Trauma

Question 1

List some mechanisms of TBI?

Answer 1

diffuse axonal injury 
direct neuronal and axonal damage
brain oedema and raised ICP
brain hypoxia
brain ischaemia

Question 2

Describe mild TBI?

Answer 2

person is stunned or dazed for a few seconds before recovery, headache may follow, complete recovery is usual

Question 3

Describe serious TBI?

Answer 3

unconsciousness, recovery may take weeks or months, may have focal deficits e.g. hemiparesis, aphasia

Question 4

List some sequelae of TBI?

Answer 4

cognitive impairment, epilepsy, post traumatic syndrome (still suffer from headaches, dizziness and malaise even after better), BPPV, chronic subdural haematoma, chronic traumatic encephalopathy

Question 5

List 3 signs of basal skull fractures?

Answer 5

racoon eyes
battles sign (bruising behind the ear)
blood or CSF running out ears or nose

Question 6

Why are basal skull fractures important to recognise?

Answer 6

they signify significant head trauma and potential brain injury

Question 7

What is the max and min CGS score, what do they mean?

Answer 7

15= max = normal alert person
3= min = extremely high mortality rate

Question 8

List the scoring for GCS

Answer 8

EYE OPENING

Spontaneous = 4

Verbal command= 3

Opens to painful stimuli= 2

None= 1

VERBAL

Oriented= 5

Confused= 4

Inappropriate words= 3

Incomprehensible sounds= 2

None= 1

MOTOR RESPONSE

Obeys= 6

Localizes to pain= 5

Withdraws to pain= 4

Abnormal flexion (Decorticate)= 3

Extension (Decerebrate)=2

None= 1

Question 9

Describe decorticate posturing and what it means

Answer 9

indicates severe brain damage to areas including the cerebrum, internal capsule and thalamus. The midbrain is generally spared. The patient presents with abnormal flexion of his arms, the hands are clenched into fists, and the legs extended and feet turned inward. This is because the lateral corticospinal tracts are disrupted so the rubrospinal tracts takes over causing the abnormal flexion to the upper extremities and the reticulospinal tracts takes over causing the extension of the legs.

Question 10

Describe decerebrate posturing and what it means

Answer 10

indicates an even more severe brain damage and brainstem damage, specifically at a level below the red nucleus in the midbrain. The patient presents with his head arches back and both arms and legs extended. In this case, both the lateral cortical spinal tract and rubrospinal tract are damage so the reticulospinal tract takes over and causes extension of the whole body.

Question 11

Neurosurgeons are concerned when GCS drops by more than ____

Answer 11

1

Question 12

What is the most significant category of GCS? Why?

Answer 12

Most significant is motor score as this only drops when there is a significant neurological issue