Traumatic CNS Injury and Repair Flashcards
The 3 types of focal intracranial lesions are:
contusion, hematoma/hemorrhage, herniation syndromes
The 2 types of diffuse intracranial lesions are:
diffuse axonal injury (DAI), concussion
The 3 types of post-traumatic sequelae are:
pneumocephalus, post-concussion syndrome (PCS), chronic traumatic encephalopathy (CTE)
The 3 cellular events in general associated with axotomy are:
proximal stump, distal stump, transneuronal events
cervial spinal cord injuries are referred to as _________
tetraplegia
spinal cord injuries below T1 are __________
paraplegias
A grade A spinal cord injury is ________ with ___________
complete, no motor or sensory function below the lesion
A grade C spinal cord injury is __________ with ___________
incomplete, some motor strength
_____ is the leading cause of death for individuals younger than 45 years old, more than 50% are due to ________
trauma, TBI
All types of TBI involve __________
loss of consciousness
TBI injuries are always _________ and are considered _______ injuries
multifactorial, complex
A Glassgow coma scale is a way to classify _______
TBI
A glassgow coma number ______ is a severe TBI
<7
A glassgow coma number >12 is considered a ___________
mild TBI (good prognosis)
The __________ is not designed to test focal neurological deficits
Glassgow coma scale (GCS)
A __________ involves the skull moving faster than the brain causing the brain to strike the brain
closed head TBI
A _________ involves coup-countercoup, contusions, hemorrhage, and axonal sheering
closed head TBI
A ___________ involves cavitation stretches, vasculature and axons, and compression of neurons and glia
penetrating TBI
A 1 degree blast TBI involves __________, __________, and _________
pressure passes through the brain, stretching axons, and compression of neurons and glia
______ is easy to miss on CT scan
basal skull fracture
occult signs of basal skull fracture are _________, ________, and __________
leakage of CSF (otorrhea, rhinorhea), signs of cranial nerve damage (esp. I, VII, VIII), characteristic accumulations of blood
The 2 types of characteristic accumulations of blood in basal skull fracture are:
postauricular ecchymosis (Battle’s sign), periorbital ecchymosis (raccoon eyes)
The following cranial nerves are the most vulnerable in basal skull fractures:
I, VII, and VIII
A patient fractures her frontal bone, she experiences _________ and ___________, which are signs due to damage to ____
anosmia, apparent loss of taste (actually loss of flavor associated with CN I), CN I
A patient has either a transverse or longitudinal fracture of the petrous bone which affects ______ and ______.
He experiences ___________, __________, __________, and _________
CN VII, VIII, ipsilateral facial palsy typically permanent (unless surgical anastamosis of transected ends), ipsilateral deafness, postural vertigo, nystagmus
A ___________ is almost always accompanied by cortical contusions and surrounding edema
focal intracranial lesion
A ________ is an injury that results in hemorrhagic necrosis of brain tissue
contusion
A _______ injury produces mainly coup lesions
frontal
A ________ injury produces mainly countercoup lesions
occipital injury
Blows to the side of the head produce ______, ________, or both types of lesions
coup, countercoup
Most commonly injured areas in a contusion are _______ and ___________
orbitofrontal lobe, temporal lobe
contusion of _________ and __________ are rare due to smooth inner table of skull posteriorly
occipital lobes, cerebellum
Contusions typically involve _____________ often superficially. They often only involve __________ due to this.
