Traumatic Brain Injury Flashcards
Three types of primary injury
contusions, diaschisis, DAI
what is diaschisis?
damage to one area affects remote area connected to damaged area
two most common site of brain contusions
inferior frontal and anterior temporal
three locations of white matter involved with DAI
brain stem, corpus callous, central white matter
secondary injury in TBI
detrimental biochemical cascade
decorticate posture
arms flexed due to lesion above the brainstem
decerebrate posture
arms extended due to brainstem involvement
three locations of brain bleeds
epidural, subdural, subarachnoid
most commonly injured cranial nerve in TBI
CN 1
most common presentation of brain tumor
headaches with cognitive deficits
two most common posterior fossa tumors in children
1 - astrocytoma, 2- medulloblastoma
most common primary brain tumor in adults
GBM
most common site that metastasizes to the brain
lung
part of brain that regulates consciousness
RAS
persistent vegetative state
over one month
permanent vegetative state
over one year ( 3 months if non-TBI)
most important predictor of outcome in GCS
motor score at two weeks post injury
GCS for moderate TBI
9-12
2 ways to define emergence from PTA
75 or higher on GOAT or 25 or higher on O-Log for two days straight
most common type of post-traumatic seizure
simple partial
Treatment for post-traumatic seizure
1 week of AED for prophylaxis and 2 years if a late seizure occurs
common cause of post traumatic hydrocephalus
subarachnoid hemorrhage
GCS scoring?
EVM
Rancho Los Amigos scoring
- Scored 1 - 8
- 1 = no response
- 2= generalized response
- 3 = localized response
- 4 = confused agitated
- 5 = confused inappropriate
- 6 = confused appropriate
- 7 = automatic appropriate
- 8 = purposeful appropriate
Classification of post-traumatic seizures
- immediate = within 1 day
- early = within one week
- late = over one week
Tx for SIADH
restrict free water or demeclocyline (blocks ADH)
Tx for CSW
IV fluids
Tx for diabetes insipidus
ADH (vasopressin or DDAVP)
what is post-concussion syndrome?
cognitive deficit and symptoms for over 3 months that interfere with daily life.
most common cause of death in MVA?
ejection from the vehicle
archtypal TBI patient demographic?
20 yo single white male employed with HS education
leading cause of TBI (2014 data)
falls
leading cause of TBI-related death?
intentional self-harm
What does diffuse axonal injury look like on imaging?
white matter punctate petechial hemorrhages
most common cause of unconsciousness in first 24hrs of TBI?
axonal injury (DAI)
What are the two mechanisms of brain plasticity?
neuronal sprouting and reogranization
prominent imaging in finding in vegetative state?
bilateral thalamic lesions
scoring on glasgow outcome scale
- Death
- Vegetative state
- Severe disability
- Moderate disability
- Good recovery
What ICP level is fatal?
> 60 mmHg
What are two respiratory treatments that may increase intracranial pressure?
suctioning and chest PT
Four risk factors associated with late posttraumatic seizures?
- “EPILepsy”
- Early seizure
- Penetrating injury
- Intracranial hematoma
- Long coma
Posttraumatic seizure classificaton
- Immediate: within first 24 hrs
- Early: after 24 hrs but within one week
- Late: after the first week
Probability of recurrent posttraumatic seizure within 2 years after first late posttraumatic seizure?
86%
When can you consider withdrawal of antiepliptic drugs in a patient who had a late post-traumatic seizure?
after they are seizure free for two years
What is a Craig bed?
Floor bed used for agitated, non-ambulatory patients with 1:1 supervision
Atypical antipsychotic with higher incidence of EPS than others in the same class?
Risperidone
Atypical antipsychotic with D2 agonist/antagonist action, is the least sedating and has fewest EPS?
Aripiprazole (Abilify)
Two benzodiazepines with short duration of action?
Midazolam (Versed) and Alprazolam (Xanax)
Most common location for heterotopic ossification in TBI patient?
Hip
Inexpensive test for early detection of heterotopic ossification?
serum alkaline phosphatase
What is a patient with GI tube feeding at increased risk for?
aspiration (futher increased with GERD or proximal tube placement)
Seizure medication that can cause SIADH?
Carbamazepine
What is the maximum that sodium can be corrected in order to avoid pontine myelinolysis
No more that 10mEq/L over 24hrs until reaching 125mEq/L
Fracture location that can cause diabetes insipidus?
sella turcica
Treatment for diabetes insipidus?
DDAVP (desmopressin acetate - an ADH analog)
pharmacologic agent that can be used in chronic SIADH?
demeclocycline (inhibits ADH action in the kidney)
