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HHD 2 > Traumatic Brain Injury > Flashcards

Traumatic Brain Injury Flashcards

1
Q

What are the most common causes of traumatic brain injury (TBI)?

A

road traffic collisions (RTCs)
falls <2m

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2
Q

What is the presentation of a traumatic brain injury?

A

history of a blow to the head
headache
vomiting
decreased consciousness
fixed pupils- due to pressure on interpupillary nerves (abducens nerve CNVI- lateral rectus muscle- no lateral movement of eye)
post traumatic amnesia
seizure
neurological deficit

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3
Q

A glasgow coma scale score of 15 is the best score. Why is this?

A

this is indicative of a responsive patient
good eye, verbal and motor responses

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4
Q

A glasgow coma scale score of </=8 is indicative of a _________ patient

A

a comatosed patient

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5
Q

A glasgow coma scale score of 3 is indicative of an _________ patient

A

unresponsive

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6
Q

What does the Monroe-Kellie doctrine hypothesise/state?

A

it states that the sum of the volumes of the brain, CSF and intracerebral blood, are constant

this means that when the volume of one component increases, the volume of the other component decreases to keep the sum of the volumes constant

for instant if a mass is present, there are compensatory decreases in the volume blood and CSF

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7
Q

What are the things inside the brain that makes up its volume?

A

brain tissue
blood
CSF

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8
Q

When compensatory decreases in blood and CSF volumes stops, what happens?

A

rise in intracranial pressure

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9
Q

What is the consequence of a rise in intracranial pressure?

A

there is a decrease in cerebral perfusion pressure (CPP)
CPP= MAP - ICP
therefore an increase in ICP leads to a reduction in CPP
this leads less nutrients and oxygen for brain cells and this ischaemia and cell death (infarction)

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10
Q

What are the consequences of an elevated ICP?

A

midline shift
central descent
uncal herniation —> compression of CNIII (oculomotor)
tonsillar herniation —> cushings response

there is no where for the pressure to go in an enclosed space this, tissue is shifted or pushed downwards leading to brain herniation. Hernias in the brain can compress CNIII

CNIII is located in midbrain

Midbrain also contains breathing and respiratory centres

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11
Q

How are traumatic brain injuries classified ?

A

acute V chronic
lesion type
diffuse or local
blunt vs penetrating
Severity (glasgow coma scale)

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12
Q

What is the most common type of TBI?

A

Concussion

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13
Q

Concussions are referred to as _________ TBIs

A

“mild”

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14
Q

What are the characteristics of a concussion?

A

brief alteration in neurology (transient)
there is a functional disturbance
no structural injury on CT scan

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15
Q

What is the long term consequence of a concussion referred to as?

A

post- concussive syndrome

41% of people with concussions will develop post concussive syndrome

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16
Q

What is the management for a concussion?

A

discharge home with medical device and appropriate adult
graduated return to normal activity

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17
Q

A skull vault fracture is the result of …

A

a significant force

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18
Q

What are the type of a skull vault fracture?

A

Linear fracture
Depressed fracture
Open Wound fracture

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19
Q

What is the management of a linear skull fracture?

A

if no underlying brain injury then no treatment is required

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20
Q

What is the management of depressed skull fracture?

A

may need elevating if there is an underlying contusion as this increases seizure risk

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21
Q

What is the management of an open skull fracture?

A

wound closure

-Open fracture breaks through the skin-

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22
Q

Base of the skull fracture is caused by …

A

high impact injury

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23
Q

Base of skull fractures are usually associated with …

A

brain injury

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24
Q

What are the clinical presentations of a base of skull fracture?

A

CSF:
Otorrhoea- CSF drainage from ear
Rhinorrhoea- CSF drainage from nose

Battles sign- bruising over the mastoid process; bleeding and therefore bruising behind the ear

