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year 2 > Response To Traumtic Brain Injury > Flashcards

Response To Traumtic Brain Injury Flashcards

1
Q

How is blood flow to the brain regulated?

A

Myogenic mechanism of vasodilation and vasoconstriction of blood vessels.

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2
Q

What is the most common cause of death and disability?

A

Traumatic brain injury.

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3
Q

What are common causes for traumatic brain injury?

A

Road traffic collisions
Falls
Violence
Non-accidental injuries of children

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4
Q

What is primary traumatic brain injury?

A

Occurs at the moment of trauma.

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5
Q

What is secondary traumatic brain injury?

A

Changes in the brain after the trauma which causes further destruction.

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6
Q

What are the types of primary brain injury?

A

Separated into a focal brain injury and diffuse brain injury which includes:
Intracranial haemorrhage
Penetrating wound
Skull fracture
Laceration

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7
Q

What is a focal brain injury?

A

Localised primary brain trauma, such as contusions(bruise) and lacerations.

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8
Q

What is a diffuse brain injury?

A

Primary brain injury with widespread lesions such as:
Hypoxia
Diffuse brain swelling
Diffuse axonal swelling

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9
Q

What is intracranial pressure?

A

Pressure exerted by Cerebrospinal fluid on the brain tissues, with normal range being 7-15 mmHg.

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10
Q

What is mean arterial pressure?

A

Average blood pressure produced in one cardiac cycle.

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11
Q

What is cerebral perfusion pressure?

A

Pressure required to maintain blood supply to the brain. It is the sum of mean arterial pressure- intracranial pressure.

Therefore increased intracranial pressure will result in a drop in cerebral perfusion, resulting in brain ischaemia.

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12
Q

What is the normal range for cerebral perfusion pressure?

A

50-70 mmHg.

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13
Q

What is the response when mean arterial pressure is low?

A

Results in a drop in cerebral perfusion pressure, so myotonic mechanism of vasodilation occurs, increasing cerebral blood volume and eventually resulting in increased blood pressure.

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14
Q

What is the Monro-Kellie hypothesis?

A

Cranium contains the brain, arterial + venous blood supply and cerebral spinal fluid which contribute to pressure. When one of these components is high, the other components reduce in volume to maintain a standard intracranial pressure however, this is only within a limit.

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15
Q

What is diffuse axonal injury?

A

A fall or blunt injury of the head causes injury of the brain as it rotates against the skull in a coup and contracoup injury. This results in extensive damage to the grey matter with a shearing force of stretching and tearing applied to axons.

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16
Q

What are the types of skull fractures?

A

Linear fracture: break in the continuity of bone
Diastatic fracture
Depressed fracture: depression in the skull
Vault fracture

17
Q

What is a diastatic fracture?

A

Skull fracture along the suture lines, which commonly occurs in infants and children with unfused sutures. This usually affects the lambdoid and saggital sutures.

18
Q

What is a vault fracture?

A

Skull fracture at the base which presents with bruising around the eyes.

19
Q

What is an extradural haematoma?

A

Bleeding and bruising in the space between the brain and the dura mater, which commonly occurs in a skull fracture due to head trauma, affecting the middle meningeal artery that travels through the foramen spinosum. It presents with altered consciousness nests, bleeding, vomiting and aphagia.

It is most common in young people.

20
Q

What is a subdural haematoma?

A

Bleeding in the space between the dura mater and arachnoid mater from the rupture of the bridging veins, as a result of head trauma. Commonly associated with a coma in majority of cases. Alcoholics, elderly people and shaken baby syndrome are common presentations with this.

Bridging veins drain blood from the cerebral cortex to the superior saggital vein.

21
Q

What is an subarachnoid haemorrhage?

A

Cerebral artery damage with saccular/berry balloon-like aneurysm ruptures and commonly presents with a thunderclap headache. Bleeding that occurs can engulf the entire brain and skull, resulting in an increase in intracranial pressure.

**increased risk of this with Ehlers-Danlos syndrome.-

22
Q

What is the consequence of traumatic subarachnoid haemorrhage?

A

Lacerations to the cerebral arteries in the space results in hydrocephalus. This is excess build up of cerebrospinal fluid due to the bleeding in the space around the brain increasing cranial pressure, which disrupts the production and drainage of CSF in the ventricles to compensate.

23
Q

What is an intracerebral haemorrhage?

A

Haemorrhage which occurs within the cerebral hemispheres due to hypertension or embolism. It is associated with neurological symptoms relating to the affected area. It is the second most common cause of stroke following ischaemic stroke.

24
Q

What is an intraventricular haemorrhage?

A

Haemhorrage of the ventricular system which occurs in very severe traumatic brain injury, or the progression of severe intracranial or subarachnoid haemorrhage.

25
Q

What is a cerebral contusion?

A

Bruising of the brain caused by a direct blow.

26
Q

What is a coup injury?

A

Injury at the site of impact with a moving object when the head is stationary.

27
Q

What is a contracoup injury?

A

Injury to the brainat the opposite side of the impact when the head is moving and object is stationary.

28
Q

What is a concussion?

A

Occurs after injury to the head and is a type of mild diffuse axonal injury with short lived loss of mental function. Presentation includes dizziness, headaches, visual disturbances and emotional changes.

29
Q

What are the causes of raised intracranial pressure?

A

Intracranial pressure is high when it exceeds mean arterial pressure when:

Intracranial Haemorrhage
Brain tumour
Hypertension
Oedema
Hydrocephalus.

30
Q

What is the presentation of raised intracranial pressure?

A

Headache, vomiting and papilloedema. It can worsen traumatic brain injury and result in hypoxia, ischaemia and brain herniation.

31
Q

What is brain herniation?

A

Occurs due to uncontrolled high intracranial pressure where the brain protrudes through the:
falx cerebri, Foramen magnum and tentorium cerebelli. This presents with vomiting, severe headache, dilated pupils and Cushing’s triad.

32
Q

What is Cushing’s triad?

A

Physiological response by the body to increased intracranial pressure. It includes 3 markers:
Hypertension
Bradycardia
Slow respiratory rate.

33
Q

How is the severity of traumatic brain injury assessed?

A

Glasgow Coma Scale

34
Q

How is a mild head injury managed?

A

Period of observation but conservative treatment with NSAIDs.

35
Q

How is a moderate to severe head injury managed?

A

year 2 (247 decks)

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