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Brain Injury Flashcards

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0
Q

Traumatic brain injury epidemiology?

A

trauam is the most common cx of death 1-45yo - 50% head injury

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1
Q

Traumatic Brain Injury?

A

damage to the brain from external mechanical forces

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2
Q

Head vs brain injury?

A

Head: laceration of the head, scalp
brain: the BRAIN is injured

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3
Q

Traumatic brain injury cx?

A 
direct impact (car accident and hit your head through the windshield)
rapid acceleration or deceleration (brain sloshing around but not hitting the head anything)
blast waves (military)
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4
Q

Traumatic brain injury classification?

A

Primary

Secondary

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5
Q

TBI - YA cx? Adults cx?

A

YA - MVA

Adults- falls

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6
Q

Primary injury: Intra-axial injury?

A

acceleration-deceleration injury

  • shearing: axonal injury (the gray and white matter shear from going different directions)
  • Coup/countrecoup: cerebral contusion (head injury from hitting the skulls: front and back)
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7
Q

Primary - extra-axial injury?

A

Direct for injury

  • epidural: high impact –> fx –> arterial injury (min to hrs) –> lenticular shape –> recovery is ok b/c brain is separated
  • subdural: lower force –> no skull fx –> injury to the vein –> crescent shape –> recovery is not so ok b/c brain is not separated
  • subarachnoid: spontaneous or high force –> small vessels/Death Star –> THUNDERCLAP
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8
Q

Traumatic brain injury - hx?

A

mechanism (did they fall from the stairs, rug on the carpet, etc)
LOC - loss of consciousness (long or short?)
HA (secondary from brain trauma)
visual changes
focal neural complaints
neck pain (comes in together w/ brain injury)
seizures

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9
Q

Secondary traumatic brain injury?

A

molecular injury mechanisms that start from the beginning of the trauma but lasts for hrs or days
leads to neuronal cell death and cerebral edema and ICP to worsen brain injury

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10
Q

Traumatic brain injury - what PE do you do?

A

neuro exam

glasgoow coma scale

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11
Q

Traumatic brain injury - what are you looking for/PE?

A

external findings -hematomas, depresison, lacertions
signs of ICP
signs of basilar skull fx

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12
Q

Signs of ICP?

A

fixed/dilated pupils
decorticate/decerebrate
Cushing response (bradycardia, HTN, dec respiratory drive)

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13
Q

Cushing response?

A

DEC: heart and respiratory (parasympathetic tries to cancel out sympathetic)
HTN (sympathetic runs first - so HTN)

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14
Q

Basilar skull fracture?

A 
battle sign
raccoon eyes
hemotympnum 
otorrhea
rhinorrhea
*blood mixed w/ CSF
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15
Q

TBI - dx studies?

A 
CT scan (GCS<14, detects skull fractures, intracranial hematomas, cerebral edema)
Lumbar puncture (detect blood in CSF, if CT is questionable for subarachnoid)
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16
Q

Traumatic brain injury- what can you use to estimate pt’s consciousness?

A

Glasgow coma scale
TBI classes
general rules

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17
Q

TBI - tx prehospital?

A

prevent hypotension and hypoxia (can cx secondary injury)
- isotonic crystalloids (normal saline)
-intubtion for GCS <8
backboard (Cspine)

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18
Q

TBI - tx ED?

A

1) maintain vitals (BP 90, 02 greater 60)
2) neuro exam w/ GCS
3 assess systemic trauma
4) check labs (CBC - not hemorrhaging GI, lytes, glucose, coags - pt on warfarin? BAD, ETOH-messes up GCS -> auto CT, DAS)

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19
Q

Severe TBI tx?

A 
head elevation
osmotic therapy (mannitol for hypertonic saline)
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20
Q

TBI -tx ICU?

A

monitor ICP
-maintain vitals (BP 90, 02 60)
-increased ICP (osmotic tx, hyperventilation, sedation)
limit secondary brain injury (seizure - phenytoin, fever - hypothermia, glucose - insulin therapy, coag - vitamin K, FFP)

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21
Q

TBI tx - surgery?

A

Burr hole

Craniotomy

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22
Q

TBI - prognosis?

A

severe - most likely to die

mild - good recovery

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23
Q

Severe TBI survivors?

