Brain Injury Lecture Flashcards
(118 cards)
1
Q
what are some common complications associated with BI? (7)
A
- raised ICP
- heterotopic ossification
- decubiti
- DVT
- autonomic dysfunction
- infections and pulmonary problems
- amnesia
2
Q
what is heterotopic ossification?
A
formation of bone in abnormal anatomical locations
3
Q
what percentage of patients with BI or SCI develop HO?
A
5-20%
4
Q
is it more common in males or females?
A
males > females
5
Q
S/S of HO
A
- loss of ROM (common in hip)
- swelling
- heat
- erythema
- non-septic fever
6
Q
what should be avoided with HO?
A
vigorous stretching
7
Q
what is retrograde amnesia?
A
partial or total loss of the ability to recall events that have occurred DURING THE PERIOD IMMEDIATELY PRECEDING brain injury
8
Q
what is post-traumatic Amnesia?
A
time lapse between ACCIDENT and the point at which the FUNCTIONS CONCERNED WITH MEMORY ARE RESTORED
9
Q
what is anterograde amnesia?
A
decreased attention or inaccurate perception; inability to DEVELOP ONGOING SHORT TERM MEMORY (new memories after the BI)
10
Q
what are the different presentations of amnesia?
A
- physical
- cognitive
- behavioral
- medical involvement
11
Q
what is “comatose”
A
unconscious and unresponsive
12
Q
what is “stuporous”
A
near unconscious with apparent mental inactivity and reduced ability to respond to stimulation
13
Q
what is “obtunded”
A
opens their eyes; responds slowing to questions, somewhat confused, decreased interest in environment
14
Q
what is “lethargic”
A
dull, sluggish, and appears half asleep
15
Q
what is “alert”
A
vigilantly attentive
16
Q
what is the primary predictor of outcomes?
A
length of coma
17
Q
In relation to coma, what is the rancho level?
A
1
18
Q
In relation to coma, what is the level of arousal?
A
eyes do not open
19
Q
In relation to coma, what is the level of awareness of auditory/visual stimuli?
A
None
20
Q
In relation to coma, what is the level of communication and emotion?
A
none
21
Q
In relation to coma, what is the level of motor response?
A
no purposeful movement
22
Q
in relation to vegetative state, what is the rancho level?
A
1 or 2
23
Q
in relation to vegetative state, what is the level of arousal?
A
eyes open spontaneously, sleep-wake cycles resumes, and arousal sluggish and poorly sustained
24
Q
in relation to vegetative state, what is the awareness of auditory/visual stimuli?
A
may move eyes to person/objects, may orient to sound
25
in relation to vegetative state,, what is the level of communication and emotion?
may moan, make sounds; cry/smile without apparent cause
26
in relation to vegetative state, what is the level of motor response?
withdrawals from noxious stimuli; non-purposeful repetitive movement
27
In relation to minimally conscious state, what is the rancho level?
2 or 3
28
In relation to minimally conscious state, what is the level of arousal?
eyes open spontaneously, normal to abnormal sleep wake cycle, and arousal obtunded to normal
29
In relation to minimally conscious state, what is the level of awareness of auditory/visual stimuli?
tracks objects; localizes sound
30
In relation to minimally conscious state, what is the level of communication and emotion?
communication ability; inconsistent - yes/no, gestures, basic emotions
31
In relation to minimally conscious state, what is the level of motor response?
localizes noxious stimuli, reaches for objects, automatic behaviors
32
in relation to confusional state, what is the rancho level?
4, 5, or 6
33
in relation to confusional state, what is the level of arousal?
fluctuation in level of responsiveness, may be excessively drowsy
34
in relation to confusional state,, what is the level of awareness of auditory/visual stimuli?
response to external stimuli may be accentuated
35
in relation to confusional state, what is the level of communication and emotion?
able to communicate but disoriented; impaired attention and memory
36
in relation to confusional state, what is the level of motor response?
purposeful motor responses
37
how common is dizziness associated with TBI?
15-78%
38
what percentage of patients experienced abnormal vestibular testing?
32-61%
39
what percentage of patient with post-traumatic dizziness showed at least one vestibular deficit?
88%
40
what percentage of patients with post-traumatic dizziness received a diagnosis of BPPV?
