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2) Patho 2 > 13) TBI > Flashcards

13) TBI Flashcards

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1
Q

TBI

A

Caused by a bump, blow, or jolt to the head or penetrating head injury that disrupts normal fxn of the brain

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2
Q

Who is more at risk for TBI?

A

Males

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3
Q

Risk factors for hospitalization/death post-TBI

A
  • Male
  • Age
  • Previous TBI
  • Drugs & alcohol use
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4
Q

Primary Injury

A

Occurs at the moment of impact

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5
Q

Focal Injury

A

Occurs at moment of impact

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6
Q

Diffuse Injury

A

Widespread brain tissue damage

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7
Q

2° Injury

A

Triggered by primary injury, causing even more brain damage

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8
Q

What does 2° injury cause?

A
  • Inflammation
  • Cell receptor-mediated dysfxn
  • Free-radical & oxidative damage
  • Ca2+/Ion-mediated Damage
  • Cerebral Edema
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9
Q

Contusion

A

Bruising

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10
Q

Coup Injury

A

At site of impact

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11
Q

Contre Coup Injury

A

Injury to the opposite side

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12
Q

Diffuse Axonal Injury

A

Shearing, tensile stress, & widespread injury

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13
Q

Open Head Injury

A

Skull Fx

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14
Q

Epidural Bleeding

A

Bleeding btwn the skull & dura; Caused by a blow to the head

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15
Q

What can epidural bleeding cause?

A

High ICP & brain shift

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16
Q

Why do epidural bleeds progress so quickly?

A

Bc the bleeding is usually arterial

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17
Q

What is the 1st sx of epidural bleed?

A

Fixed/dilated pupil on ipsilateral side bc of CN3 compression

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18
Q

What region of the brain is the most common place for epidural bleeds to occur & why?

A

Temporal region bc the temporal bones are the most commonly fx’ed

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19
Q

Tx for Epidural Bleed

A

Evacuation via burr hole or craniotomy

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20
Q

What gives a more favorable prognosis for epidural bleed?

A

If pt was conscious immediately after injury

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21
Q

Subdural Bleeding

A

Venous bleeding btwn the dura & brain

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22
Q

What determines the severity of a subdural bleed?

A

Speed of Onset

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23
Q

True or False: Sx’s of subdural bleed can appear immediately or be delayed.

A

True

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24
Q

Who are subdural bleeds most common in?

