2 - trauma and neoplasm Flashcards
(89 cards)
1
Q
overarching principles
A
- brain function is site specific
- the CNS is filled with and surrounded by fluid
- The brain has few lymphatic channels
- the brain is encased in bone and has little room to swell or move
- neurons are exquisitely sensitive to oxygen and glucose deprivation
- large molecules cannot diffuse easily into the brain from the blood
- cerebral blood vessels are frequently affected by atherosclerosis
2
Q
trauma - mechanism of injury
A
- blunt
- penetrating
3
Q
trauma - types
A
- focal
- diffuse
4
Q
trauma brain injury - definition
A
- scalp
- skull
- brain
5
Q
trauma brain injury - causes
A
- falls
- collisions
- concussions
6
Q
trauma brain injury - groups at risk
A
- elderly
- todlers
- young males (motor injury)
7
Q
possible outcomes to trauma to the brain
A
- full recovery
- recovery with disability
- long-term changes in LOC
- brain death
8
Q
long-term changes in LOC
A
- persistent vegetative state
- permeant/irreversible coma
- locked in syndrome
9
Q
Persistent vegetative state
A
wake up but don’t have awareness
10
Q
permeant/irreversible coma
A
don’t wake up and not aware
11
Q
locked in syndrome
A
wakefulness and awareness but cannot respond
12
Q
brain death
A
- death of cerebellum, brain stem and cortex
- require ventilator to stay alive
13
Q
penetrating injury
A
- open injury
- skull is not intact
- brain is exposed
14
Q
blunt injury
A
- closed injury
- no external damage evident
- skull remains intact
- brain not exposed
15
Q
focal
A
- generally associated with a direct impact to the head
- specific, localized injuries to the brain
16
Q
diffuse
A
- not limited to a localized area
- difficult to detect and treat
17
Q
focal brain injuries examples
A
- skull fractures
- contusions
- hematomas
18
Q
hematomas
A
- epidural
- subdural
- intracranial
19
Q
skull fractures
A
- linear
- depressed
- basilar (basal)
20
Q
basilar
A
- base of skull
- CSF leak from nose or ear
- periorbital brusing
- battle’s signs
21
Q
periorbital brushing
A
raccoon eyes
22
Q
battle’s sign
A
bruising behind ear
23
Q
contusions
A
- brushing of brain tissue
- frequently located on frontal and temporal lobes
- often are “coup-contrecoup” injuries
24
Q
coup-contrecoup
A
- 2 contusions
- if you hit the back of your head, your head will push forward and injure the front of your head
- sometimes countercoup can be worse
25
hematomas
accumulation of clotted blood within the tissue
26
subdural
- tear venous blood
| - worst fast
27
epidural
tear artierial blood
28
3 meninges layer
- pia matter
- dura matter
- arachnid
29
intracerebral hematoma
blood clot with brain tissue inside
30
diffuse brain injury
- widespread areas of the brain
| - can be difficult to detect and treat
31
diffuse brain injury - types
- concussion
| - diffuse axonal injury
32
concussion - types
- mild concussion
| - classic cerebral concussion
33
concussion
- transient neurological dysfunction due to a traumatic impact
34
concussion - manifestation
- headache
- confusion
- disorientation
- dizziness
- visual distrubances
- possible loss of consciousness
- memory deficits
35
memory deficits
- retrograde amnesia
| - anterograde amnesia
36
retrograde amnesia
anything that happened prior to
37
anterograde amnesia
unable to form new memories
38
mild concussion
- no loss of consciousness
| - grades I, II, or III
39
classic cerebral concussion
- loss of consciousness (up to 6 hours)
| - grade IV concussion
40
postconcussive syndrome
- headache
- anxiety
- irritability
- insomnia
- difficulty concentrating
- can happen to both types of concussion
41
chronic traumatic encephalopathy
- progressive degeneration of brain tissue
| - accumulation of abnormal protein (tau)
42
chronic traumatic encephalopathy - long term can cause
- dementia
- severe depression
- confusion
43
diffuse axonal injury (DAI)
- diffuse damage to axons
- stretching or shearing of neuronal axons
- can't see on CT or MRI
44
DAI - mechanism of injury
- acceleration
- deceleration
- rotation
45
DAI - results in
