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Neuro Module > Traumatic Brain Injury > Flashcards

Traumatic Brain Injury Flashcards

1
Q

Definition of traumatic brain injury

A

damage to brain resulting from external mechanical forces

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2
Q

Epidemiology of traumatic brain injury

A

trauma most common cause of death 1-45 yo; 50% are deaths from head injury

20% of head injuries cause brain injury

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3
Q

Etiology of traumatic brain injury

A

direct impact, rapid acceleration, blast waves, penetration by projectile (bullets, knifes, etc.)

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4
Q

intra-axial vs extra-axial brain injury

A

intra-axial = acceleration/deceleration injury (shearing, coup/countrecoup); in brain parenchyma

extra-axial = direct force; in epidural, subdural, subarachnoid

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5
Q

coup-countrecoup

A
  • head strikes fixed object, causing brain to collide with inside of skull at impact site and opposite side of site
  • result in cerebral contusions (bruising)
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6
Q

Primary vs secondary traumatic brain injury

A

Primary: immediate injury effects

Secondary: molecular cascade of neurochemical reactions in brain post-injury; last for hours to days

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7
Q

epidural injury mechanism

A

direct trauma, usually with skull fracture, min to hours

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8
Q

Important history information with traumatic brain injury

A

mechanism, LOC, HA, visual changes, focal neural complaints, neck pain, seizures

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9
Q

Leading cause of brain injuries

A

falls

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10
Q

where contusions likely to occur?

A

basilar temporal area

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11
Q

subdural injury mechanism

A

lower force (eg. fall), less likely skull fracture, veins, hrs to days

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12
Q

subarachnoid injury mechanism

A

spontaneous/high force, small vessels rupture, secs-mins

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13
Q

Secondary brain injury can result in

A

neuronal cell death, cerebral edema, increased ICP

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14
Q

PE of traumatic brain injury

A 
Neuro exam
Glasgow Coma Scale
External findings (hematoma, depressions, lacerations)
Signs of increased ICP
Signs of basilar skull fracture
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15
Q

Signs of increased ICP

A

fixed/dilated pupils
decorticate/decerebrate posturing
Cushing response (bradycardia, HTN, less respiratory drive)

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16
Q

Signs of basilar fracture

A
  • Battle sign
  • Raccoon eyes
  • Hemotympanum, otorrhea, rhinorrhea (may be CSF)
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17
Q

galea

A

periosteum on top region of skull

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18
Q

decorticate vs decerebrate posturing

A

decorticate is abnormal flexion rigidity and decerebrate is abnormal extension rigidity

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19
Q

Glasgow Coma Scale classes

A 
Mild = 13-15
Mod = 9-13
Severe = 8 or less
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20
Q

Tx according to Glasgow Coma Scale?

A

GCS < 8 = intubate

GCS 14 or less = CT

21
Q

What does Glasgow scale 3 or less indicate?

A

70-100% mortality

22
Q

First line diagnostic studies for head injury

A

1) CT

2) Lumbar Puncture

23
Q

ER tx and dx of traumatic brain injury

A
  1. Maintain vitals
  2. Neuro exam GCS
  3. Assess for systemic trauma
  4. Check labs (CBC, lytes, glucose, coags, etoh, urine drug screen)

For severe TBI - head elevation, Mannitol or IV hypertonic saline

24
Q

What greatly effects accuracy of Glasgow Coma Scale?

A

alcohol

25
Q

Different ways to treat increased ICP

A

Mannitol, hyperventilation, sedation

26
Q

Why monitor glucose?

A

too high - osmotic (water to brain, worsening edema)

too low - seizures

27
Q

Definition of concussion

A

trauma-induced alteration in mental status

28
Q

Definition of mild TBI

A
  • injury to brain caused by contact and/or acceleration/deceleration forces
  • GCS score 13-15 measured at ~30 min post-injury
29
Q

Etiology of mild TBIs

A

most common MVA and falls

others - occupational accidents, recreation accidents, assaults

30
Q

Hallmark sx of concussion

A

confusion, amnesia, +/- LOC

31
Q

Sx hours to days after concussion

A

mood and cognitive disturbances, sensitivity to light and noise, sleep disturbances

32
Q

PE of concussion/mild TBI

A

should be normal

  • Eval head for hematomas, lacerations, or ecchymosis
  • Neck and C-spine exam
  • Full neuro exam
33
Q

Most sensitive and specific concussion assessment

A

SAC (standardized assessment of concussion)

34
Q

Decisions to CT a mild head injury patient

A

dangerous mechanism, severe HA, vomiting, seizures, LOC, altered mental status

35
Q

Concussion Grading Scale

A

Grade 1, 2, 3 (mild, mod, severe) based upon presence and duration of LOC

But LOC doesn’t predict clinical course and long-term cognitive impairment

SHOULD NOT BE USED! for young athletes

36
Q

Discharge criteria for concussion

A

GCS = 15
No ongoing symptoms
Normal exam and CT
No predisposition to bleeding

37
Q

Admission criteria for concussion

A 
GCS < 15
Seizures
Abnormal CT
Coagulopathy
No responsible person available
38
Q

Treatment of concussion

A
  • Tylenol prn HA (not NSAIDs or narcotics)

- Physical/cognitive rest for 24-48 hrs with gradual return to work/school/play

39
Q

Discharged concussion patient should return to ED if…

A
  • Inability to awaken the patient
  • Severe/worsening headaches
  • Somnolence or confusion
  • Restlessness, unsteadiness, or seizures
  • Difficulties with vision
  • Vomiting, fever, or stiff neck
  • Urinary or bowel incontinence
  • Weakness/numbness of any part of body
40
Q

Complications of concussions

A

postconcussion syndrome (resolve in wks to months)

chronic traumatic encephalopathy (neuropsycho deficits from repeated injury)

Post-traumatic HA, epilepsy, vertigo

41
Q

Definition of post-concussion syndrome

A

common symptom complex sequela of mild TBI

42
Q

Epidemiology of post-concussion syndrome

A

30-80% of mild TBIs

Severity of TBI doesn’t correlate

43
Q

Pathophysiology of post-concussion syndrome

A

Theories:
1) Structural/Biochemical: global atrophy, regional volume loss, white matter abnormalities

2) Psychogenic: symptoms similar to somatization seen in psych disorders

44
Q

Treatment of post-concussion syndrome

A
  • Simple reassurance; most improve 1-3 months
  • Symptomatic tx (dizziness, HA, insomnia)
  • Education of family, teachers, employers, etc.
45
Q

Prognosis of post-concussion syndrome

A

First 7-10 days: sxs and disabilities greatest
1 month: sxs improved and in many cases resolved
3 months: vast majority of patients have largely recovered
1 year: 10-15% have ongoing sxs

46
Q

Clinical features of Chronic Traumatic Encephalopathy

A

Cognitive impairment: memory loss, dementia

Neuropsych sx: behavior and personality changes, depression, suicidal

Neurodegenerative sx: Parkinson’s and other speech and gait abnormalities

47
Q

Dx of Chronic Traumatic Encephalopathy

A

Typically on autopsy: cerebral atrophy, fenestrated cavum septum pellucidum, tau protein

Advanced neuroimaging studies (SPECT, PET and fMRI): white matter abnormalities, new radiopharmaceutical that binds to tau proteins but need further studies

48
Q

Prevention of Chronic Traumatic Encephalopathy

A

Better helmets
Changed return to play rules
↓ number of contact practices
Rules changes

Neuro Module (13 decks)

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