Traumatic CNS Injury and Repair

Question 1

Spinal cord injuries below T1 are:

Answer 1

paraplegias

Question 2

spinal cord injuries at the cervical level are:

Answer 2

tetraplegias

Question 3

Incomplete spinal injury:

Answer 3

sensory intact but little-to-no motor function

Question 4

All traumatic brain injuries involve:

Answer 4

loss of consciousness

Question 5

Glasgow coma scale that indicates severe TBI:

Answer 5

<7

Question 6

Glasgow coma rating that indicates moderate TBI:

Answer 6

8-12

Question 7

Closed head TBI is a coup-countercoup mechanism and results in these 3 types of injuries:

Answer 7

contusions, hemorrhages, axonal sheering

Question 8

Penetrating TBI is caused by an object breaching the skull and results in damage to these 4 structures:

Answer 8

stretches vasculature and axons, compresses neurons and glia

Question 9

Blast TBI is caused by a pressure wave from an explosion resulting in damage to these 4 structures:

Answer 9

stretching of axons and vasculature, compression of neurons and glia

Question 10

Evidences of basal skull fracture include these 4 things:

Answer 10

1. leakage of CSF (otorrhea, rhinorrhea)
2. signs of cranial nerve damage (esp. I, VII, VIII)
3. Battle’s sign
4. Racoon eyes

Question 11

A patient presents with anosmia and apparent loss of taste. He was involved in an MVA recently and briefly lost consciousness. What injury does he most likely have?

Answer 11

fracture of frontal bone (CN I)

Question 12

A patient presents with right-sided facial palsy, right-sided deafness, postural vertigo, and nystagmus. She was recently hit in the head with a baseball and briefly lost conciousness. What injury or lesion does she likely have?

Answer 12

transverse or longitudinal fracture of petrous bone (CN VII, VIII)

Question 13

A patient presents with frequent urination and it is determined he has diabetes insipidus. He recently fell out of bed and lost conciousness for a few minutes. What likely caused his diagnosis of diabetes insipidus?

Answer 13

fracture in or near sella turcica

Question 14

A patient is seen with left-sided blindness and loss of direct but not consensual pupillary light reflex. You note that he shot in the head with a potato gun by accident yesterday during a company picnic. He briefly lost consciousness. What likely caused his blindness?

Answer 14

fracture of sphenoid bone resulting in damage to CNII

Question 15

Blows to the front of the head produce ______ lesions, while blows to the occipital region cause __________ lesions.
Blows to the side of the head most commonly produce _______________ lesions.

Answer 15

coup, countercoup, coup-countercoup

Question 16

Contusions may appear on CT as _________ or __________.

Answer 16

a single blood clot, multiple contusions adjacent to bony prominences

Question 17

A patient presents in a stuporous state and confusion. He also has mild hemiparesis to his right side. He was found by paramedics with his head beside a curb and they report that he fell and possibly lost consciousness. CT scan reveals compression of ventricles on the same side he hit his head. What is causing his symptoms?

Answer 17

Acute subdural hematoma (SDH)

Question 18

A patient presents with right-sided hemiparesis and dilation of his right pupil. On CT there is an isodense region localized to the right side that borders the skull, as well as compression of ventricles on the right side. What is potentiating his symptoms?

Answer 18

subacute subdural hematoma (subacute because the blood clot is isodense; hyperdense means its an acute SDH)

Question 19

A female with history of a traumatic brain injury comes in to your office complaining of headache, light-headedness, apathy, and a few falls.
A CT scan reveals a dark (hypodense) crescent shape which lies against the left side of her skull, and compressed ventricles on one side.
What is the diagnosis?

Answer 19

chronic subdural hematoma

Question 20

epidural hematoma typically produced by ______ (fracture) resulting in laceration of __________ (artery) or _________ (sinus)

Answer 20

temporal/parietal, middle meningeal artery, dural veinous sinus

Question 21

A patient comes in with symptoms similar to hemorrhagic stroke including stupor and babinski sign on the right. He has stertorous (noisy inspiration/snoring) and irregular respirations.
CT scan reveals hyperdense area adjacent to the right lateral ventricle which is irregular in shape.
The diagnosis is:

Answer 21

intracerebral hemorrhage

Question 22

A patient comes in with the worst headache of his life and a CT scan shows diffuse hyperdense areas throughout the image.
What is the diagnosis?

Answer 22

subarachnoid hemorrhage