Traumatic Brain Injury

Question 1

Glasgow Coma Scale

Answer 1

Eye Opening (4 = spontaneous, 3=response to speech, 2 = to pain, 1 = none)
Motor Response (6 = obeys, 5= localizes, 4 = withdraws from pain, 3 = decorticate, 2 = decerebrate, 1 = none)
Verbal Response (5 = oriented, 4 = confused, 3 = inappropriate words, 2 = sounds, 1 = none)

Mild = 13-15
Moderate = 9-12
Severe = 3-8

Question 2

Diagnostic tools and their strengths

Answer 2

X-ray, good for cervical spine check

CT = good for checking for blood around the brain, gold standard

Question 3

Epidural hematoma

Answer 3

Convex collection of blood, generally from the middle meningeal artery. 5-10% mortality. Can cause uncal herniation

Question 4

Subdural hematoma

Answer 4

Concave appearance, twice as common as EDH, 50-90% mortality, generally caused by the tearing of bridging veins or cortical laceration.

Question 5

Brain contusion

Answer 5

Cell death accompanied by hemorrhage, generally occurs at a site distant from the point of impact (i.e., temporal and frontal lobes if impact is at occiput)

Question 6

Therapy for intracranial hypertension?

Answer 6

Positioning (30 degrees) ventricular drainage, osmotic diuresis, hyperventilation

Sedation, NMJ block, hypothermia, barbiturate coma.

Glucocorticoids not recommended

Question 7

Subarachnoid hemorrhage

Answer 7

Can occur due to direct vessel injury, contused cortex, or intraventricular hemorrhage. Can lead to communicating hydrocephalus (because it blocks the arachnoid granulations and shit, no good.

Question 8

Concussion

Answer 8

Transient alteration of consciousness due to impact to the head. Ion channels get messed up. Can be associated with a normal head CT.

Question 9

Diffuse axonal injury

Answer 9

Longer periods of unconsciousness or coma, CT scan often normal except for punctate hemorrhages within the grey/white junctions. Shearing of axons in white matter tracts.

Question 10

Clinical signs of concussion

Answer 10

Confusion
Amnesia (retrograde and anterograde)
Blurred vision
Mood change

Question 11

Post concussion syndrome

Answer 11

Headache, nausea, vomiting, dizziness, difficulty concentrating, reading, insomnia

Often resolves within days/weeks, but can persist for months

Question 12

Second impact syndrome

Answer 12

Reinjury occurs before resolution of previous concussion.

Diffuse cerebral dysregulation with massive cerebral edema and herniation.

Question 13

CTE

Answer 13

Repetitive brain injury, possible repetitive axonal stretching with deformation. Tau tangles and atrophy upon autopsy with sulcal involvement.