilateral and the
result of injury to the ________
superior cerebellar peduncle
T or F,
the longer the posttraumatic gap in the formation of new
memories (anterograde amnesia), the less likely the
patient is to suffer some permanent cognitive and personality changes
F
a delayed neurodegenerative
cerebral disease that follows mild traumatic brain injury
after many years
chronic traumatic encephalopathy
More recent studies show that in about one-half of all
professional boxers, both active and retired, the CT scan
discloses____________and _____________and a
_________
ventricular dilatation
sulcal widening
cavum septi pellucidi
Pathologic changes of dementia pugilistica
Neurofibrillary changes were scattered
diffusely through the cerebral cortex and brainstem but
were most prominent in the mediotemporal gray matter
Pathology in Post traumatic HCP
adhesive basilar arachnoiditis.
Other terms for post concussion syndrome
posttraumatic nervous instability syndrome and traumatic neurasthenia, PTSD
It has also been reported that military
personnel who experience head injuries of any degree
have a higher incidence of __________ than those with other somatic injuries
posttraumatic stress disorder
PTSD
The____________has been considered a
“gold standard” of pressure
measurements as it is directly coupled to the CSF
compartment, which should best reflect the summated
pressures within the cranium.
ventricular
catheter
Guidelines given by
the American Association of Neurological Surgeons and
allied groups have been that monitoring is appropriate
if:
Glasgow Coma Scale is between 3 and 8 and there are
abnormalities on CT scan,
or if there is no abnormality on the CT but the patient has any two of age over 40, posturing, or has systolic blood pressure below 90 mm Hg
the risk of infection with a
ventricular catheter is low,___________, prolonged
use may be complicated by bacterial meningitis
less than 3 percent
The
catheter may be left in place for__________, or fewer if
the clinical state and ICP are stable for 24 to 48 h.
3 to 5 days
Trial of steroids in TBI
Clinical Randomization of an Antifibrinolytic
in Significant Hemorrhage (CRASH) trial,
findings of Clinical Randomization of an Antifibrinolytic
in Significant Hemorrhage (CRASH) trial,
The effect of the infusion of methylprednisolone
2 g, followed by 0.4 g/h for 48 h, favored
survival in the untreated patients by a small but clear
margin, leading to the current recommendation that
steroids not be used routinely following head injury
severe hypertension in TBI leads to ______________and an augmentation of the edema
surrounding contusions and hemorrhages
increased perfusion
of the brain
IN TBI, ________ AND _______may be preferable for
reducing agitation because they are minimally sedating.
Etomidate and dexmedetomidine
The use of
________ or ________ to quiet episodes of vigorous
extensor posturing and accompanying adrenergic activity
bromocriptine AND __________
What is the DECRA trial
Decompression did indeed
reduce ICP, as expected, when the intracranial contents
are exposed to atmospheric pressure, but surgery did not
improve outcome.
In the survey of the large European Brain Injury
Consortium, comprising 1 0,005 adult patients, the injury
proved fatal in____________; __________ were left in a persistent vegetative state, and 16 percent remained severely
disabled neurologically
31 percent
3 percent
prognosis of head injury is dependent on:
The age of the patient
is the most important factor
Of patients
with a period of amnesia lasting less than 1 h, ____________percent
were back at work within 2 months
95
