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NEUROLOGY > TRAUMATIC BRAIN INJURY > Flashcards

TRAUMATIC BRAIN INJURY Flashcards

1
Q

What is TBI?

A
  • non-degenerative, non-congenital INSULT to the brain from an EXTERNAL mechanical force
    > temporary/permanent impariment of COGNITIVE/PHYSICAL/ PSYCHOSOCIAL fxns
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2
Q

Who is at risk of TBI?

A
  • young men and elderly
  • previous head injuries
  • inner cities residents
  • alcohol and DRUG abuse
  • low-income
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3
Q

What political stances made for preventing TBI?

A
  • seatbelt laws (‘83)
  • testing for drink driving (‘83)
  • helmets
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4
Q

How to manage a pt coming in with a TBI?

A
  1. atls managment (ABCs) —-GCS/ PUPILS/ other
  2. Secondary survey (check for other injuries) –c-spine
  3. HX (what happened/ when/ age/ PMH/ DRUGS- anticoagulants)
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5
Q

When must CT scans be performed WITHIN 1 hr of head injury?

A
  • GCS <13 at ED
  • gcs <15 AT 2HRS after injury
  • suspected skull # (open/depressed)
  • basal skull #
  • post traumatic seizure
  • focal NEUROLOGICAL deficit
  • more than one episode of VOMITING
  • SUSPICION of NAI (non-accidental injury)
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6
Q

Special request for CT scan in pts if they experience LOC or amnesia since the injury?

A
  • > 65y.o
  • coagulopathy
  • dangerous mechanism of INJURY (MVA/ fall from a height > 1m)
  • MORE than 30 mins of RETROGRADE amnesia of events before the injury
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7
Q

What is a sign of BASILAR skull fracture?

A

BATTLE’S sign

- crescent shaped bruise that appears behind ONE or BOTH ears

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8
Q

What are other signs of basilar skull fracture?

A
  • bruising around the eyes
  • anosmia
  • hearing problems
  • fluid/ blood leaking from ears/nose
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9
Q

What form of posturing is found in cerebral hemorrhage damage?

A

decorticate posturing –FLEXION of arms in wards (like mummy)

—-as red nucleus is still functioning
(nucleus relays flexor info)

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10
Q

What form of posturing is seen with brain stem damage?

A
  • decerebrate posturing

EXTENSION of arms—no red nucleus fxn

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11
Q

What is subfalcine herniation?

A

when the Cingulate gyrus HERNIATES under the FALX cerebri

to the OTHER side

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12
Q

How does subfalcine herniation present as?

A
  • ACA compression as the ACA gets dragged to the other side

- c/l hemiparesis of the LEG

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13
Q

What occurs in UNCAL herniation

A
  • medial temporal lobe crosses over the tentorium cerebelli

> COMPRESSES MIDBRAIN

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14
Q

How does an epidural hematoma usually occur?

A
  • # of pterion bone o> rupture of MIDDLE meningeal artery
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15
Q

How does Epidural hematoma present on CT?

A
  • CONVEX shape
    (LEMON)
  • because can’t cross suture lines (dura attached to the sutures)
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16
Q

What is the clinical course of the epidural hematoma?

A
  1. Initial loss of consciousness, immediately after the trauma
  2. temporary recovery of consciousness (LUCID interval)
  3. Renewed decline in MENTAL status- rapid

SYMPTOMS which may appear AFTER the trauma or after a LUCID interval

  • deteriorating GCS
  • possible HEMIPARESIS
  • u/l FIXED and DILATED pupil
  • apnoea and death
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17
Q

How does subdural hematoma occur?

A
  • rupture of BRIDGING veins

- blood b/w DURA and arachnoid mater

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18
Q

How diff. is the onset of symptoms in Subdural hematoma as opposed to extradural?

A
  • SLOW bleed in SUBDURAL hematoma d.t rupture of low pressure veins
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19
Q

Who is at risk of subdural hematoma?

A
  • old age (Brain atrophy)
  • alcoholics
  • those on BLOOD THINNERS
20
Q

When is the onset of symptoms in Subdural hemorrhage?

A
  • confusion WEEKS AFTER head injury
21
Q

What is subarachnoid hemorrhage?

A
  • bleeding between the PIA and ARACHNOID mater
22
Q

How does subarachnoid hemorrhage present as?