A

Very young & elderly

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25
Tx for Subdural Bleed
Craniotomy w/dural incision
26
Subarachnoid Bleeding
Bleeding into the subarachnoid space bc of a ruptured blood vessel or severe blow to the head
27
Sx's of Subarachnoid Bleed
* Severe HA * Vomiting * Confusion * Altered Consciousness * Sometimes seizures
28
What are the most common complications of subarachnoid hemorrhage?
Hydrocephalus, Seizure, & Re
29
Intraparenchymal Hemorrhage
Bleeding into the brain tissue
30
What is the most common cause of intraparencyhmal hemorrhage?
Non-traumatic mechanisms
31
What can intraparenchymal hemorrhages cause?
HIgh ICP & fatal herniations
32
Intraventricular Hemorrhage
Bleeding into the ventricles
33
What is intraventricular hemorrhage associated w/?
SAH & IPH
34
Subfalcine Herniation
Compression of pericallosal arteries, which causes HA & contralateral leg weakness
35
Transtentorial Hernia
Compression of PCA & CN3 causing: * CN3 paresis * Ipsilateral dilated pupil * Abn EOM's * Contralateral hemiparesis
36
Tonsilar Hernia
Compresses pons & medulla & causes obtundation
37
What are the 2° mechinisms of injury associated w/TBI?
* Acidosis * Cerebral edema * Hypoxia * Hypotension * Hypercapnia * Incr ICP * Ischemia
38
Level 1 LOC
Coma; No eye opening, no sleep/wake cycle, & no response to stimuli
39
Level 2 LOC
Vegetative State; Have sleep/wake cycle, but no purposeful responses * Means brainstem fxn is intact but cortical fxn is severly impaired * Pt has general response to noxious stimuli * Complex reflexes may be present
40
Level 3 LOC
Minimally conscious state; Inconsistent purposeful responses (Level 3)
41
Minimally conscious state (Level 3 LOC)
Inconsistent, but clearly discernible behavioral evidence of consciousness * Pt will have localized response to stimuli * Pt can inconsistantly follow 1 or 2-step motor commands
42
When is pt said to have "emerged" from a minimally conscious state?
* When they can use 2 different objects on 2 consecutive days * Ability to answer 6/6 visual or auditory situational questions
43
Favorable Prognostic Indicators
* Initial GCS \>5 * Pupillary response * Younger age * Limited trauma * Short duration of PTA * Low injury severity * Higher intelligence * Higher education level
44
Unfavorable Prognostic Indicators
* Midline shift * Repeat injury * Anoxia * Mass lesion * High ICP * Hypotension * Premorbid distability * Poor work hx * Hx of violence, drug, or alcohol use
45
What outcome measures are used to asses TBI outcomes?
* Brain Injury Awareness Questionnaire * Coma/Near Coma Scale * Community Integration Questionnaire * Disability Rating Scale * JFK Coma Recovery Scale * Fxnl Independence Measure * GCS
46
Acute care TBI management
* Early mobes in ICU * PROM/Contracture management * Positioning for skin integrity * Behavior management * Ongoing monitoring for 2° complications
47
2° complications of TBI
* Agitation * Physiological shifts
48
What causes TBI-related agitation?
Damage to the frontal & temporal lobes
49
What kinds of meds are given to TBI pt's?
* Anti-epileptics * Dopamine agonists * Anti-depressants * Anti-psychotics * Beta-blockers
50
Spasticity
Motor disorder characterized by a velocity-dependent incr in tonic stretch reflexes w/exaggerated DTR bc of UMN involvement, loss of descending inhibitory control from the reticulospinal tract, & overactive vestibulospinal tracts
51
Management for spasticity
* WB * Stretching * Serial casting * Splinting * Botox * Oral meds * Baclofen
52
Sx's of Seizures
* Uncontrolled movements * Unresponsiveness/Staring * Chewing movements * Hallucinations * Sudden fatigue or dizziness * Language changes * High fever * Loss of sleep/extreme fatigue
53
Side effects of anti-epileptic drugs
* Sleepiness * Balance deficits * Lightheadedness * Dizziiness * Trembling * Double vision * Confusion
54
What causes post-traumatic hydrocephalus?
* Overproduction of CSF * CSF blockage * Insufficient CSF absorption
55
True or False: Pt's w/hydrocephalus can have either normal or high ICP.
True
56
Is a non-communicating hyrocephalus classified as communicating or non-communicating?
Non-communicating
57
Actue Post-Traumatic Hydrocephalus
Coma & focal neurological deficits
58
How will a pt w/chronic Post-Traumatic Hydrocephalus present?
Gradual decline in fxnl status or failure to improve
59
Who usually picks up on chronic post-traumatic hydrocephalus?
PT's
60
What are the 3 cardinal signs of post-traumatic hydrocephalus?
1) Progressive gait disorder 2) Impaired cognition 3) Urinary incontinence
61
Sx's of non-communicating hydrocephalus
Papilledema & cognitive changes
62
Management of hydrocephalus
Shunt placement & rehab
63
Concussion
Traumatically induced physiological disruption of brain fxn manifested by LOC, loss of memory for events right before/after the accident, altered mental state, or focal neurological deficits
64
How does concussion present?
Constellation of varied physical, cognitive, emotional, & sleep-related sx's
65
Tx for Concussion
* Rest * Rehab * Cervical strengthening * HA management * Balance * Vestibular Therapy * Vision therapy * Psychotherapy * Sx-based meds
66
Why has there been an incr incidence of concussion?
Bc of incr youth sports participation
67
Consequences of concussion
* Predispostion for more concussions * Cognitive slowing * Early-onset alzheimers * 2nd Impact Syndrpme * Chronic Traumatic Encephalopathy
68
How long does it take for most concussions to resolve?
1wk
69
Do pt's w/post-concussion syndrome return to baseline fxn?
No

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