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08 Neuro > Traumatic Brain Injury > Flashcards

Traumatic Brain Injury Flashcards

1
Q

causes of tbi

A

vehicle crashes, falls, firearms, sports/recreation, others

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2
Q

common ages and groups at risk for tbi

A

<5 yo, 15-24 yo, >70 yo

males, 0-4 yo, 15-19 yo, >75 (most hospitalization and deaths)

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3
Q

coup vs contrecoup forces

A

coup: produce effects at or near impact site
contrecoup: remote from the area of impact (opposite side)

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4
Q

> 2 sqin vs <2 sqin objects

A

> 2 sqin: localized skull bending immediately beneath the impact point
<2 sqin: penetrating injury

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5
Q

examples of local effects

A 
linear fractures (hairline crack)
depressed fractures
epidural hematoma
subdural hematoma
coup contusion
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6
Q

examples of remote contact effects

A

due to skull distortion or stress waves

remote vault fractures

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7
Q

what are inertial injuries: shearing and vessel injury

A

differential movement of the skull and brain produced by head acceleration
(brain lags behind skull for a brief moment after acceleration begins)

can tear bridging vessels, and cause structural or functional brain damage

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8
Q

types of head acceleration

A

translation (linear)
rotation
angular (most damaging)

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9
Q

what are bridging veins

A

parasagittal bridging veins connect brain and sagittal sinus

located in subdural space

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10
Q

what are inertial injuries: parenchymal injury

A

strain manifesting as classic “cerebral concussion”, diffuse axonal injury, hemorrhage, and contrecoup contusions

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11
Q

types of parenchymal injuries

A

shear* (different directions)
forward backward affects projection fibers
side to side affects commissural fibers (in corpus callosum)
rotational affects association fibers (front to back)

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12
Q

primary vs secondary brain damage

A

primary: effects of actual trauma on the brain at the moment of injury (not preventable)
secondary brain damage: complication of primary brain damage, usually inc icp

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13
Q

categories of brain injuries

A 
skull fracture
focal injury
diffuse injury
penetrating injury
blast injury
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14
Q

types of skull fractures

A 
open (compound)
closed (simple)
depressed
diastatic
basilar
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15
Q

t/f open fractures require more aggressive treatment

A

true, due to exposure to external environment

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16
Q

indications for nonsurgical intervention in closed fractures

A

not depressed

linear type for fracture

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17
Q

indication for surgery in depressed fractures

A

if depressed fracture is greater than thickness of calvaria and those not meeting criteria for nonsurgical management

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18
Q

indications for non-surgical management in depressed fracture

A 
no evidence of dural penetration
no significant intracranial hematoma
depression <1 cm
no frontal sinus involvement
no wound infection or gross contamination
no gross cosmetic deformity
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19
Q

t/f elevating depressed fractures can reduce post traumatic seizures

A

false, no evidence of this

DEPTH OF FRACTURE correlates to how much pressure on brain

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20
Q

what are fractures through suture lines called

A

diastatic fractures

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21
Q

types of petrous bone fracture

A

longitudinal fracture through petrosqumousal suture

transverse fracture: perpendicular to eac –> cn 7 and 8 defects, peripheral facial palsy

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22
Q

what are postauricular ecchymoses called

A

battle’s sign

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23
Q

management of csf leak at eardrum

A

slow type of bleeding: venous origin = can be stopped with pressure
put cotton ball in ear (tamponade effect)
refer to neurosurgeon/ent

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24
Q

tx for basilar skull fracture

A

prophylactic antibiotics

specific treatments

25
Q

key sign of frontal sinus fractures

A

pneumocephalus –> dural laceration

26
Q

what is a cerebral contusion

A

due to damage on small blood vessels on brain surface

27
Q

t/f contusions can expand over time

A

true, require monitoring

monitor icp to prevent contusions from expanding and deteriorating brain

28
Q

types of contusions

A

coup
contrecoup
intermediate coup: deep within neural parenchyma between impact and opposite side of the brain

29
Q

indications for surgery of hemorrhagic contusion

A

progressive neurological deterioration referable to contusion
volume > 30 cc
frontal or temporal contusion >20 cc, WITH MIDLINE SHIFT >/=5 MM, compressed basal cisterns

