Traumatic Brain Injury Flashcards
Decorticate Rigidity/Posturing
Flexor or extensor?
FLEXOR
UEs flexed: Corticospinal tract interrupted/damaged; Red Nucleus intact and Vestibulospinal & Reticulospinal tracts intact or uninhibited so lower extremities (LEs) extend
Decerebrate Rigidity/ Posturing
Flexor or extensor?
EXTENSOR!
all 4 extremities tonically extended
Corticospinal and Rubrospinal tracts interrupted or damaged
Vestibuospinal /Reticulospinal tracts intact or uninhibited
Worse clinical sign and transition from decorticate to decerebrate could signify brain herniation
Types of TBI (not mutually exclusive categories)
- Concussion
- Contusion/ Intracerebral hemorrhage
- Coup-Contrecoup Injury
- Subdural hematoma
- Epidural hematoma
- Subarchnoid hemorrage
- Diffuse Axonal Injury
- Second Impact Syndrome: “Recurrent TBI”
Concussion
- type of TBI, caused by a bump, blow, or jolt to the head
* can also occur from a fall or a blow to the body that causes the head and brain to move quickly back and forth.
Danger signs of a Concussion
- Headache that gets worse and does not go away
- Weakness,numbnessordecreasedcoordination
- Repeated vomiting or nausea
- Slurredspeech
- Drowsiness
- Dilatedpupil(s)
- Convulsions or seizures
- Cannot recognize people or places
- Confusion, restlessness, or agitation
- Unusualbehavior
Danger Signs in Children
- constant crying and inability to be consoled
* Refusal or unwilling to nurse or eat
Cerebral Contusion
• can be associated with multiple microhemorrhages; numerous small contusions from broken capillaries that occur in grey matter under the cortex
Frequently associated with edema and are especially likely to cause increases in intracranial pressure (ICP) and crushing of delicate brain tissue and vasculature.
Mass Effect
Physical mass can:
-directly compress vascular
structures,resulting in ischemia and infarct
– directly impinge upon other vital structures
– herniate different parts of the brain
– Stretch or compress cranial nerves
Distinction between contusion and intracerebral hemorrhage is blurry, cutoff is ..
injury is a contusion if 2/3rds or less of the tissue involved is blood while a hemorrhage exists if more than that is blood.
Important! coup injury
contrecoup injury
- a coup injury occurs under the site of
impact with an object - a contrecoup injury occurs on the side opposite the area that was impacted
- Inertia is involved in the injuries (the brain keeps moving after the skull is stopped by a fixed object or when the brain remains still after the skull is accelerated by an impact with a moving object).
Subdural Hematoma
- most common type of intracranial traumatic lesion (crescent shape)
- cranial volume is a constant, part of the cranial contents will herniate through the tentorial incisure (e.g uncal herniation) or under the Falx cerebri (cingulate herniation) to make room for the mass.
Brain Herniations
- Uncal (transtentorial): common
- Central: diencephalon and more of temporal lobe herniates through tentorial notch
- Cingulate: gyrus pushed under falx cerebri
- Transcalvarial (brain herniates out through skull fracture or surgical site)
Important! Coma (CGS of 8 or less):
Coma (CGS of 8 or less): person unconscious, unaware of anything and unable to respond to any stimulus. This results from widespread damage to all parts of the cortex. After a few days to a few weeks, a person may emerge from a coma or progress to a vegetative state.
Important!! Locked-in- syndrome
can occur from traumatic brain injury
person is fully conscious/aware of surroundings and awake, but can’t move or speak. May be able to communicate with vertical eye movement. This state results from damage limited to the lower brainstem. (Note: more commonly due to a basilar artery infarct)
