Traumatic Brain Injury Flashcards
Define TBI
Structural injury or a pathological disruption of brain function, due to external force
Define concussion
Immediate alteration of mental status or level of consciousness resulting from Mechanical force
What things do you need to look for when deciding if to do a head CT for TBI?
Loss of consciousness, focal neurological signs, seizures, older age etc…
How long should a patient with no head CT needed be observed for?
6-8 hours
Where is an epidural haemorrhage located?
Between the meninges and the skull
Where is a subarachnoid haemorrhage located?
Between different levels of the meninges
Where is a subdural haemorrhage located?
Under the dura
What is a contusion TBI?
A bruise in the brain
What happens in a diffuse axonal injury?
Shearing or tearing of axons
What is a craniotomy?
Taking a flap of skin from the skull to suck out the haematoma or blood
What are burr holes?
Making small holes in the skull to relieve pressure
What is the cause of raised inter-cranial pressure?
Monroe-Kellie doctorine- if something in the brain changes volume, everything else else to compensate and so the brain pushes to one areaj
What is it called when the brain pushes into the hole in the bottom of the skull?
Coning or brain/tons a herniation
What are some of the main symptoms of raised inter-cranial pressure?
Headache, nausea, vision loss, 3rd and 6th nerve palsy, pallioedema, double vision and Cushing reflex
What is the Cushing reflex?
A response to increased intracranial pressure
What does the Cushing reflex lead to?
High blood pressure
Slower pulse
Decreased respiratory
What causes intraparenchymal haemorrhage?
Primary - hypertension
Secondary - tumor, cerebral amyloid etc…
What are some of the symptoms of intraparenchymal haemorrhage?
Headache, nausea, reduced conscious level, agitation, focal neurology, sudden acute onset and hypertension
What complications are associated with intraparenchymal haemorrhage?
Seizures, increased ICP and hydrocephalus
What causes hydrocephalus?
Blocked ventricles, so CSF can’t escape
What 3 imaging techniques should be used for intraparenchymal haemorrhage?
CT head
MR head
Angiogram
How can subarachnoid haemorrhage be caused?
Traumatic or non traumatic brain injury
What are the symptoms of subarachnoid haemorrhage?
Sudden onset, meningism, reduced consciousness, 3rd/6th nerve palsy and vasospam
How can a lumbar puncture help determine subarachnoid haemorrhage?
If there is blood in the CSF or after a few hours, the blood has broken down into yellow liquid
What are the main causes of subdural haemorrhage?
Ruptured bridging veins
A fall
What are the main symptoms of subdural haemorrhage?
Headache, confusion, reduced conscious level and may have a rapid onset
What complications are associated with subdural haemorrhage?
Increased ICP and focal neurology
On a CT head, what color is blood shown as?
White
What is a cause of epidural haemorrhage?
Ruptured menigeal artery
What are the symptoms of an epidural haemorrhage?
Period of lucidness with headache, loss of conscious, 6th nerve palsy and skull fracture
What complications are associated with epidural haemorrhage?
Raised ICP, infection, cerebral ischemia, seizures, focal neurology, cognitive impairments and hydrocephalus
What is a common cause of diffuse axonal injury?
Acceleration, deceleration insult
What symptoms are associated with diffuse axonal injury?
Coma, vegetive state, agitation, varied cognitive dysfunction
What complications are associated with diffuse axonal injury?
White matter abnormalities, small volume haemorrhage and MRI abnormalities
What is post traumatic amnesia?
The time between a head injury and regaining full normal conscious memory
What is PTA commonly measured with?
The Westmead scale
What does the Westmead scale measure?
Orientation and anterograde amnesia
How can PTA correlate with psychiatric problems?
Commonly impacted brain areas in TBI are ones that also control emotion and mood, therefore causing psychiatric problems for some patients
What is the main management strategy for PTA?
Keep the patient safe and be wary of interactions of drugs for psychiatric disorders
What are the main aims of Neuro rehabilitation?
Restore previous abilities
Acquire new skills and strategies
Make alterations
