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aNeuro Exam 2- Lindsey's > CNS Injury I > Flashcards

CNS Injury I Flashcards

1
Q

Translational acceleration from high velocity–> rupture of the bridging veins that connect the cortical brain surface to the sagittal sinus–> hemorrhage into the subdural space–> _______ and _______.

A

elevated intracranial pressure, distant secondary cerebral injury

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2
Q

What causes “retraction balls?”

A

shearing of axons

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3
Q

This is bradycardia and HTN in the setting of high ICP.

A

Cushing’s reflex

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4
Q

What do free radical mediators do?

A

break down of the BBB–> interstitial (vasogenic) edema–> brain swelling –> increased ICP —> further hypoxia –> dysautoregulation –> herniation

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5
Q

Epidural hematomas typically result from ______.

A

intracranial, extradural arterial bleeding

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6
Q

What is Cushing’s reflex?

A

bradycardia and HTN in the setting of high ICP

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7
Q

What is a cerebral contusion?

A

contusions on the brain caused by an impact or high velocity translational injury

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8
Q

What is a subdural hematoma?

A

hemorrhage into the subdural space because of rupture of bridging veins that connect the cortical surface of the brain to the sagittal sinus

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9
Q

The principal mechanisms involved in head injuries are either _____ or _____.

A
  • contact
  • acceleration/deceleration
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10
Q

This injury occurs at the moment of impact and is largely irreversible.

A

primary injury

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11
Q

What is a Kernohan’s notch?

A

when a transtentoral (uncal) herniation compresses the opposite cerebral peduncle against the tentorial edge, causing hemiparesis that is ipsilateral to the mass lesion

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12
Q

This causes break down of the BBB–> interstitial (vasogenic) edema–> brain swelling –> increased ICP —> further hypoxia –> dysautoregulation –> herniation

A

free radical mediators

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13
Q

What causes subdural hematomas?

A

translational acceleration from high velocity

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14
Q

What are some consequences of a cerebral contusion?

A

hemorrhage into areas of damaged brain –> mass effect –> herniation with 2a brain injury

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15
Q

____ in its mild form is thought to underlie the phenomenon of concussion.

A

Diffuse axonal injury (DAI)

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16
Q

What is the tx for an epidural hematoma?

A

surgical removal

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17
Q

The highest incidence of head injury occurs in what social class, age, and gender?

A
  • economically disadvantaged
  • age 24-35
  • males
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18
Q

This is death due to 2nd concussion while still suffering from the 1st one.

A

second impact syndrome

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19
Q

How is elevated ICP treated?

A

endotracheal intubation controlled ventilation to a pCO2 of 35mmHg elevation of the head IV osmotic diuretics (mannitol) ventricular catheters drug induced coma w/ barbs

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20
Q

A transtentorial (uncal) herniation compresses the _____ and its ______, usually producing an ipsilateral 3rd nerve palsy and contralateral hemiparesis or hemiplegia.

A

midbrain; ipsilateral cerebral peduncle

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21
Q

Contact phenomena result from _____.

A

an object striking the head

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22
Q

This is neuron damage and death by overreaction of receptors for glutamate (NMDA and AMPA).

A

excitotoxicity

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23
Q

What is the end result of elevated ICP?

A

reduction and cessation of cerebral blood flow

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24
Q

A ____ compresses the midbrain and its ipsilateral cerebral peduncle, usually producing an ipsilateral 3rd nerve palsy and contralateral hemiparesis or hemiplegia.

A

transtentorial (uncal) herniation

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25
Q

In _____, the cingulate gyrus is pushed away from the expanding mass and herniates beneath the falx cerebri

A

subfalcine herniations

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26
Q

This is when the cerebellar tonsils are herniated downward into the foramen magnum (coning) due to mass lesion in the posterior fossa.

A

tonsillar herniation

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27
Q

These are traumatic separations of the skull at suture lines.

A

diastatic fractures

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28
Q

What other lesion is a subdural hematoma often associated with?

A

underlying cerebral contusions

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29
Q

What is a secondary injury?

A

injury from inadequate resuscitation

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30
Q

This is astrocyte swelling due to K+ influx.

A

cytotoxic edema

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31
Q

What is the Glascow-Coma Score (GCS)?

A

an assessment of the head injured pt that correlates w/ the likelihood that the pt has an intracranial mass lesion and the outcome

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32
Q

What is a Duret hemorrhage?

A

hemorrhage in the brainstem characteristic of uncal herniation –> disruption of ascending RAS

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33
Q

In _____, the uncus herniates across the tentorial edge and downward into the posterior fossa.

A

transtentorial (uncal) herniation

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34
Q

What is the mortality rate for cerebral contusions?

A

less than 20%

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35
Q

Name 5 types of skull fractures.

A
  1. linear
  2. depressed
  3. basilar
  4. diastatic
  5. growing
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36
Q

What is the tx for a subdural hematoma?

