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NEUROPSYCH & CLINICAL NEURO > Week 3: Brain injury > Flashcards

Week 3: Brain injury Flashcards

1
Q

What are the two main causes of brain injury?

A 
Cerebrovascular accidents(CVAs)/stroke
Traumatic brain injury
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2
Q

What are CVAs categorised into?

A
  1. Cerebral blood flow

2. Stroke and related disorders

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3
Q

How much of the bodys oxygen consumption does the brain use?

A

25%

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4
Q

When oxygen is cut off from the brain, how long does it take for irreversible brain damage to occur?

A

2-3 minutes

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5
Q

Arteries carry blood…..

A

Away from the heart to our vital organs

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6
Q

Veins carry blood…..

A

Back to the heart (deoxygenated)

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7
Q

What 2 pairs of vessels are involved in arterial blood supply to the brain?

A
  1. Internal carotid arteries

2. Vertebral arteries

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8
Q

What are the main divisions of the internal carotid arteries?

A

Middle and anterior cerebral arteries

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9
Q

How is communication between the carotid arteries possible?

A

There is communication between the anterior cerebral arteries through the anterior communicating artery

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10
Q

Explain the vertebral-basilar system?

A

The vertebral arteries converge at the pons, turning into the basilar artery
This then splits into the posterior cerebral arteries (PCA)

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11
Q

What are the two main divisions of the vertebral-basilar system?

A
  • basilar artery

- posterior cerebral arteries

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12
Q

What is the circle of willis?

A

The Circle of Willis is the joining area of several arteries at the bottom (inferior) side of the brain

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13
Q

Explain how we can see both the vertebral-basiliar and carotid system within the circle of willis…

A

We can see that the vertebral-basilar system joins up with the carotid system via the posterior communication arteries

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14
Q

What are the benefits of the circle of willis?

A

Allows flow of blood through an alternative route so if a certain artery is blocked or has reduced flow, the other arteries can supply blood to that area

Can also transfer blood to the other side of the brain if needed via the posterior communicating artery

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15
Q

Where does the anterior cerebral artery supply blood to?

A

The medial (middle) frontal and parietal lobes

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16
Q

Where does the middle cerebral artery supply blood to?

A

Most of the lateral surface of hemispheres (outsides)

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17
Q

Where does the posterior cerebral artery supply blood to?

A

Medial (middle) part of the occipital lobes and inferior surface of temporal lobes

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18
Q

What is a CVA?

A

Cerebral vascular accident - a vascular disorder that results in brain injury

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19
Q

What is ischaemia?

A

Insufficient or lack of blood supply to the brain

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20
Q

What does ischaemia typically lead to?

A

Infarction

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21
Q

What is infarction?

A

Tissue death due to inadequate blood supply

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22
Q

What is an infarct?

A

An area of damaged or dead tissue from infarction

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23
Q

What is Penumbra?

A

Tissue surrounding infarct which may recover or die

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24
Q

What is oedema?

A

Swelling of the brain

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25
Q

What is Exitotoxicity?

A

Excess activity in glutamate signalling pathways (NMDA receptors) resulting in cell death - toxic chain reaction from neuron to neuron

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26
Q

What are the signs of stroke?

A

Weakness/numbness/paralysis of the face, arm or leg on one side of the body
Difficulty speaking or understanding
Dizziness/loss of balance/unexplained fall
Loss of vision
Headache
Difficulty swallowing

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27
Q

What is the acronym for checking for stoke?

A

FAST

Face, Arms, Speech, time(act quickly)- call ambo

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28
Q

What does the size of blood vessel have to do with stroke recovery?

A

If it occurs in a large artery, then likely to have more devastating consequences

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29
Q

What do the remaining intact vessels have to do with stroke recovery?

A

If the stroke is restricted to a certain area, sometimes other blood vessels can supply the area

E.g. through anterior and posterior communicating arteries

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30
Q

What are the 2 main types of strokes?

