Brain

Question 1

___ brain injury is caused by direct impact

Focal: one area

Diffuse: more than one area

Answer 1

Primary brain injury

Question 2

Altered brain function due to external force. Closed or open head trauma is called ___ brain injury

Answer 2

Traumatic

Question 3

__ brain injury indirect consequence of primary injury.

Ex ischemia due to vascular interruption

Answer 3

Secondary brain injury

Question 4

The hallmark of a severe tbi is loss of consciousness for 6 hours or more

Answer 4

Know

Question 5

Gas glow grading

Best response is 15
Comatose client 8 or less
Total unresponsive is 3

Answer 5

Know

Question 6

Diffuse injuries
Diffuse axonal injury
Blast
Confusion

Focal
Contusion
Penetrating

Answer 6

Know

Question 7

___ brain injury fan he closed (blunt) or open (penetrating)

Closed is more common, head strikes a surface or moving object strikes head. Or by blast waves. Dura mater remains intact and tissues are not allowed exposed to environment

Causes both focal and diffuse axonal injury

Open: penetrating trauma. Break in dura mater and exposed cranial content

Answer 7

Focal

Question 8

___ injury directly below point of impact

*closed brain injury

Answer 8

Coup

Question 9

___ injury is when the head bounces back and you get injury on opposite side

*closed brain injury

Answer 9

Contrecoup injury

Question 10

Closed brain injury the force of the impact on typically produces contusions. Contusions Usually in frontal and temporal

Answer 10

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Question 11

Bleeding between dura mater and skull

Answer 11

Epidural hematoma

Question 12

Bleeding between dura mater and arachnoid membrane of the body

Headache confusion drowsiness

10-20% of persons with TBI

Answer 12

Subdural hematoma

Question 13

___ hematoma bleeding within brain. 2-3% of people with TBI also seen with stroke

Answer 13

Intracerebral hematoma

Question 14

With any brain injury, monitor ICP and advanced imaging EEG, MRI, control ICP

Answer 14

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Question 15

If someone says worst headache of their life think of subarachnoid hemorrhage

Answer 15

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Question 16

___ brain injury breaks the dura and exposes the cranial contents to the environment

Causes both focal and diffuse injuries

Answer 16

Open brain injury

Question 17

Something shot at head and causing injury

Answer 17

Missile injury

Question 18

___ injury is splintering of the bone

Answer 18

Compound

Question 19

Identified as a coma that lasts 6 or more hours after TBI

Involves widespread area of brain

Acceleration and deceleration or rotational forced cause axonial damage. Shearing, tearing, stretching or nerve fibers.

Long term neuro issues

Whiplash injury *

Trouble responding, behavior and cognitive changes

Answer 19

Diffuse brain injury axonal injury

Question 20

___ indirect result of primary brain injury, trauma and stroke syndrome, systemic processes (hypotension, hypoxemia, Amemia) cerebral processes (inflammation, cerebral edema)

**Management is to prevent hypoxia and maintain cerebral perfusion

Answer 20

Secondary brain injury

Question 21

Mild TBI (mild concussion) 
Glasgow coma 13-15, blunt trauma to head, no or short loss of consciousness, confusion for minutes and retrograde amnesia

Moderate TBI( moderate concussion)
GCS 9-12
Loss of consciousness 30 minutes to 6 hours
Confusion with amnesia longer than 24 hours

Severe TBI
GCS 3-8
Loss of consciousness longer than 6 hours
Severe cognitive system defects
Pupil changes, cardiac and respiratory systems, abnormal reflexes & posture abnormal, severe cognitive defect

Answer 21

Know

Question 22

Complications of TBI

Post concussion syndrome
Lasts weeks or months post mild concussion
Symptomatic relief with observation

Post traumatic seizures
Occurs within days, lasts up to 2-5 years post injury
Seizure prevention initiated early with moderate to severe TBI

Chronic traumatic encephalopathy
Progressive cementing disease
Violent behaviors
Repeated injury

Answer 22

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Question 23

Spinal cord injury

___ occurs with initial mechanical trauma and immediate tissue destruction

Answer 23

Primary

Question 24

Spinal cord injury

___ pathophysiologic cascade of events that begin immediately after injury and continues for weeks

Life threatening

Answer 24

Secondary

Question 25

Vertebral injury •most often occur at C1-C2 c4-c7 and t10-L2 SCI most commonly occur die to vertebral injuries Rest from acceleration, deceleration, deformation forces Simple fracture- single break that usually affects transverse or spinus process Compressed (wedged) fracture- vertebral body is compressed anteriorly Comminuted( burst)fracture- shattered vertebral body Dislocation- our of place

