X Neuro: Trauma/SCI/BrainAbcess (Ms Si) Flashcards
2nd most common cause of neuro injury
Craniocerebral Trauma:
head injury, falls, motor cycle/car acc, assault, sports
Craniocerebral Trauma
- involves scalp, skull, brain tissue
- minor - severe
- obvious damage NOT EQUAL to severity
- Blood NOT EAUAL to severity
Head Injury classifications
- open (penetration, object thru skull into brain)
- closed (no penetration)
- direct trauma (bat to head)
- indirect trauma
Closed Head injuries
- coup-contrecoup phenomenon (acceleration/deceleration, direct/indirect, head hit in front and whiplash back hits back of brain)
- concussion
- contusion
Concussion
-brain injury fro head impact
-mild - severe
SS: confusion, dazed, amnesia, possible unconsciousness
-NO bleeding
Contusion
- brain bruise
- CAUSE: damaged/broken bv d/t blunt force
- SS: confused, tired, agitted, mem loss, attention probs, motor coor probs
Other Skull Injuries
- skull fx
- scalp lacerations
- hematomas (a solid swelling of clotted blood within the tissues)
Skull Fx
- linear (fracture in shape of line, parallel to bones’ long axis)
- comminuted
- depressed (crushed/caved inwards)
- compound/open (penetrate skull/brain)
- basilar (base of skull)
Basilar Skull Fx
- at base of skull
- fx line can extend into sinus’ (bacteria access to brain)
- -> leakage of CSF or blood from nose/ears
SS: Battle’s sign, periorbital ecchymosis, CSF rhinorrhoea (mucous filled nose, runny nose) /otorrhoea (ear infection middle ear)
CSF Halo
- put CSF on filter paper
- blood draws to center
- then yellow outer ring (CSF)
Beta-2 Transferrine test
looks @ specific protein only found in CSF
Battle’s Sign
bruising or ecchymosis over mastoid process
Periorbital Ecchymosis
- w nose break or after Sx
- basilar skull fracture
- Raccoon eye/eyes or periorbital ecchymosis is a sign of basal skull fracture or subgaleal hematoma, a craniotomy that ruptured the meninges,
Laceration
Cut
Hematoma
accumulation of blood
Type of Hematomas
- Epidural: btwn skull/dura mater
- Subdural: btwn dura mater/arachnoid
- Subarachnoid: subarachnoid space
3 components of the Cranium
blood, CSF, brain
when 1 component not in balance, alters pressure –> IICP
Subdural Hematoma
btwn dura mater/arachnoid
CAUSE: head trauma, anticoagulant therapy
TYPES: acute, subacute, chronic
RISK: elderly on warfarin
SS of Craniocerebral Trauma
- HA, N, V
- bleeding from any orifice (ears/nose)
- loss of consciousness
- Chang in size and reactivity of pupils
- change in orientation
- change in motor
- battle sign (bruise behind ear)
- abnormal speech
Craniocerebral Trauma: Dx Tests
- Med Hx, what injury sustained
- head CT, MRI
- PET
- EEG (brain activity)
Craniocerebral Trauma: Rx
- airway mgmt
- LO cerebral edema (Mannitol, osmotic diuretic)
- MED: Analgesics (pain, narcotics should e avoided because pt needs to be conscious an oriented. won’t be able to monitor LOC. are changes due to narcotic or IICP?
- MED: Anticonvulsants (seizures)
- Craniotomy/Burr Holes
Complications of Head Injury
- IICP
- Cerebral Edema
- Diffuse Axonal Injury (DAI, tearing of axons)
Normal ICP
5 - 15 mmg
How many vertebrates?
26 Vertebrates
Cervical - 7 Thoracic - 12 Lumbar - 5 Sacral - 1 Coccyx - 1
How many spinal nerves?
31 - spinal nerves 8 pair - Cervical Spinal Nerves 12 pail - Thoracic 5 pair - Lumbar 5 pair - Sacral 1 pair - Coccyx
parts of the Vertebrae, Opening
Vertebral Body, Vertebral Arch, Vertebral Foramen
Spinal Cord
- connected to brain stem (medulla oblongata)
- diameter of a thumb
- 17” long
- extends from Foramen Magnum to L1
Spinal Cord makeup
- Grey matter surrounding white (myelinated) matter
- ascending and descending tracts
Grey Matter
- cell bodies, axons, dedrites
- signals generated and processed
White Matter
- myelinated axons
- transmits signals
Location of Cervical, Thoracic, Lumbar/Sacral nerves
neck, upper back, lower back
Spinal Cord Injury (SCI)
- damage to any part of the spinal cord or to the nerves and end of spinal canal.