A

Obstructive (ishaemic)

Haemorrhagic

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31
Q

What is an ishaemic stroke?

A

Reduction of blood flow or complete blockage of a blood vessel - often due to a fatty plaque

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32
Q

What is a haemorrhagic stroke?

A

Result from bleeding into brain tissue (rupture of a blood vessel) often due to weakening or malformation of the vessel
(often resulting in permanent brain damage or death)

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33
Q

What is the most common form of stroke?

A

Obstructive (ishaemic)

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34
Q

What are ishaemic strokes caused by?

A
  1. Thrombosis (thrombotic)
    Occlusion of blood vessels by a thrombus (clump of cells) often a fatty plaque
  2. Embolism (embolic)
    Occlusion of blood vessels by embolism which has broken off of a thrombus in a larger blood vessel somewhere, travelling to the brain
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35
Q

How long does an ischaemic stroke take to develop?

A

30 minutes to fully develop

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36
Q

What are TIAs?

A

Transient Ischaemic attacks - common forewarning with ischaemic strokes (occur in 50-80% of cases)

Temporary obstruction of a blood vessel lasting less than 24 hours with many lasting only a few minutes

Precursor to stroke

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37
Q

After an ischaemic stroke, at what point is it unlikely to have little further spontaneous improvement?

A

3 months

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38
Q

Where do most thrombotic strokes occur?

A

In the internal carotid or vertebral-basilar arteries

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39
Q

What are the signs of a thrombotic stroke?

A

Lateralized limb weakness/paralysis and somatosensory changes
Visuospatial (right) and language (left) deficits

40
Q

What kind of effects do ischaemic strokes have on cognition and behaviour?

A

Tend to have unilateral effects on function (arterial supply to left or right)

Prominent acute effects that become less prominent overtime (e.g. confusion, due to swelling)

Signs of bilateral or diffuse damage in acute stages, which resolve as brain swelling diminished

41
Q

What kind of stroke promotes the poorest recovery?

A

Hemorrhagic

42
Q

What are some of the unilateral effects of ischaemic strokes?

A

Hemiparesis: weakness in half of the body (contralateral side)
Hemiplegia: complete paralysis in half of the body
Aphasias (left): expressive and receptive language disorders (returns within 1 month - less than 25% become fluent later if not at one month)
Unilateral neglect (right parietal lobe) - failure to attend to space at the opposite side of the lesion

43
Q

Unilateral neglect occurs despite any visual problems, this suggests…

A

Problem with attention

  • Can have their attention directed towards something in the neglected area
44
Q

Does unilateral neglect stick around?

A

It is often transient, becoming less. and less over time

45
Q

Within the first months of developing TIAs, how many people have a full-blown stroke?

A

30%

46
Q

What are the two different types of TIAs?

A

Those that cause infarctions that can be seen on CT scans (cerebral infarction with transient signs)
Those that don’t

47
Q

Do TIAs cause any neuropsychological deficits?

A

They can bring subtle deficits but these are only apparent under test conditions

E.g. speed of processing, memory etc

48
Q

What is a hemorrhagic stroke?

A

When there is a bleed in the brain due to the rupture because of weakening of blood vessels

49
Q

What are the risk factors for haemorrhagic strokes?

A
  1. Hypertension/high blood pressure
  2. Chronic use of oral anticoagulants (aspirin)
  3. Cocaine use
  4. Excessive alcohol use
50
Q

What are the two primary mechanisms that cause haemorrhagic stroke?

A
  1. Weakening of a vessel due to hypertension

2. Rupture associated with a vascular abnormality, such as an aneurysm, arteriovenous malformation (AVM), a tumor

51
Q

What is an aneurysm?

A

Weak area in an artery wall, causing it to balloon out

52
Q

Why do aneurysms occur?

