Traumatic CNS Injury and Repair Flashcards by Daniel Harned

The 3 types of focal intracranial lesions are:

contusion, hematoma/hemorrhage, herniation syndromes

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The 2 types of diffuse intracranial lesions are:

diffuse axonal injury (DAI), concussion

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The 3 types of post-traumatic sequelae are:

pneumocephalus, post-concussion syndrome (PCS), chronic traumatic encephalopathy (CTE)

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The 3 cellular events in general associated with axotomy are:

proximal stump, distal stump, transneuronal events

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cervial spinal cord injuries are referred to as _________

tetraplegia

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spinal cord injuries below T1 are __________

paraplegias

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A grade A spinal cord injury is ________ with ___________

complete, no motor or sensory function below the lesion

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A grade C spinal cord injury is __________ with ___________

incomplete, some motor strength

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_____ is the leading cause of death for individuals younger than 45 years old, more than 50% are due to ________

trauma, TBI

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All types of TBI involve __________

loss of consciousness

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TBI injuries are always _________ and are considered _______ injuries

multifactorial, complex

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A Glassgow coma scale is a way to classify _______

TBI

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A glassgow coma number ______ is a severe TBI

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A glassgow coma number >12 is considered a ___________

mild TBI (good prognosis)

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The __________ is not designed to test focal neurological deficits

Glassgow coma scale (GCS)

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A __________ involves the skull moving faster than the brain causing the brain to strike the brain

closed head TBI

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A _________ involves coup-countercoup, contusions, hemorrhage, and axonal sheering

closed head TBI

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A ___________ involves cavitation stretches, vasculature and axons, and compression of neurons and glia

penetrating TBI

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A 1 degree blast TBI involves __________, __________, and _________

pressure passes through the brain, stretching axons, and compression of neurons and glia

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______ is easy to miss on CT scan

basal skull fracture

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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

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The 2 types of characteristic accumulations of blood in basal skull fracture are:

postauricular ecchymosis (Battle’s sign), periorbital ecchymosis (raccoon eyes)

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The following cranial nerves are the most vulnerable in basal skull fractures:

I, VII, and VIII

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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

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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)