Answer 25

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Question 26

All cervical spinal cord trauma except for axial compression

Answer 26

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Question 27

Normal activity of spinal cord ceases below level of injury. Temporary and lasts 2-3 days

Answer 27

Spinal shock

Question 28

Vasogenic shock, occurs with injury above T6, caused by absence of sympathetic activity and **unopposed parasympathetic tone**

Answer 28

Neurogenic shock

Question 29

Sudden *massive reflex sympathetic* discharge because descending inhibition is blocked. Stimulation of the sensory receptors * below the level of the cord lesion* Most common cause is distended bladder or distended rectum *** Stroke, seizures, death

Answer 29

Autonomic hyperreflexia (dysreflexia)

Question 30

The autonomic nervous system The sympathetic stimulates fight or flight- everything speeds up. Parasympathetic inhibitory- slows everything down

Answer 30

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Question 31

Any abnormality of the brain caused by a process in the blood vessels * most frequently occurring neurologic disorder * ischemia with or without infarction (death of brain tissue)

Answer 31

Cerebrovascular accident

Question 32

Leading cause of disability * Third in females and 5th in makes as leading cause of death in US. 25% are recurrent

Answer 32

CVA

Question 33

Occurs when there is obstruction to arterial blood flow to the brain due to clot or low perfusion *type of stroke

Answer 33

Ischemia stroke

Question 34

___ stroke is obstruction by thrombus in arteries supplying the brain

Answer 34

Thrombotic

Question 35

Episode of neurological dysfunction that lasts no more than one hours. Temporary destruction of brain blood flow

Answer 35

TIA

Question 36

___ stroke is where thrombus fragments obstructing brain vessels (from heart)**

Answer 36

Embolic

Question 37

*SYSTEMIC hypoperfusion decreases blood supply to brain

Answer 37

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Question 38

____ infarction when a area of the brain loses blood supply due to vascular occlusion Central core of irreversible ischemia and necrosis, surrounded by ischemia *penumbra- prompt infusion of thrombolytic agents may restore perfusion in penumbra preventing necrosis

Answer 38

Central infarction

Question 39

Rim of boarderline hypoxic tissue

Answer 39

Penumbra

Question 40

Bleeding occurs in brain tissue or subarachnoid and subdural spaces. HTN is primary cause of this type of stroke

Answer 40

Hemorrhagic

Question 41

Dilated area or ballooning of cerebral vessel in the brain bc the vessel is weak. Born with it, trauma, smoking or hereditary Most common indicator of this is hemorrhage

Answer 41

Aneurysm

Question 42

Escape of blood into subarachnoid space

Answer 42

Hemorrhage

Question 43

A mass of dilated vessels, no capillary bed in between. Present at birth can be a symptomatic or have headache and seizures

Answer 43

Arteriovenous malformation

Question 44

Inflammation of brain or spinal cord

Answer 44

Meningitis

Question 45

Acute inflammation of the brain, *usually of viral origin *herpes simplex 1 Can be mild or life threatening

Answer 45

Encephalitis

Question 46

For encephalitis keep intracranial pressure as normal as you can and treat cause

Answer 46

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Question 47

Chronic progressive immune mediated inflammatory disease Multiple areas of myelin loss. *disrupts nerve conduction Weaknesses Impaired gait Visual disturbances More common in women ages 20-40

Answer 47

Multiple sclerosis

Question 48

__ ___ ___ is Acquired inflammatory disease that causes *demyelination* of peripheral nerves Acute onset, ascending motor paralysis Humoral and cellular immunologic reaction Lower extremities, after infection Months-2 year to recover

Answer 48

Guillain barre syndrome

Question 49

Acquired chronic autoimmune disease. Results from defect in nerve impulse transmission at neuromuscular junction Rare and more common in women Prob with thymus gland

Answer 49

Myasthenia gravis

Question 50

a primary brain tumor that originate from brain substance Extra cerebral tumors is outside of the brain.. Astrocytoma makes up 75% of all tumors of brain and spinal cord and is most common glioma

Answer 50

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Question 51

Metastatic brain tumor is most prevalent brain tumor and comes from outside of the brain an spread to the brain

Answer 51

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Question 52

Spinal cord tumor are rare Intramedullary tumor originate from spinal cord Extramedullary tumor outside of spinal cord Compressive syndrome motor and sensory function affected when tumor gets bigger-pain Irritating syndrome- result of compressed nerve roots, numbness and weakness, continuous pain

Answer 52

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