A

Maybe congenital, be born with it

or it may be due to trauma or infection

53
Q

There is a higher risk of aneurysm rupture among…

A

Women and older people

Those with aneurysms that are symptomatic (e.g. bodily pain)

If they are bigger

Basiliar artery aneurysms are more likely to rupture

54
Q

The rupture of an aneurysm can be accompanied by severe symptoms. What are they?

A

Severe headache accompanied by nausea and vomiting
Neurological dysfunction
May lose consciousness
Vasospasm - when the bleed forms a clot and when the blood cells break down the nearby arteries may contract and spasm

55
Q

The rupture of an aneurysm can be immediately…

A

Fatal

The mortality rate is 50% within the first month of the rupture

56
Q

Which blood vessels are affected by hypertensive hemorrhage stroke? which parts of the brain are affected because of this

A

Blood vessels at the base of the cerebral hemisphere

Affects the basal ganglia, thalamus and brain stem

57
Q

What does AVM stand for?

A

Arteriovenous malformations

58
Q

What are AVMs?

A

Tangled masses of arteries and veins that grow much like a tumour

Are weak and very likely to rupture

59
Q

How common are AVMs?

A

Not very common, accounting for only 1% of all strokes

60
Q

How do you get AVMs?

A

They are typically congenital, so people are born with them

61
Q

What is locked in syndrome?

A

A rare disorder frequently caused by ischaemic or haemorrhagic stroke in the Basilar artery

Where you lose all motor function with the exception of my movements but your cognition and consciousness remain fully intact

62
Q

What is TBI?

A

Traumatic brain injury

An insult to the brain caused by external force that may produce diminished or altered states of consciousness resulting in impaired cognitive or physical functioning

63
Q

What kind of people have the highest TBI rates?

A

Young adults

More likely to engage in risky activities such as driving substance use or sport

64
Q

What are the two types of traumatic brain injury

A

Closed head injury

Penetrative head injury

65
Q

What is penetrative head injury

A

The skull is fractured exposing the brain breaking the blood brain barrier and allowing the entry a foreign matter

66
Q

What is a closed head injury

A

No insult to the skull
But there has been some kind of blow to the head

For example assaults falls and sports

67
Q

What cushions the brain?

A

Cerebrospinal fluid that surrounds the brain and the spinal cord

Acts like a shock absorber but not good when force to the brain is excessive

68
Q

Brain damage following traumatic brain injury typically occurs in two stages what are these stages?

A

Primary injury the damage that occurs at the time of impact

Secondary injury the secondary effects of physiological processes initiated by the primary injury

69
Q

What is a contact force

A

Where the head is still and receives a blow
- status injury

Rapid inward defamation of the skull with compensatory outward defamation in adjacent areas followed by rebound affects

Results in the compression of the brain tissue and the extension

70
Q

What are inertial forces?

A

Movement of the brain within the head as a result of acceleration or movement

71
Q

What are the three types of inertial forces

A

Translational

Rotational

Angular

72
Q

What is translational acceleration

A

The head moves in a straight line with brain centre of gravity

Eg. Car accident and breaking suddenly. Brain moves within the skull and hits the front of the head

73
Q

What is rotational acceleration

A

The brain rotate around the centre of gravity

Eg. Sports type injuries

74
Q

What is angular acceleration

A

It is a combination of translational and rotational forces

75
Q

What are the different types of primary injury

A

Coup: injury at site of impact

Contre-coup injury: The brain rebounds against opposing side of the skull causing further damage

Diffuse-axonal injury: rapid deceleration forces lead to widespread damage throughout the brain axons get torn twisted and broken

Intracranial haemorrhage: Large blood vessels maybe torn on impact these haemorrhages create haematomas (bruise) within the skull

76
Q

What are the type of haematomas intracranial haemorrhages cause

A

Epidural haematoma: between the skull and the dura matter often due to contact injury and most often arterial

Sub dural haematoma: between duramatter and arachnoid membrane produced by torn veins or brain surface on either side of dura

Subarachnoid haematomas: occurs between the arachnoid and the brain itself - often due to cerebral artery aneurysm

77
Q

What are intracerebral haematomas?