61%
41
what are some of the causes of dizziness associated with TBI?
1. lesions of the peripheral vestibular system
2. lesions of the central vestibular system
3. non-vestibular causes
4. conditions unrelated to trauma
42
what are some lesions of the peripheral vestibular system?
1. BPPV
2. perilymphatic fistula
3. labyrinthine concussion
43
what are some lesions of the central vestibular system?
1. brainstem concussion/ post-concussive syndrome
| 2. cerebellar contusion
44
what are some non-vestibular causes?
1. cervicogenic dizziness
| 2. migraine
45
what are some conditions unrelated to trauma?
1. prior history of migraine
2. CNS disorders
3. prior compensated peripheral vestibular lesion
46
why are we concerned about dizziness after TBI?
1. underlying cause of TBI?
2. complicate rehab for the sequelae of TBI
3. mimic cognitive impairments seen with TBI
4. cognitive impairments due to TBI may complicate vestibular rehab
47
special considerations: Musculoskeletal
limit types of exercises a patient can perform
48
special considerations: cognitive impairments
memory problems may influence follow through of exercises; confusion/decreased processing may increase space and motion discomfort = overwhelming to pt
49
special considerations: strategies
1. reduce confusion
2. improve motivation
3. encourage consistency with performance
50
what are two "improvements" you can make with patients post TBI having dizziness
1. improve attention
| 2. improve problem solving ability
51
what kind of learning should you encourage
declarative and procedural
52
what level of arousal would you like for these patients?
moderate to optimize learning
53
is progress slower for patients who have cognitive impairments?
yes
54
what are some s/s of TBI?
HA, fatigue/lack of energy, disruption of sleep patterns, dizziness, increase sensitivity to noise/light/distractions
55
what are examples of local brain damage?
contusions, lacerations, hematomas, and herniations
56
what are examples of diffuse brain damage?
axonal shearing, small hemorrhages
57
what are examples of secondary brain damage?
edema, hypoxia, hypotension, infection, salt/water imbalance, concussions or post traumatic epilepsy
58
what are examples of scalp injuries?
abrasion/contusion, hematoma/herniation, and scalp laceration
59
what are examples of skull fractures?
linear, comminuted, and compound
60
what are examples of intracranial injuries?
concussion, epidural/subdural hematomas, and ICP monitoring
61
what are examples of traumatic cerebro-vascular lesion?
aneurysms, and carotid-cavernous fistulas
62
what are examples of CN pathologies?
CN 2,3,6,7,8 commonly injured
63
how is the prognosis of the recovery stages measured?
1. Glasgow Coma Scale
| 2. Rancho Los Amigos Cognitive Scale
64
Brain infection can be from: (4)
1. bacterial
2. parasitic
3. fungal
4. viral
65
All of the 4 microorganisms do what?
attack the CNS
66
how do the microorganisms get to the brain?
1. most hematogenously (through blood)
| 2. through PNS (rabies, herpes)
67
How are brain infections categorized?
by location and cause
68
what are the 3 common locations infections are found within the brain?
1. abscesses (enclosed infections)
2. meningitis (infection of meninges)
3. encephalitis (inflammation of brain/SC)
69
In relation to an abscess, how do organisms reach brain tissue?
staph or pseudomonas -- secondary to inflammatory process elsewhere - lungs, heart, sinuses, ear mastoiditis
70
what part of the brain tissue does an abscess involve?
white matter, most often reaches frontal and parietal lobes through superior sagittal sinus
71
An abscess is a ____________ infections that ______________ _________.
generalized; increased ICP
72
Due to the increased ICP, what are some s/s of an abscess?
HA, convulsions, hemiparesis, incoordination, and ataxia if the cerebellum is involved
73
what are the 4 kinds of meningitis?
