Traumatic Brain Injury

Question 1

Types of primary brain injury

Answer 1

concussion-compression, sudden deceleration, rotational acceleration

Question 2

Main causes of Increased ICP

Answer 2

focal shear-strain mechanisms or hemorrhage

Question 3

talk and deteriorate phenomenon

Answer 3

“lucid interval”- unconscious then wake up and talk to you, then die suddenly. Get Head CT. accounts for nearly one third of all head injuries leading to death

Question 4

Secondary traumatic brain injury causes

Answer 4

systemic insults, intracranial insults, cerebral ischemia-reperfusion injury

Question 5

Most frequent systemic insults causing secondary brain injury

Answer 5

hypoxemia and hypotension

Question 6

if subarachnoid hemorrhage is seen on CT, there is an increased likelihood of…

Answer 6

patient developing cerebral vasospasm

Question 7

Problems with cerebral ischemia

Answer 7

oxygen radical formation, lipid peroxidation (breaksdown BBB)- leads to cell death

Question 8

should you be worried about major scalp laceration?

Answer 8

yes, can cause hemorrhagic shock

Question 9

What fracture can cause injury to cranial nerves?

Answer 9

basilar skull fracture

Question 10

penetrating injuries at risk for…

Answer 10

meningitis or brain abscess

Question 11

pontomedullary junction is prone to laceration injury following..

Answer 11

hyperextension of the head of the neck

Question 12

concussion refers to transient loss of consciousness that may result from…

Answer 12

temporary dysfunction of either cortical hemispheric neurons bilaterally or the reticular activating system

Question 13

how are contusions different from concussions?

Answer 13

contusions have some tissue injury with capillary damage and interstitial hemorrhage

Question 14

three classifications of contusions

Answer 14

coup, intermediate, and contrecoup

Question 15

severe consequences of contusions

Answer 15

nidus for hemorrhage, swelling, and post-traumatic epilepsy

Question 16

Diffuse axonal injury results from..

Answer 16

strain-shear forces in deceleration or rotational acceleration injury

Question 17

diffuse axonal injury can result in triad of damage involving-

Answer 17

corpus callosum, dorsal lateral quadrant of midbrain, and microscopic damage within the subcortical white matter

Question 18

diffuse axonal injury test of choice

Answer 18

MRI

Question 19

Primary brain injuries include..

Answer 19

scalp injury, skull fracture, penetrating injuries, lacerations, concussions, contusions, diffuse axonal injury, intracranial hematomas

Question 20

Intracranial hematoma types

Answer 20

intracerebral hematomas, subdural hematomas, epidural hematomas, subarachnoid hemorrhage

Question 21

hemorrhage into brain parenchyma caused by shear-strain forces rupturing blood vessels

Answer 21

intracerebral hemorrhage

Question 22

acute subdural tx

Answer 22

prompt craniotomy and evacuation

Question 23

subacute and chronic subdural hematoma tx

Answer 23

burr hole evacuation

Question 24

Midline shift magic number

Answer 24

5 mm.

Question 25

If midline shift more than 5mm..

Answer 25

surgical evacuation. or monitor aggressively and tx of ICP if can’t do surgical evaluation

Question 26

Patient with concussion. lucid interval, then HA, loss of consciousness again. May have progressive neurological deterioration now-

Answer 26

epidural hematoma

Question 27

tx of epidural hematoma

Answer 27

emergency craniotomy and evacuation

Question 28

2 things to manage cerebral blood flow

Answer 28

mannitol and hyperventialation

Question 29

ICP over 20

Answer 29

urgent. mannitol, hyperventilation

Question 30

ICP 30-50

Answer 30

poor prognosis

Question 31

all patients with major trauma should be assumed to have..

Answer 31

a head injury and a c-spine fracture until proven otherwise

Question 32

Lowest score on GCS

Answer 32

3

Question 33

coverage on gunshot wounds

Answer 33

gram negative and anaerobic

Question 34

coverage for open depressed skull fractures and penetrating wounds

Answer 34

antistaph PCN or first generation cephalosporin

Question 35

If hyperventilation and mannitol not working, consider

Answer 35

barbiturates “phenobarb coma”

Question 36

neurological evaluation of head trauma patient

Answer 36

mental status exams, cranial nerves, pupillary reflexes, eye rmovements, motor responses, DTR, sensory exam, cerebellar tests

Question 37

CVA can occur from

Answer 37

ischemia or hemorrhage