A
  • worst headache of my life
  • SUDDEN onset
  • FEVER and nuchal rigidity
  • Photophobia
  • focal neurological deficits
23
Q

How to confirm dx of subarachnoid hemorrhage?

A
  • CT

- blood stained or xanthochromic (6-48 hrs) CSF spinal tap

24
Q

What causes subarachnoid hemorrhage?

A
  • ruptured BERRY aneurysm

- –esp. at anterior circle of WILLIS (branch points of AComm artery)

25
Q

What conditions result in subarachnoid hemorrhage?

A
  • AV malformations
  • MARFAN Syndrome
  • ADPKD (auto. dominant polycystic kidney disease)
  • Ehler-Danlos (connective tissue d.o)
26
Q

How does UNCAL herniation present as?

A
  1. ipsilateral CNIII compression
    (BLOWN pupil) and lack of pupillary constriction
  2. CORTICAL blindess/ Homonymous hemianopia (collpased PCA)
  3. cerebral PEDUNCLE comprssion (c/l PARESIS)—or herniates to opp. side (ipsilateral paresis)
  4. May have duret hemorrhage of PONs and midbrain
27
Q

Summarize the signs of uncal herniation.

A
  • dilated pupil at side of lesion
  • VISUAL loss
  • HEMIPARESIS
28
Q

What occurs with central transtentorial herniation?

A
  • thalamus/ hypothalamus/ medial parts of temporal lobes HERNIATEs through the tentorium cerebelli
29
Q

How does central herniation present as?

A
  • LOC
  • somnolence
  • intially: SMALL, reactive pupils (dilated, fixed pupils)
  • LATER: non-reactive
  • ——–paralysis of UPWARD eye movement (SUNSET eyes sign)
  • POSTURING
30
Q

What is the danger of TONSILLAR herniation?

A
  • compression of MEDULLA results in depression of centers for RESPIRATION and CARDIAC rhythm control
31
Q

What occurs with tonsillar herniation?

A
  • CEREBELLAR tonsils HERNIATE down into the FORAMEN magnum

- -> usually d.t post. fossa mass lesion

32
Q

What are the signs of tonsilar herniation?

A
  • headache and neck stiffness
  • LOC > FLACCID paralysis
  • CNiii palsy / CN VI palsy
  • ATAXIA
  • (+)ve BABINSKI
  • –irregular breathing
33
Q

What are the signs of RAISED ICP?

A
  • reduced LOC
  • neurological signs
  • PAPILLEDEMA
  • cushing’s triad= irregular breathing+ Incr. BP+ bradycardia
34
Q

What is the level of raised ICP?

A
  • > 100mmhg-180mmHg
35
Q

When is intubation and ventilation recommended?

A
  • when GCS is <9
36
Q

At what point of a pt with TBI, should the neurosurgeons step in?

A
  • with further deterioration of GCS and neck range of motion

- LARGE extradural or subdural bleed is noted on CT

37
Q

What are some ddx for SUDDEN onset headache?

A
  1. SAH
  2. Migraine
  3. benign Coital cephalgia
38
Q

What focal neurological deficits may a pt present with, in a suspected SAH?

A
  1. Dysphasia
  2. Hemiparesis
  3. III CN palsy
39
Q

On fundoscopy, what is seen in suspected SAH?

A
  • retinal or vitreous hemorrhage
40
Q

How accurate is a CT scan post-SAH?

A

-if within 48hrs; detects >90% of the bleeds
may be negative if >3days POST-ictus
- negative in 15% of pts who HAVE bled

41
Q

When is a lumbar puncture safe to perform>

A
  • in alert pt
  • no neurological deficit
  • NO papilloedema
  • after normal CT scan
42
Q

How to differentiate traumatic tap from SAH + csf tap?

A
  • no. of blood cells would be roughly equal through out the 3 testubes if it is SAH
  • in a traumatic tap; the no. reduces
43
Q

What is the gold standard method of dx for SAH?

A
  • cerebral angiography
    (seldinger tech. via the femoral artery)
    ——though may miss aneursym d.t vasospasm
44
Q

Other methods of dx for SAH?

A
  • MRI

- CT

45
Q

What are complications of SAH?

A
  1. re-bleeding
  2. delayed ischaemic deficit
  3. hydrocephalus
  4. hyponatremia
  5. seizures
46
Q

Duret hemorrhages are seen in which brain herniations ?

A
  • Uncal

- Central

NEUROLOGY (36 decks)

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