Racoon eyes- fracture bled into the eyes

Deafness
Diplopia

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25
What is the management for a base of skull fracture if the patient is at risk of future meningitis?
pneumovax- pneumococcal vaccine do not give antibiotics
26
When should a base of skull fracture be fixed?
if the CSF leak is >2 weeks
27
What is encephalitis ?
infection of the brain
28
What is meningitis?
infection of meninges surrounding the brain
29
List some causes of penetrating TBIs
knife gun crime battle TBI- secondary blast, ballistic
30
Penetrating TBIs have a high rate of infection. True or false
True
31
How are penetrating TBIs managed?
do not chase all fragments manage raised ICP
32
Acute subdural haematomas are common injuries. What are they?
a collection of acute blood (and therefore clot) in the subdural space subdural space is where the venous sinuses exist they result from tears in the veins- hence acute collection of blood as blood leaks out into the subdural space
33
What is the characteristic presentation of an acute subdural haematoma?
cresent shaped haematoma
34
What kind of injury leads to a subdural haematoma?
de-acceleration injury often leads to tears in the veins
35
What is the management for an acute subdural haematoma?
reverse any coagulopathy- dissolve the colt neuroobeservations manage intracranial pressure seizure prophylaxis +/- surgery
36
Extradural haemotomas are less common injuries. What are they?
they result from tears in the arteries that exist in the space between the skull and the dura mater (outer protective lining of the brain)
37
What artery is most implicated in extradural haematomas?
middle meningeal artery
38
Extradural haematomas have a "talk and die" presentation. Briefly explain what this means
loss of consciousness for the second time; this is because the middle meningeal artery continues to bleed
39
What is the clinical presentation of extradural haematomas?
biconvex haematoma
40
What is the management of extradural haematomas?
if they are neurologically stable then close monitoring if neurologically unstable URGENT SURGICAL EVACUATION
41
What is the main cause of chronic subdural haemtomas?
innocuous (offensive) bump to the head weeks previously leads to chronic bleeding from bridging veins the clot forms and then acts as a sponge for CSF
42
Why are elderly patients at risk of subdural haematomas?
veins in the subdural space (venous sinus) are very prone to tearing in the elderly
43
The symptoms for a chronic subdural haematoma presents over days. What are the symptoms ?
hemiplegia- lack of control/stiffness/weakness of one side of the body headache confusion
44
What is the management for a chronic subdural haematoma?
surgical evacuation reverse anti-coagulants/antiplatelets to stop bleeding ?dexamethasone??
45
What is a cerebral contusion?
scattered areas of bleeding on the surface of the brain intraparenchymal bleeding- bleeding in the brain
46
What are the consequences of cerebral contusions?
may cause generalised swelling
47
What is the management for a cerebral contusion ?
limited surgical options
48
What is a diffuse axonal injury?
this is when rotational/twisting forces in the brain cause shearing of axons when the brain twists and shifts inside the bony skull shearing of microvessels occurs as well there is multiple petechial haemorrhage (multiple sites of bleeding)
49
There is good prognostic factor for diffuse axonal injuries. True or false
False prognostic factor is poor
50
What are the management options for diffuse axonal injury?
limited surgical options
51
What are clinical investigations can be performed for traumatic brain injuries?
CT- includes c-spine MRI Coagulation studies Intra-cranial pressure
52
What is the aim of the management of TBIs?
to reduce the damage caused by secondary injury
53
What is a primary brain injury ?
these are the immediate damages caused to the brain by the trauma
54
What is a secondary brain injury?
ischaemic insult from hypotension, hypoxia, disrupted autoregulation, raised intracranial pressure
55
What are the management techniques employed for TBIs ?
prevention- education surrounding alcohol, driving Prehospital- advanced trauma life support protocol ABCDE Acute- Advanced trauma life support protocol ABCDE Neuro ITU Surgical Rehab Diuretics- reduce fluid and therefore reduce ICP
56
List neuro-protective measures that are employed in TBIs
remove hard collar sit to 45 degree angle protect airway avoid hypoxia avoid hypotension mannitol to reduce ICP induced coma normothermic AED (automated external defib) - prophylaxis
57
What are the surgical management techniques for TBIs
CSF diversion craniotomy- hole in skull craniectomy burr-hole- extradural haematoma, acute subdural haematoma elevation of depressed skull fracture
58
What are poor prognostic factors of TBIs ?
loss of grey white differentiation bilateral F&D pupils (full and dilated???) diffuse injury (not localised) poly trauma- extracranial injury brainstem involvement
59
What are some complications of TBIs?
infection- intra/extracranial spectrum of disability affective disorders psycho-social impairment pituitary dysfunction vitamin D deficiency post traumatic seizures post- concussive syndrome (long term)
60
What are the dental considerations for TBIs?