1. leptomeninges
2. bacterial
3. viral
4. chronic
74
what does leptomeninges involve?
pia + arachnoid mater (dura mater usually doesn't get infected)
75
what is the process of leptomeninges?
infection spread through CSF with inflammatory process of pia mater, arachnoid mater, and superificial CNS tissues - includes SAS
76
how does infection spread with leptomeninges?
organisms cross blood brain barriers and blood CSF barriers; or with trauma to torn meninges from a contaminated wound
77
why is CSF an ideal growth medium
contains no antibodies and few cells
78
what is leptomeningitis usually classified as?
bacterial or viral meningitis
79
For bacterial meningitis, what are the age specific agents?
neonate - e.coli
childhood - h influenza
adolescent - n meningitides
adult - s pneumoniae
80
what is the process of bacterial meningitis?
inflamed congested pia-arachnoid mater with PMN exudate - obstructs ventricular foramina -- increased ICP
81
what is a symptom of bacterial meningitis?
decreased blood sugar levels
82
what are some s/s of bacterial meningitis?
HA, vomiting, fever, altered consciousness, convulsions, irritability, and nuchal rigidity
83
what is a test to confirm nuchal rigidity (can't move the neck)
+ Brudzinski Neck Sign (neck flexion causes hip/knee flexion
84
if bacterial meningitis is left untreated, what happens
death
85
what are the s/s of viral (aseptic) meningitis?
similar to bacterial but not life-threatening
86
what is an adjective used to describe viral meningitis?
fulminating (occurs suddenly)
87
who does viral meningitis affect?
children and young adults
88
what are the blood sugar levels like for viral meningitis?
normal
89
what is the process of viral meningitis?
viral contamination of CSF with an increase in lymphocytes (acute viral lymphocytic meningitis)
90
what are some agents for viral meningitis?
mumps, ECHO, lymphocytic choriomeningitis, and coxsackie B
91
what are some agents for chronic meningitis?
mycobacterium tuberculosis (lung TB), preponema pallidum (syphillis)
92
what is the process of chronic meningitis?
gelatinous exudate in meninges, increased lymphocytes/plasma cells/macrophages/fibroblasts
93
what happens if chronic meningitis is in the SAS
hydrocephalus
94
what are some s/s of hydrocephalus?
gait disturbances, incontinence, altered mental status
95
what are some s/s of chronic meningitis?
HA, vomiting, mental confusion, weight loss, fatigue, night sweats, chest pain, malaise
96
what is the medical management of meningitis?
antimicrobial antibiotics for bacteria; treat viral infections symptomatically - antivirals if caught soon
97
what is the process of encephalitis?
viral invasion of brain ans SC cells (neurons and glia)
98
what does encephalitis cause?
edema and inflammation of the brain/SC destroying white matter
99
what does ICP lead to?
transtentorial herniation (tentorium spearates cortex from cerebellum)
100
S/S of encephalitis
HA, fever, nuchal rigidity, vomiting, malaise -- coma, CN palsies (III), hemiplegia
101
what does encephalitis stand for?
inflammation of the brain
102
what does encephalomeningitis mean?
inflammation of the brain and SC
103
what does encephalomyeloneuropathy?
inflammation of the brain, SC, and PNS
104
what does acute viral encephalisis affect?
frontal/temporal lobe gray matter
105
what is the most fatal type of encephalitis?
acute viral encephalitis
106
what is acute viral encephalitis a combination of?
herpes simplex I and II, CNS primary infection
107
what is parainfectious encephalitis a combination of?
rubella measles, paramyxovirus mumps, and varicella zoster chicken pox
108
what is acute toxic encephalitis?
arbovirus arthropod-borne systemic infection
109
what diseases are associated with acute toxic encephalitis?
lyme disease, west nile virus
110
what is the progress of the slow virus encephalitis?
incubation periods, fatal within months - progressive dementia
111
what does slow virus encephalitis look like in the brain?
"spongiform" bubbles and holes in brain cortex, resembles degenerative disease
112
what are the s/s of the slow virus encephalitis?
personality abnormalities, visual and spatial orientation/coordiation problems -- leads to dementia with myoclonus
113
what is creutzfeldt Jacob Disease caused by?
prion
114
what is the etiology of CJD
familial, sporadic, and iatrogenic
115
does CJD show symptoms immediately?
no, it takes decades for the s/s to show
116
what are the s/s in the beginning for CJD
altered mental status, gait disturbances, no safety awareness, poor behavioral reactions, no memory
117
when should CJD be considered?
when patient develops rapid dementia and myoclonus
118
patients with CJD die when?
within 6 months-1 year
