Traumatic Brain Injury Part 2 Flashcards

1
Q

Why are concussions not visible through standard imaging techniques?

A

The damage it has on axons are microscopic

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2
Q

What are complications of axonal tearing

A
  • inflammation
  • necrosis
  • disruption in communication between neurons
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3
Q

The damaged axons may contribute to symptoms of concussions such as;

A

-dizziness, nausea, vomiting
- memory and concentration problems
- sensitivity to light
- fatigue

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4
Q

Why is it challenging to distinguish post concussive symptoms from mental health disorders like depression, bipolar, and PTSD?

A

These symptoms can overlap with mental health disorders. Concussions impact cognitive and emotional functioning mimicking symptoms

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5
Q

What are post concussive syndrome symptoms

A
  • headache/dizziness
  • irritability
  • difficulty concentrating
  • sleep disturbances/fatigue
    -sensitivity to light and noise
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6
Q

When does the timeline for post concussive syndrome start, how long do symptoms typically last

A

Starts when symptoms first appear and not when the head injury occurred. Most symptoms resolve within 6-12 months from their onset

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7
Q

What are 5 treatments for concussions and PCS?

A
  • rest and rehabilitation
  • medications
  • cognitive behavioural therapy
  • physical therapy
  • avoiding re injury
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8
Q

What medications migh be used for treatment with concussions and PCS

A
  • analgesia to manage headache
  • antidepressants and anxiolytics
  • sleep aides like melatonin
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9
Q

What is the consequences of increased ICP?

A
  • brain tissue compressions (vessels and nerves)
  • reduced blood flow leading to ischemia and hypoxia in the brain
  • herniation of the brain
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10
Q

What are ways to manage increased intercranial pressure?

A
  • draining CSF through a craniotomy
  • medications to reduce welling such as mannitol
  • hypertonic saline to decrease ICP
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11
Q

What is Space occupying lesions?

A

Anything that occupies space and increases pressure in the cranial vault

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12
Q

The dura mater contains the Dural sinuses. What is the dural sinuses function?

A

A space that drains blood from the brain back to the venous system

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13
Q

What is the function of the Pia matter

A

To contain the CSF keeping it from leaking into the brain tissue

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14
Q

Beneath the temporal bone lies this artery which is often ruptured in cases of epidural hematoma

A

The middle meningeal artery

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15
Q

Why is nausea and vomiting a common symptom for increased ICP?

A

Because the pressure is irritating the medullary centre of the brain (vomiting centre)

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16
Q

What happens when the herniation centres in the medulla oblongata are irritated?

A

It can affect various cranial nerves particularly the vagus nerve.

17
Q

What does the vagus nerve influence?

A

The nerve extends through the foremen magnum and influences the PSNS function of the body including the GI system. Irritation can lead to projectile vomiting due to PSNS response

18
Q

Where does hemipligia often occur?

A

Contra-lateral to the bleed

19
Q

Where would pupil dilation occur?

A

Ipsilateral to the bleed

20
Q

What is normal ICP (in mmHg)

A

1-10 mmHg

21
Q

What is cerebral perfusion pressure? (CPP)

A

The amount of pressure needed to ensure that blood can adequately perfume the brain

22
Q

How is CPP calculated

A

MAP-ICP=CPP

23
Q

What happens to cerebral perfusion as ICP increases

A

Cerebral perfusion becomes more difficult

24
Q

In order to have adequate CPP. The MAP must be ______ than ICP for perfusion

A

MAP must be greater than ICP

25
Q

What would happen if there is a significant drop in CPP?

A

It can lead to brain ischemia

26
Q

What is typical MAP for an adult?

A

70-100 mmHg

27
Q

How might the body compensate for an increased ICP

A
  • systemic vasoconstriction through alpha 1 adrenergic activation (increasing BP,Increasing MAP)
  • widened pulse pressure (systolic pressure significantly higher than diastolic)
28
Q

As ICP increases, ischemia occurs. What is the ischemic casscade that happens

A

Ischemia - hypoxia - cell damage - Na/k+ pump fails - cell swelling - further increase to ICP - necrosis

29
Q

For every 5 mmHg increase in ICP, the body will try to increase MAP by how much to maintain perfusion?

A

5mmHg

30
Q

Cushings triad is an indicator of increase ICP. What is this triad?

A
  • hypertension (widening pulse pressure)
  • Brady cardia
  • respiratory irregularity (Cheyenne stokes breathing)
31
Q

Why is bradycardia present during an increase in ICP

A

Because the Systolic pressure is high, the baroreceptors in the carotid body and aortic arch trigger the vagus nerve which causes bradycardia

32
Q

Why do Cheyenne stokes respirations occur in cases with increased ICP

A

As ICP raises, pressure it put on the brain stem, particularly the medulla oblongata which controls respiratory function