Loose teeth polypharmacy poor dental hygiene concurrent maxillofacial trauma may be primary presentation of brain injury
61
What are the stages of a seizure
Prodromal Aura (early ictal) Ictal /ictus Post ictal period
62
What occurs in the prodromal stage of a seizure?
mood or behavioural change preceeding attack (hours)
63
What does the the early ictal/aura stage of a seizure refer to?
these are the symptoms immediately before the attack localises to point of origin
64
What is the ictal stage of a seizure?
refers to where the seizure is occuring the seizure itself
65
What does the post-ictal stage of a seizure refer to ?
the time immediately after ictus pt is often confused and irritated
66
What is the pathogenesis of epilepsy ?
balance between excitatory and inhibitory neurotransmitters is disturbed decreased GABA action increased glutamate action
67
What are the main classifications of epilepsy?
Partial seizures (restricted to one part of the cortex) Generalised seizures (all over the brain) Unclassified
68
Partial seizures can be classified according to their severity. What are the classes of partial seizures according to their severity
simple partial complex partial secondar generalised
69
Partial seizures can be classified according to their site of onset. List the sites of onset for a partial seizure
frontal lobe parietal lobe temporal lobe occipital lobe
70
What are the types of generalised seizures/epilepsy?
tonic clonic absence myoclonic tonic
71
What are the characteristics of a simple partial seizure?
* consciousness preserved * they are of cortical origin
72
What are the characteristics of complex partial seizures?
* degree of impaired consciousness level- wider effects * cortical origin
73
What is a partial seizure?
in a partial seizure only one part of the brain is affected; one area of the cortex, one lobe or one hemisphere
74
What are the characteristics of a frontal lobe partial seizure?
* jacksonian march- involuntary muscl movement from one group of muscle to the next, usually begins in the hands and face * todds paralysis- post ictal weakness in the limb affected * adversive seizures- movement of the head and eyes away from the site of origin * supplementary motor area- stereotyped movements in sleep e.g.cycling | remember frontal lobe: face, arms, limbs and trunk; watch videos in lect
75
What are the characteristics of a parietal lobe partial seizure?
sensory cortex origin parasthesiai in extremity or face
76
What are the characteristics of a temporal lobe partial seizure?
* complex aura- taste, smell, lip smacking, memory disturbance, semi-purposeful movements, affective disturbance * automatism involuntary, complicated movement * associated with hippocampal sclerosis (learning and memory)
77
What is a generalised seizure?
there is widespread electrical discharge/ disturbance might be left/right hemispheres or both
78
What can the initial symptoms of a generalised seizure identify? Why is this ?
the origin of the seizure only the origin can be identified by the initial symptoms because the seizure (electrical disturbance) will spread to sub-cortical regions and release discharge before spreading bact to the cortex of both hemispheres (at this time a more diverse range of symptoms can be produced)
79
What are the characteristics of the tonic phase of a tonic clonic attack?
sudden stiffness of joints and muscles in muscles of arms, legs and trunk * lasts for 10 seconds * LOC * eyes open * elbows flexed * legs extended * teeth clenched * breath held
80
What are the characteristics of the clonic phase of a tonic clonic attack?
repeated jerking movements of the arms and legs on both sides of the body * lasts minutes * tremor gives way to violent shaing * eyes roll back * tachycardia * tongue biting
81
What are the post ictal symptoms of a tonic clonic attack?
confusion headache
82
Absence seizures are also known as ...
Petit mal seizures
83
List the characteristics of absence seizures
* more common in children * vacant staring * may occur multiple times a day * 5-15 seconds
84
What are the characteristics of myoclonic seizures?
* sudden brief generalised muscle contractions; of a muscle or group of muscles * commoner in the morning * onset after puberty * degenerative and metabolic disease * do not last more than a second or two
85
What does status epilepticus refer to?
a seizure that does not stop after 5 minutes consciousness does not return between attacks
86
What are some consequences of status epilepticus?
pyrexia coma circulatory collapse
87
What are some clinical investigations used for diagnosis of epilepsy?
CT MRI Electrocencephalogram (EEG) video telemtry ECG serum glucose
88
What is the management of acute phase epilepsy?
ABCDE Once seizure is over put in recovery position do not put anything in their mouth
89
What are the long term management strategies for epilepsy?
Medical Surgical
90
List the dental considerations for patients with epilepsy
* carry out treatment when seizures are infrequent when possible * keep as much apparatus away from area as possible * some medicines precipitate condition- be aware of those * conscious sedation is generally safe (midazolam) * acrylic best for prostheses * seizures can result in cranio-facial trauma * tongue lacerations

HHD 2 (37 decks)

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