Trauma to the Neurological System

Question 1

Describe the difference between stupor and coma

Answer 1

Stupor: unresponsive except to repeated vigorous stimuli

Coma: unarousable and unresponsive although reflex movements and posturing may be seen

Question 2

In decerebrate posturing, where is the lesion?

Answer 2

Lesion of midbrain and rostral pons

Question 3

In decorticate posturing, where is the lesion?

Answer 3

Lesions of internal capsule and rostral cerebral peduncle

Question 4

Describe Cheyne-Stokes respiratory pattern and cause

Answer 4

Episodes of breathing alternating with apnea
Bi-hemispheric or diencephalic or metabolic disease

Question 5

Describe atactic breathing respiratory pattern and cause

Answer 5

Irregular breathing pattern
Lower pontine tegementum or medulla

Question 6

Describe central neurogenic hyperventilation respiratory pattern and cause

Answer 6

Lesions in brainstem tegmentum

Question 7

Describe apneurstic breathing respiratory pattern and cause

Answer 7

Prominent end-inspiratory pauses
Damage to pontine

Question 8

What criteria must be proven before the diagnosis of brain death?

Answer 8

Irreversibly comatosed patient must be shown to have lost brainstem reflexes (Pupillary, Corneal, Oculovestibular, Oculcephalic, Oropharyngeal, Respiratory)

Those reflexes need to be proven absent before brain death can be determined and must be gone for at least 6 hours

Rule out hypothermia and overdose of a CNS depressant drug (Remember: not dead until they are warm and death)

May use EEG and radioisotope cerebral angiography to help confirm

Question 9

What brainstem reflexes need to be shown to be lost in a brain dead patient?

Answer 9

Pupillary

Corneal

Oculovestibular

Oculcephalic

Oropharyngeal

Respiratory

Question 10

What is the most common cause of death in young people?

Answer 10

Trauma

Question 11

What factors determine the prognosis in a head injury?

Answer 11

determined by the length of loss of consciousness, site of injury and severity

Question 12

What factors do you assess for the severity of a head trauma?

Answer 12

Length of LOC

Severity of amnesia

Retrograde amnesia

Fracture ≠ severity

Question 13

Head trauma workup - Imaging

Answer 13

Xray - skull and C-spine

CT - rule out hemorrhage

Question 14

The CCHR requires a head CT for patients with mild traumatic brain injury
and any one of these factors

Answer 14

GCS <15 two hours after injury

Suspected open or depressed skull fracture

Any sign of basilar skull fracture: hemotympanum, raccoon eyes (intraorbital
bruising), Battle sign (retroauricular swelling), or cerebrospinal fluid leak, oto-or
rhinorrhea

Two or more episodes of vomiting

Sixy-five years of age or older

Amnesia for events occurring more than 30 minutes prior to contact

Dangerous mechanism (Pedestrian struck by motor vehicle, occupant ejected from motor vehicle, fall from ≥3 feet or ≥ 5 stairs)

Question 15

Additional features in patients with head injuries where a CT can be considered even if no severe risk factors

Answer 15

Neurologic deficit

Seizure

Prescence of bleeding diathesis or oral anticoagulant use

Return visit for reassessment of a head injury

Question 16

Patients with head trauma/injury should be admitted to hospital with the following features/characteristics

Answer 16

Patients >65 years who are intoxicated with drugs and EtOH or have soft
tissue injuries above the clavicles (Admit because these patients who can deteriorate rapidly)

Focal neurologic deficits

Lethargy

Skull fractures

Retrograde amnesia > 30 minutes

Question 17

Blood in external auditory meatus is called what?

Answer 17

battle’s sign

Question 18

Bruising around orbits is called what?

Answer 18

racoon eyes

Question 19

Complications from a basilar skull fracture to watch out for

Answer 19

battle’s sign
racoon eyes
Leakage of CSF (+ glucose on CSF testing from nose or ear)
CN palsies I, II, III, IV, VII, VIII

Question 20

Post head trauma fluid from nose or ear - what result would you diagnose CSF?

Answer 20

+ glucose on CSF testing from nose or ear

Question 21

There is an association with head trauma and later development of these
diseases

Answer 21

Parkinson’s disease
Alzheimer’s dementia
ALS

Question 22

Chronic subdural hematoma signs/symptoms

Answer 22

Slowness
Drowsiness
Headache
Confusion
Personality change
Memory disturbance
Hemiparesis
hemisensory

Question 23

Spinal trauma typically occurs in these locations

Answer 23

Cervical area

Lower thoracic area

Upper lumbar area

Question 24

Clinical presentation of a unilateral cord lesion

Answer 24

leads to ipsilateral motor disturbance with impairment of proprioception, contralateral loss of pain and temperature below the lesion (Brown-Sequard Syndrome)

Question 25

Clinical presentation of a central cord lesion

Answer 25

lower motor neuron deficit, loss of pain and temperature