- often causes perm changes in strength, mvmt, sensation and other body fx BELOW site of injury
- 16-30
- Males 81.2%, 89.8% sports related
SCI: Causes
Trauma (car accident, falls, assault, sports), CA, Disease (osteoporosis, compression, fractures, cerebral column collapse)
- more common MALES
- ETOH involve in 25% SCIs
- MotorVeh 46%, Falls 22%, Violence 16%, Sports 12%
Leading Cause of SCI’s
- Both Genders, car acc/falls/gunshots
- Males, driving acc, Motorcycle
- Females, med/surg complications, Driving Acc
- MVA, 65 and younger
- Falls, 65 and older
- Sports/Rec, under 29yrs
SCI Classification
- Complete Cord Injury, no fx below level of injury
- Incomplete Cord Injury, some fx below level of injury
SCI Classification…more
- Class A, Complete Injury
- Class B, Incomplete w preserved sensation only
- Class C, Incomplete w non useful motor fx
- Class D, Incomplete w useful motor fx
- Class E, Complete recovery
Level of Injury Fx
- C1-C3: no resp fx, usually fatal
- C4: tetraplegia, loss of diaphragm mvmt (quad, ventilator)
- C6-C8: paraplegia
- T11 and below: lose bowel, bladder and sex fx
High Cervical Nerves (C1-C4)
- most SEVERE
- paralysis in arms, hands, trunk, legs
- may not be able to breath, cough or control bowel/bladder
- ability to speak maybe impaired
- all 4 limbs affected (Quad)
- require assistance w ADLs
- may be able to use powered wheelchair
- CAN NOT drive car on own
- 24hrs personal care
Low Cervical Nerves (C5-C8)
- corresponding nerves control arms and hands
- may be able to breath and speak on own/normally
C5 Injury
- Peron can raise arms/legs, bend elbows
- partial or total paralysis of wrists, hands, trunk, legs
- can speak and use diaphragm, weak breathing
- will need assistance w most ADLs, but can move w power WC.
C6 Injury
- nerves affect wrist extension
- paralysis in hands, trunk, legs typically
- should be able to bend wrists back
- can speak and use diaphragm, weak breathing
- can move in and out of WC and bed w asstv equip
- may be able to drive adapted vehicle
- little or no voluntary control of bowel/bladder, but able to manage w special equip
C7 injury
- nerves control elbow extension, some finger extension
- can straighten arm, normal mvmt of shoulder
- can do most ADLs, may need asst for diff tasks
- maybe drive
- -little or no voluntary control of bowel/bladder, but able to manage w special equip
C8 injury
- nerves control some hand mvmt
- should be able to grasp/release objects
- most ADLs, asst for more diff tasks
- maybe drive
- little or no voluntary control of bowel/bladder, but able to manage w special equip
Thoracic (T1-T5)
- affect muscles, upper chest, mid back, abd muscles
- arms/hand normal fx
- affect legs (paraplegic)
- manual wc
- can drive modified car
- stand in frame, walk w brace
Thoracic (T6-T12)
- affect trunk muscles (abd, back)
- normal upper body mvmt
- paraplegia
- fair/good control/balance trunk in seated position
- cough productively (if abd muscles intact)
- little/no bowel/bladder, manage w equip
- manual wc
- drive modified car
- stand in frame, walk w brace
Lumbar (L1-L5)
- loss of hip/leg fx
- little/no bowel/bladder, manage w equip
- wc or braces
Sacral (S1-S5)
- loss of hip/leg fx
- little/no bowel/bladder, manage w equip
- can walk
C4 - tetra (neck down)
C6 - tetra (chest down)
T6 - para (abdomen down)
L1 - para (legs down)
C4 - tetra (neck down)
C6 - tetra (chest down)
T6 - para (abdomen down)
L1 - para (legs down)