Traumatic Brain Injuries Flashcards
What is the cause of a Concussion?
Head trauma (closed or open)
What are the sx of a concussion?
- Transient alteration in awareness or consciousness
- Some degree of amnesia is common (sec or longer)
- Residual problems w/ memory, HA, attention span or behavior
What will be found on PE in a Concussion?
- Pt examined immed. may seem confused or amnestic
- Neuro exam otherwise normal
- Days later the exam is normal
What is the mech of damage in concussion?
- Biochem & ultrastructural ABN occur such as mito ATP depletion & local distrutpion of BBB
- Central brainstem core, the reticular activating system (RAS) is thought to suffer the brunt of some of the changes d/t the traumatic force waves transmitted
What are the technical features of concussion?
- Labs & imaging are normal
- If ABN found its in add to concussion
What is the tx of a concussion?
Time & sx tx of assoc sx
What is the management of a concussion?
Athletes in “contact sports” should avoid further contact for a defined period of time
What is the cause of Subdural Hematoma?
Severe fall or hit on the head
Minor bump on the head in elderly
What is found on PE in a Subdural Hematoma?
- Altered mental status
- Focal neuro findings are common dpending on location of the hematoma
- If inc ICP there could be papilledema
What are the technical features of Subdural Hematoma?
- Brain CT or MRI is us dx
- If acute, blood in the subdural space
- If chronic there may be water density fluid in the subdural space
What does the Subdural hematoma result from?
Shearing/tearing of the pia veins that span the subdural space
What is the prognosis of Acute sumbdural hematomas?
Often lethal
What is the prognosis of Chronic subdural hematomas?
Gradual progressive condition
What is the tx of Acute subdural hematoma?
Often require surgical evacuation unless os small clinical implications are trival
What is the tx of Chronic subdural hematoma?
May require surgical evacuation but may resolve spon in time
What is the cause of Epidural hematoma?
Temporal bone fx d/t trauma to middle meningeal artery
What are the characteristics of Epidural hematoma?
Lucid interval followed by a dec in level of concsiousness & dev of focal neuro deficit
What is found on PE in Epidural hematoma?
- Altered mental status
- Focal neuro findings–sensory deficit, weakness, pupillary & eye movement dysfx
What are the technical features of Epidural hematoma?
- Brain CT or MRI are us. dx w/ blood in epidural space (biconvex hematoma)
- Fx involving temporal bone
What is the tx of an Epidural hematoma?
Nearly always surgical evacuation of the hematoma
What is the cause of Intracerebral hemorrhage?
Most are d/t hemorrhage but may occur following taumatic force causes tearing of intraparenchymal vessels
What is found on PE in an Intracerebral hemorrhage?
- Focal neuro deficits us. predom
- Altered mental status is common
What are the technical features of Intracerebral hemorrhage?
Brain CT or MRI are usually dx
What is the tx of Intracerebral hemorrhage?
- Tx supportive w/ monitoring, head elevation & bed rest
- If pt is rapidly deteriorating, surgical eval may be required
What is a Concussion?
Head trauma w/ altered mental status
What is Post Percussive synd?
Persisten HA & irritabilty
MC in adults
What is a Battle sign?
Ecchymosis of mastoid process or hemotympany (middle cranial fossa problem)
What do Raccoon eyes indicate?
Periorbital blood from direct trauma to oribits or basilar skull fx
What can Rhinorrhea be d/t in head trauma?
CSF leak
What is the most sensitive test for CSF leak?
Dipstick test for glucose
(CSF is 1/2-2/3 serum glucose)
What can cause Ansomnia in head trauma?
Fx to cribiform plate & olfactory bulb damage
Where is the middle meningeal artery torn in an epidural hematoma?
At the pterion (weakest point of the skull)
What 4 skull bones make up the Pterion?
- Frontal
- Parietal
- Squamous portion of temporal
- Greater wing of sphenoid
Who are MRI’s CI in?
Pt w/ pacemakers