Study These Flashcards
A

disabled
25% functional independence (GCS <8)
5-15% are vegetative state and 50% wake up in a yr

24
Concussion?
trauma induced alteration in mental status
25
TBI - epidemiology of mild?
75-95%
26
Mild TBI - cx? - GCS?
injury d/t contact or acceleration/deceleration froces resulting in GCS 13-15 30min post injury
27
Mild TBI - etiology?
``` MVA 20-45% Falls 30-38% occupation accident 10% Recreational accident (sports) 10% Assaults 5-17% ```
28
Mild TBI - primary?
shearing forces in mild axonal injury
29
Mild TBI - patho?
1) Structure - TBI but mild - primary - secondary - complicated 2) Function - shear strain - neuronal depolrization - lactic acid accumulation - decreased blood flow
30
TBI mild - secondary?
free rdiacl release --> brian metabolism disruption
31
Mild TBI - hx/sx?
hallmark: confusion and amnesia | with/out LOC
32
Mild TBI - early sx?
``` HA dizziness lack of awareness N&V min to hours ```
33
Mild TBI - late sx?
mood and cognitive disturbance sensitivity to light and noise sleep disturbances hours and days
34
Mild TBI - PE?
evaluate head for hematomas, lacerations | neck injuries
35
Mild TBI - assessment?
SAC - mostly used SCAT - sports imPACT-screening before starting sports (baseline)
36
Mild TBI - dx testing?
CT - first line | MRI - persistent sequelae (secondary injury)
37
Decision to CT head injury?
Canadian CT rule New Orleans criteria (ONLY FOR GCS 15) loss conscious, N&V, altered mental status, worst HA ever, hematoma, ETOH
38
Concussion grading scale?
Grade 1 (mild), 2 (mod), 3 (severe) based on consciousness or not (confused, amnesia >15min) BUT loss of consciousness DOES NOT have ANYTHING
39
Concussion of Mild TBI - discharge criteria?
``` GCS = 15 no sx normal exam normal CT no bleeding ```
40
Concussion and mild TBI - admit?
``` GCS <15 seizures abnormal CT aogulopsthy no responsible caregiver ```
41
Concussion and mild TBI - sx care?
sx resolve over 7-10days DO NOT TAKE NSAIDS-GIVE THEM TYLENOL!!! NO narcotics
42
Concussion and mild TBI - discharge instruction?
physical and cognitive rest for 24-48 hrs (bed rest) | slowly return back to work (5 days)
43
Concussion and mild TBI - return to ED?
``` cannot wake pt (when they're sleeping randomly) worsening HA somnolence or confusion restlessnes gat probs seizures vision vomit more than 1x fever stiff neck urinary and bowel incontinence weakness/numbness CAN INDICATE INC ICP ```
44
Concussion - sport players tx?
NO return to play if symptomatic | no return to play for 24 hrs
45
Complication of concussion and mild TBI?
post concussion sx (sx that resolves over wks, mo) chronic traumatic encephalopathy post traumatic HA, epilepsy
46
Post concussion syndrome?
common symptom complex sequelae of mild TBI
47
Post concussion sx patho?
structural/biochemical | psychogenic
48
Post concussion sx-structural/biochem patho?
global atrophy | white matter abnormality - scarring
49
Post concussion sx - psychogenic patho?
sx similar to somatization in psychiatric disorders | lack of sleep, mood, irritability --> internally pain turns into physical pain
50
Post concussion sx - sx?
cognitive thinking emotional concussion like- but lasts longer
51
Post concussiosn sx - dx test?
CT scan- first line, abnormality found MRI neurophyscological
52
Post concussion sx - tx?
Simple reassurance - 3mo symptomatic approach (insomonia, dizziness, etc) eduation - pt, family teacers, employers, attornes, insurance companies (let them be aware b/c it can all affect work, school, etc)
53
Post concussion sx - prognosis?
first 7-10 days: sx and disabilities the greatest 1 mo: sx are improved 3 mo: largely recovered 1yr: 10-155 ongoing sx (post traumatic HA)
54
Chronic traumatic encephalopathy-epidemiology?
prof boxers NF combat related blast injuries
55
CTE - PE?
cognitive impairment - memory loss, dementia neurosychological sx - behavior, personality changes, depression, suicidality neurodegenerative sx - parkinsonims, speech and gait abnormalities
56
CTE-dx?
autopsy | radiopharmaceutical that binds to tau proteins --> MRI/PET
57
CTE- prevention?
helmets

Neurology (13 decks)

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