- outcomes unpredictable
| - high morbidity and mortality
46
DAI - types
shaken baby syndrome
47
shaken baby syndrome
- because they have big heads and smaller brains within their skulls
- weak neck
48
spinal cord injury - groups at risks
all ages however high in the elderly and young adults due to motor accidents and sport injuries
49
flexion injury
- hitting the head from the back
| - motor vehicle injury from the front
50
extension injury
motor vehicle injury from getting hit from the back
51
compression injury
- something falls on your head
52
flexion-rotation injury
- motor vehicle injury
53
classification of SCI
- level of injury
| - complete or incomplete
54
level of injury
- cervical
- thoracic
- lumbar
- sacral
- quadriplegia
- paraplegia
55
complete or incomplete
all vs part of sensory and motor function affected
56
quadriplegia
anything C7 or higher
57
paraplegia
paralysis of the lower limbs
58
spinal shock
- flaccid paralysis below the injury
- loss of reflexes below the injury
- last 48 hours - 6 weeks
59
spinal shock - manifestations
- respiratory impairment
| - immobility
60
flaccid
limply
61
complications of SCI
- depend on the level of injury and whether complete or incomplete SCI
62
types of complications of SCI
- neurogenic shock
- respiratory failure
- autonomic dysreflexia
- bowel/bladder/sexual dysfunction
- pressure ulcers
63
neurogenic shock
C6 or higher
64
respiratory failure
C4 or higher (loss never innervation of the respiratory system)
65
autonomic dysreflexia
- a complication of spinal cord injury with injury above T6
- associated with disconnect between the SNS and PNS
- always starts with the lower extremities
66
autonomic dysreflexia - pathway
1. noxious stimulus - major SNS response: vasoconstriction
2. vasoconstriction below the injury causes injury causes increased blood volume above the injury
3. hypertension about the injury - triggers: parasympathetic response - bradycardia and vasodilatation
67
summary of autonomic dysflexia
- SCI T6 or above
- severe hypertension above the injury
- bradycardia
68
autonomic dysflexia - treatment
- get rid of the cause
| - use gravity, bring their head up
69
neoplasm brain - cause
no proven causative agents
70
neoplasm brain - metastatic
- 10-15% of people with other cancers will develop metastasis to the brain
- lung, melanoma, breast or kidney
71
neoplasm brain - primary
- intracerebral tumors
| - extracerebral tumors
72
intracerebral tumors
- astrocytoma (40%)
- oligodendroglioma (4%)
- ependymoma (3%)
73
extracerebral tumors
- outside of the brain
| - meningioma (30%)
74
neoplasm brain - adults
- incidence increases up to age 70 then decreases
| - most are (on top) supratentorial
75
neoplasm brain - children
- brain tumors are the most common solid tutors in children
| - most are (below) infratentorial
76
neoplasm brain - adults vs children (way to remember)
adults are taller than children
77
brain tumours
- benign vs. malignant
- microscopically small benign tutors can cause severe debility or death
- difficult to remove
- some tumors cannot be accessed
- primary malignant brain tumour rarely metastasize (because bbb)
78
brain tumour - manifestations
- local
| - generalized
79
brain tumour - local
may be malignant by location
80
brain tumour - generalized
- due to intracrainal pressure
- LOC
- headache
- pupils
- vital signs
- seizures
- nausea and vomitting
81
brain tumour - treatment
- radiation
| - surgery
82
why is chemotherapy not effective with brain tumours?
because of the bbb
83
spinal tumors
- as with brain tumors can be primary or metazoic
| - much less common than brain tumours
84
spinal tumour - locations
- intramedullary
- extramedullary
- extradural
85
intramedullary
- in the spinal cord
- astrocytomas
- ependymomas
86
extramedullary
- outside spinal cord
| - meningiomas
87
extradural
- in the bones of the vertebrae
| - often metastatic
88
spinal tumor - manifestations
- due to compression on the spine
- pain
- numbness, tingling, weakness
- trouble walking
89
spinal tumor - treatment
- surgery
| - radiation