30
Q

common area for epidural hematomas

A

temporoparietal regions, middle meningeal arteries and diploic veins

limited by suture lines

31
Q

classic presentation of epidural hematoma

A

brief post-traumatic loss of consciousness
lucid interval of a few hours
obtundation, contralateral hemiparesis, ipsilateral pupillary dilatation

32
Q

common causes of subdural hematoma

A

accumulation around parenchymal lacerations (from laceration of bridging veins/superficial vessels)

surface of bridging vessels torn from cerebral acceleration-deceleration during violent head motion

33
Q

indications for surgery in acute subdural hematoma

A

asdh with thickness >10 mm or midline shift >5 mm
OR
gcs drops by 2 points & icp >20 mmhg

34
Q

ct scan findings in chronic subdural hematoma

A

crescentic mass of increased attenuation adjacent to inner table

35
Q

t/f there may be gradual or repeated bleeding from neo membranes in chronic subdural hematoma

A

true

36
Q

what is a diffused brain injury

A

occurs without macroscopic damage
most prevalent cause of disability in TBI survivors

mildest form: concussion
most severe: diffuse axonal injury

37
Q

presentation of concussion

A

transient loss of consciousness, no visible structural damage but there is disturbance in brainstem or cortex

38
Q

t/f in diagnosing concussion the patient should have shown signs of recovery before the 24th hour

A

true

39
Q

category 1 for concussion

A

cantu: pta <30 mins, no loc
aan: transient confusion, no loc, symptoms resolve in <15 mins

40
Q

category 2 for concussion

A

cantu: pta >30 mins, loc <5 mins
aan: transient confusion, symptoms resolve in <5 mins, no loc, (+) pta

41
Q

category 3 for concussion

A

cantu: pta >24 hrs, loc >5 mins
aan: any loc

42
Q

management of post-concussion syndrome

A

symptomatic

reassure patient that symptoms will resolve in 4-6 weeks

43
Q

definition of diffuse axonal injury

A

clinicopathologic syndrome in patients unconscious form the time of trauma with widespread traumatic damage throughout the brain in the absence of intracranial lesion with mass effect

disrupted connections of axons

44
Q

histologic findings in dai

A

axonal swelling, disruption of axons, retraction balls, punctate hemorrhages in pons midbrain and corpus callosum

45
Q

dai classification

A

1: axonal injury of parasagittal white matter of cerebral hemisphere
2: grade 1 + focal lesion in corpus callosum
3: grade 2 + focal lesion in cerebral peduncle

46
Q

mild, mod, and severe dai

A

mild: coma 6-24 h
mod: gcs 6-8 and coma >24 h
sev: gcs 4-5 and coma >24 h

47
Q

t/f dai does not mean severe traumatic injury

A

false

48
Q

what are retraction balls

A

twisted, stretched, and lost connection of axons which retract

found in: corpus callosum, periventricular white matter, basal ganglia, brainstem

49
Q

presentation of subarachnoid hemorrhage

A

no inc icp
severe headaches
nape pain (irritated meninges)
spontaneous resolution in 2-3 wks

50
Q

what is intracranial hypertension

A

persistent elevation of icp above 20 mmhg for >5 mins (poor outcome)

51
Q

normal cerebral perfusion pressure

A

60-65 mmhg

45-55 = ischemia
<45 = neuronal death
52
Q

pressure monitoring objectives

A

maintain map 75-100
keep icp <15 mmhg
cpp 60-70 mmhg

cpp = map-icp

53
Q

t/f when it’s not possible to intervene surgically or to relieve the pressure, patients are sedated and place in a coma

A

true, to reduce the metabolic demands of the brain

54
Q

what is the carotid cut off sign

A

contrast only reaches level of mandible, aca and mca do not appear on angiogram due to compression

can be seen in extreme increase of icp

55
Q

hallmarks of uncal herniation

A

ipsilateraly pupillary dilation (cn 3)

kernohan’s notch: false localizing paradoxical ipsilateral hemiparesis

56
Q

gcs table

A

table 4, page 11

57
Q

cushing’s triad

A

increasing bp, decreasing hr, decreasing rr

58
Q

indications for ct scan

A 
<15 gcs 2 hrs post op
evident head injury seen clinically
otorrhea or rhinorrhea
suspect for basal skull fracture
has repeated vomiting episodes
>65 yo
59
Q

indicators of prognosis in severe tbi

A 
gcs score
age
pupillary diameter and light reflex
hypotension
ct scan features

08 Neuro (24 decks)

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