Traumatic Brain Injury

Question 1

What three groups of TBIs are there?

Answer 1

1. Concussion

2, Contusion

3. S.E.S.I

Question 2

TBIs

____ – “mild” TBI - No evidence of abnormality on imaging, “transient disruption of normal neurological function.”

___ - Spans mild to moderate. - Imaging will demonstrate “bruising” of the brain with macroscopic change (can include edema) - CT will give a good imaging of blood in brain

__ __: venous blood and lower pressure. Tearing of bridging veins from coup & contracoup or rotation.

__ __ - arterial blood and high pressure. Common places of impact: Foramen spinosum/temporal bone. Temporal bone fracture (often with depression) lacerates the __ ___ artery.

Subarachnoid Hemorrhage - ___ blood ___ pressure. Severe!

Intracerebral Hemorrhage (2) - ___ blood. Spans from moderate to severe.

• ______ - within the brain tissue itself (intra-axial)
• _____ – blood accumulates within the ventricles (often the lateral ventricles, but can be anywhere

Answer 2

TBIs

concussion – “mild” TBI - No evidence of abnormality on imaging, “transient disruption of normal neurological function.”

contusion - Spans mild to moderate. - Imaging will demonstrate “bruising” of the brain with macroscopic change (can include edema) - CT will give a good imaging of blood in brain

subdural: venous blood and lower pressure. Tearing of bridging veins from coup & contracoup or rotation.

epidural - arterial blood and high pressure. Common places of impact: Foramen spinosum/temporal bone. Temporal bone fracture (often with depression) lacerates the middle meningeal artery.

Subarachnoid Hemorrhage - arterial blood, high pressure. Severe!

Intracerebral Hemorrhage (2) - arterial blood. Spans from moderate to severe.

• intraparenchymal - within the brain tissue itself (intra-axial)
• intraventricular – blood accumulates within the ventricles (often the lateral ventricles, but can be anywhere

Question 3

Causes of Intracerebral Hemorrhage:

Answer 3

Causes of Intracerebral Hemorrhage:

T - trauma (MVA, assault)

H - hypertension

A - aneurysm/AVM

R - rapid bleeding

Question 4

Subarachnoid Hemmorrhage Characteristics?

Answer 4

CHANTS

Circle of willis on CT

H/A (thunderclap)

Arterial blood aneuryms

Nausea and Neck stiffness

Trauma

Seizures/Syncope

Question 5

Epidural hemm characteristics

Answer 5

FLAIR (temporal)

Fracture

Lens shaped on CT

Arterial (MMA)

Interval (lucid interval) - Lucid interval is a temporary improvement in a patient’s condition after a traumatic brain injury, after which the condition deteriorates.
Ripped dura

Question 6

Subdural hemm characteristics

Answer 6

A,B,C,D,E

Alcoholics

Bridging veins

Crescent shaped on CT

Dura intact

Elderly

Question 7

Types of Trauma:

1. __ = cell death
2. ____ = swelling = metabolic dysfunction/apoptosis or change in blood supply/inability to remove toxic byproducts of metabolism

Answer 7

Types of Trauma:

1. Direct trauma = cell death
2. Trauma = swelling = metabolic dysfunction/apoptosis or change in blood supply/inability to remove toxic byproducts of metabolism

Question 8

Epidemiology of TBI
__>___ (3:1)

Falls, MVC, Strike - Age (__ and __)

• ___ use (impaired judgement)

Answer 8

Epidemiology of TBI
Males>Females (3:1)

Falls, MVC, Strike - Age (older and younger)

• alcohol use (impaired judgement)

Question 9

Emergencies and the CUSHINGS TRIAD:

Answer 9

Emergencies and the CUSHINGS TRIAD

Confusion (increasing)

Drowsiness

Pupillary changes

Respiratory changes (Cheyne-Stokes)

Bradycardia

Hypertension (with widened pulse pressure)

“Call Deputy Police if RBH (really bad headache)” The three in red, when seen in combination, are called Cushing’s Triad. This is bad news. This means you have an ICP problem and have impending herniation. CALL NEUROSURGERY! GET A NEUROSURGEON IF: CPP = MAP – ICP Bleeds, particularly SAH, ICH, EDH REDUCE ICP but permit some HTN - HOB to 30 degrees - Hyperventilate - Hypertonic saline (23.5%) - Sedation - EVD (extraventricular drain)