Traumatic Brain Injury Flashcards
traumatic brain injury subtypes
*concussion
*contusion
*diffuse axonal injury (DAI)
*intracranial hemorrhage
*intracerebral hemorrhage
concussion - characteristics
temporary disruption in normal neurological function induced by traumatic forces
*direct or impulsive force
*rapid onset
*functional
*clinical symptoms
*no abnormality on standard imaging
concussion - mechanics
SHEARING & TWISTING
*macroscopic: shearing force in the Z plane; strain force at the white-gray interface (thalamus, hippocampus, midbrain, hypothalamus, amygdala, etc)
*microscopic: trauma causes the axon to twist and tear, causing mechanoporation (decouples the charge gradient of the axon by putting holes in the semipermeable membrane)
contusion - characteristics
*brain “bruising”
*common locations: frontal bones, anterior aspects of temporal bones, occiput
contusion - mechanics
*coup (blow)
*countrecoup (counter-blow)
subdural hemorrhage
*venous blood (low pressure)
*caused by tearing of bridging veins
*usually a slow bleed, and the problem is the amount of blood, causing chemical changes and a mass effect (shifting/herniation)
*crescent shaped on CT
ABCDE acronym for subdural hemorrhage
A - alcohol use disorder
B - bridging veins
C - crescent shaped on CT
D - dura intact
E - elderly
epidural hemorrhage
*arterial blood (high pressure)
*skull fractures (esp temporal bone) are the main cause
*middle meningeal artery
*mass effect is a major concern
*LENS shaped on CT
FLAIR acronym for epidural hemorrhage
F - fracture (temporal bone)
L - lens-shaped on CT
A - arterial (middle meningeal)
I - interval (lucid interval)
R - ripped dura
subarachnoid hemorrhage
*arterial blood (high pressure)
*severe
*often caused by trauma or hypertension + aneurysm
*rapid bleeding
CHANTS acronym for subarachnoid hemorrhage
C - circle of willis on CT
H - headache (thunderclap)
A - arterial blood/aneurysm
N - nausea, neck stiffness
T - trauma
S - seizures or syncope
intracerebral hemorrhage
2 types: intraparenchymal and intraventricular
*arterial
*severe
*often caused by trauma
*can be caused by small artery hypertension and/or aneurysm
*symptoms correlate with location of bleeding
assessment of a traumatic brain injury
1) CABs (circulation, airway, breathing)
2) rule out spinal cord injury
3) assess for polytrauma (additional injuries)
4) use GCS scale to triage
5) history
6) physical exam
7) imaging
important history for traumatic brain injury
*thinking/remembering
*physical (headache, nausea, etc)
*emotional/mood
*sleep disturbance
physical exam findings for concussion
*mental status: abnormal
*cranial nerves: abnormal (esp accommodation, nystagmus)
*coordination: abnormal (feeling off balance)
*strength: normal
*sensation: normal
*reflexes: normal
important physical exam for traumatic brain injury
*mental status
*cranial nerves
*coordination
*strength
*sensation
*reflexes
imaging for TBI
*usually CT > MRI
*CT is fast, does not require patient to stay still, and it good at detecting blood
emergency red flag signs in traumatic brain injuries
*increasing confusion
*increasing drowsiness
*pupillary changes
respiratory changes (Cheynes-Stokes)
hypertension (with widened pulse pressure)
bradycardia
management of TBI emergencies
*get neurosurgery
*reduce ICP but permit some HTN:
-elevate head of bed to 30 degrees
-hyperventilate
-hypertonic saline (23.5%)
-sedation
-extraventricular drain (EVD)
non-surgical treatment for TBI
*close monitoring
*anit-epileptics
*rehab
treatment of concussion
*relative rest
*activity restrictions
*accommodations
*symptom management
*graduated return