crests of gyri, gray matter
lesions of a contusion often appear as ___________ mixed with areas of ______________
edematous regions of cortex and subcortical white matter, areas of increased density representing leaked blood
Areas of leaked blood and fluid may _____________ in a contusion
coalesce and appear as a single large clot
___________ are common sequelae that may develop with a contusion
delayed hematomas and edema
The _____________ effect is a big factor in genesis of tissue shifts and elevated ICP in a contusion
mass effect
craniotomy can relieve _______ after a contusion, but has no effect on _________
ICP, focal neurological deficit
A contusion may appear as multiple _____________ adjacent to ____________
contusions, bony prominences
________ is the most common post-traumatic bleed and may be unilateral or bilateral
acute subdural hematoma (SDH)
___________ usually results from tearing of bridging veins
acute subdural hematoma (SDH)
Patients may be __________ or ________ on admission with an SDH, or they may be ________
stuporous, comatose, alert
Coma is typically developed ________ in patients with SDH, if it is present
immediately
_______ is rarely observed in SDH
aphasia
__________ is rarely observed in SDH because the ____________ is deep and not easily compressed
homonymous hemianopia, geniculocalcarine tract (optic radiation)
In _________, the clot is initially hyperdense but becomes slowly more isodense on CT and may be difficult to detect
subacute SHD
A subacute SDH is typically difficult to detect on CT except by the __________
tissue shift that it causes
__________ is a reliable indicator of the side of the subacute SDH
dilation of ipsilateral pupil
___________ may result in subacute SDH due to compression of the ____________
ipsilateral hemiparesis, compression of contralteral peduncle against edge of tentorium (Kernohan phenomenon)
If _________ is bilateral, there will be no shift in tissue and effect can cause herniation which compresses upper brainstem
chronic SDH
symptoms of chronic SDH are mainly associated with _______
increased ICP
Symptoms of a __________ include headache, light-headedness, slowness in thinking, apathy, unsteady gait, and occasional seizures
chronic SDH
epidural hematomas (EDH) typically arise with a _________ or _________ fracture and _____________. Or less commonly with _________
temporal, parietal, laceration of middle meningeal artery, tear in dural venous sinus
A patient with a ___________ has an intial loss of consciousness that is brief followed by a lucid interval
epidural hematoma
Signs and symptoms of a __________ may appear in a few hours and include worsening headache, vomiting, drowsiness, confusion, aphasia, seizures, and hemiparesis with mild babinski sign
epidural hematoma
progression of a _________ can lead to a coma and ipsilateral pupil may dilate and be nonresponsive, decerebrate posturing may appear
epidural hematoma
decerebrate posturing is associated with _________, due to herniation
worsening epidural hematoma
__________ are hemorrhages associated with coup-contrecoup injuries which cause sheering forces that produce bleeding within white matter as well as gray matter in contused areas
intracerebral hemorrhage
With intracerebral hemorrhage (or intraparenchymal hemorrhage) bleeding occurs in the _________ of one lobe of the brain or deeper structures like the _________ or ________
subcortical white matter, basal nuclei, thalamus
_________ is noisy inspiration occuring in coma or deep sleep
stertor
Stertor is associated with _____________
intracerebral hemorrhage (or intraparenchymal hemorrhage)
________ is associated with microhemorrhages into the _________ space from damaged blood vessels associated with cerebral contusions
traumatic subarachnoid hemorrhage, subarachnoid space
traumatic subarachnoid hemorrhage (SAH) is associated with _________ symptamotology and _________________
rapidly-developing, blood tracks into sulci and cisterns
All __________ form space-occupying lesions that can cause herniation via mass effect
intracranial bleeds
Headache due to meningeal irritation from blood in CSF is associated with _________
traumatic subarachnoid hemorrhage (SAH)
The 3 herniation syndromes that can occur with closed head TBI are:
subfalcine herniation, central herniation, and uncal herniation
A _________ is a type of closed head TBI herniation syndrome that presses the cerebral hemisphere medially against the falx cerebri
subfalcine herniation
__________ is particularly prominent in acute SDH
subfalcine herniation
___________ is associated with midline shift and compression of cingulate gyrus, pericallosal and callosomarginal arteries
subfalcine herniation
__________ is due to pressure from an expanding supratentorial mass lesion on the diencephalon
central herniation
Mild _________ can produce abducens palsy as compression on VI as it crosses the clivus
central herniation
Continued expansion of the mass in central herniation after a closed-head TBI can continue to bilateral _____________
uncal transtentorial herniation
____________ is due to an expanding mass lesion located laterally in one cerebral hemisphere which forces the medial edge of the temporal lobe to herniate over the free tentorial edge into the tentorial notch
uncal herniation
The _______ can be compressed between the uncus and tentorium in uncal herniation
PCA
The key sign of _________ is CN III dysfunction (ipsilateral pupil fixed and dilated), decreased consciousness, and hemiplegia
uncal herniation
The clinical triad of uncal herniation due to closed head TBI is:
“blown” pupil, hemiplegia, coma
Cheyne-Stokes breathing is common with worsening __________ which affecting the diencephalon
uncal herniation
Decerebrate posturing is first seen in uncal herniation if it worsens to the point of reaching the _________
midbrain (additionally, pupils will be fixed at midpoint and will be non-reactive)