A

They form within the brain usually occurring in the frontal and temporal lobe‘s but also in the Basal ganglia and cerebellum

Result from rupture of blood vessels in the brain

Associated with diffuse axon also injury’s

78
Q

When does a delayed traumatic intracerebral haematoma occur

A

Within 72 hours post injury

79
Q

What is a burst lobe

A

A combination of an intracerebral haematoma and a sub dural haematoma

80
Q

What are some examples of secondary injury following traumatic brain injury

A

Brain swelling, cell death, elevated intracranial pressure, ischaemia, dysregulation of the blood brain barrier, infection

81
Q

Cerebral oedema is common following TBI. What are the two types

A

Vasogenic oedema: occurs when damage to the brain and surrounding membranes leads to increased extracellular fluid (fluid around cells)

Cytotoxic oedema: occurs when neurons membrane pump fails and leads to increased intracellular fluid (allows fluid to rush into the cell, it bursts)

82
Q

What are the two different processes of cell death

A

Necrosis: passive death of cells as a result of damage that occurs within hours of injury and leads to inflammation in possible damage to surrounding cells

Apoptosis: programmed death that occurs when cell is damaged (but doesn’t happen quickly) it requires significant resources and may take days no inflammation or damage to surrounding cells

83
Q

What happens during apoptosis?

A

The cell shrinks

Material is divided into vesicles (attract clean up cells)

Scavenger cells clean up the debris

84
Q

What’s three key indicators tell us how severe traumatic brain injury is

A

The length of the loss of consciousness

The depth of the coma

Length of post traumatic amnesia (PTA)

85
Q

How do we know the depth of coma

A

The Glasgow coma scale

Used to assess the level of consciousness at any given time following an injury

86
Q

Explain more about the post-traumatic amnesia period following traumatic brain injury

A

The person is incapable of learning new information and remains confused and disoriented

The most common test is the Westmead post-traumatic amnesia scale (orientation questions and memory tasks)

87
Q

What are some problems that make it hard to estimate the severity of traumatic brain injury

A 
The time of the assessment 
Reliability of information
Medical intervention
Drug and alcohol use
Are they elderly and can they be impacted by things like dementia
88
Q

What are some of the cognitive problems that may follow traumatic brain injury

A 
Attention 
Concentration 
Speed of information processing
Memory 
Executive function 
Word finding 
Speech production
89
Q

What are some of the emotional and behavioural affects following traumatic brain injury

A 
Lack of emotional control 
Emotional liability 
Emotional blunting 
Lack of emotional awareness 
Disinhibition 
Failure to pick up on social cues 
Lack of insight/awareness 
Change in sex drive 
Personality changes
90
Q

What are some psycho social outcomes following traumatic brain injury

A

Increased strain on or total breakdown of relationships

Reduced capacity of poor decision-making surrounding work

Withdraw from activities or change in social activities

91
Q

What are some clinical outcomes following traumatic brain injury

A

Depression, anxiety, personality disorders, PTSD

92
Q

Following traumatic brain injury what are people at risk of

A

Substance abuse, homelessness, violence, relationship breakdown, domestic violence, unemployment, social isolation, reduced capacity for education

93
Q

What can be seen with concussions

A

Blackouts, headache, blurry vision, balance problems, altered mood and behaviour

94
Q

What is the myth surrounding concussion

A

That you can’t sleep after it

95
Q

What is post concussion syndrome And what causes it

A

Where you get constant headaches and learning difficulties it is likely to develop if you return to sport too soon after injury

96
Q

What are sub concussive impacts

A

There’s a lower impact jolts to the head there are no noticeable impact straight away but it can lead to severe degenerative brain disease is over time

May lead to chronic traumatic encephalopathy

97
Q

Chronic traumatic encephalopathy?

A

Changes in mood and behaviour later in life can result in dementia due to the tau protein
there are damaged microtubules so tau clump together

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