A
  • surgical removal of the blood clot
  • control of intracranial pressure
  • restoration of cerebral blood flow
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37
Q

In conditions of extremely elevated extracellular K+, ______.

A

the glutamate transporter reverses

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38
Q

What is excitotoxicity?

A

neuron damage and death by overreaction of receptors for glutamate (NMDA and AMPA)

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39
Q

Name the 3 largest causes of brain injury.

A
  1. Motor vehicles
  2. recreation
  3. violence
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40
Q

What are the steps in the concussion grading scale?

A
  • grade 1 = confusion w/o amnesia or LOC
  • grade 2 = confusion and amnesia
  • grade 3 = LOC
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41
Q

_____ injuries result from rapid head movement that can create shear, tensile, and compressive strains.

A

Acceleration/deceleration

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42
Q

What does translational acceleration from high velocity cause?

A

subdural hematomas

43
Q

______ typically result from intracranial, extradural arterial bleeding.

A

Epidural hematomas

44
Q

What does the Monroe-Kelly doctrine state?

A

the volume of the CSF + volume of blood in the cerebral systems + the volume of brain + volume of any mass lesion MUST = the volume of the intracranial compartment (constant)

45
Q

This is a fracture in an infant resulting from dural tears and herniation of the arachnoid into the fracture site–> CSF pulsations –> bone loss.

A

a growing fracture

46
Q

What are the common symptoms of brain herniation syndromes?

A
  • progressive lethargy
  • poor responsiveness (obtundation)
  • headache
  • nausea
  • vomiting
47
Q

What causes second impact syndrome?

A

loss of autoregulation of CNS vasculature–> cerebral vessels lose tone–> congested with blood –> increased ICP –> widespread ischemia and vasogenic edema

48
Q

This is a hemorrhage in the brainstem characteristic of uncal herniation –> disruption of ascending RAS,

A

a Duret hemorrhage

49
Q

What is the tx for a cerebral contusion?

A
  • med mgmt. to prevent brain swelling
  • possible surgical evac
50
Q

DX?

  • headache
  • dizziness
  • poor attention
  • inability to concentrate
  • memory problems
  • fatigue
  • irritability
  • depressed mood
  • intolerance of bright light or loud noise
  • sleep disturbance
A

concussion

51
Q

A transtentorial (uncal) herniation compresses the midbrain and its ipsilateral cerebral peduncle, usually producing ______ and ______.

A

an ipsilateral 3rd nerve palsy; contralateral hemiparesis or hemiplegia

52
Q

Name 2 characteristic locations of cerebral contusions.

A
  1. anterior cranial fossa (frontal lobe)
  2. greater wing of the sphenoid (temporal lobe)
53
Q

What is a basilar skull fracture?

A

high velocity blunt injury causes cribiform plate or petrous bone fractures, resulting in CSF leaks

54
Q

This results from high velocity rotational acceleration/deceleration.

A

diffuse axonal injury (DAI)

55
Q

In _____, the pt is always unconscious at time of injury.

A

Diffuse axonal injury (DAI)

56
Q

This is a high velocity blunt injury that causes cribiform plate or petrous bone fractures, resulting in CSF leaks and possible meningitis.

A

a basilar skull fracture

57
Q

Acceleration/deceleration injuries result from rapid head movement that can create _______.

A

shear, tensile, and compressive strains

58
Q

What causes an epidural hematoma?

A

skull fractures in the distribution of the middle meningeal artery

59
Q

Acceleration/deceleration injuries result from ______ that can create shear, tensile, and compressive strains.

A

rapid head movement

60
Q

What is a depressed skull fracture?

A

comminuted bone fragments that may be driven into the brain

61
Q

What is a diastatic fracture?

A

traumatic separations of the skull at suture lines

62
Q

This is downward central pressure that causes bilateral uncal herniation.

A

central herniation

63
Q

This is when a transtentoral (uncal) herniation compresses the opposite cerebral peduncle against the tentorial edge, causing hemiparesis that is ipsilateral to the mass lesion.

A

a Kernohan’s notch

64
Q

This is hemorrhage into the subdural space because of rupture of bridging veins that connect the cortical surface of the brain to the sagittal sinus.

A

a subdural hematoma

65
Q

What is a growing fracture?

A

fracture in an infant resulting from dural tears and herniation of the arachnoid into the fracture site–> CSF pulsations –> bone loss

66
Q

What is the mortality rate for an epidural hematoma?

A

less than 20% (if evacuation wi 1 hour)

67
Q

What is the classic presentation of an epidural hematoma?

A
  • post impact injury
  • lucid interval prior to progressive obtundation and coma
68
Q

In diffuse axonal injury (DAI), MRI shows _____ in large white matter tracts and near the gray-white junction bc of its density difference.

A

punctuate hemorrhages

69
Q

What causes a diffuse axonal injury (DAI)?

A

high velocity rotational acceleration/deceleration

70
Q

DX?

  • mild traumatic brain injury
  • alteration of mental status caused by biomechanical forces
  • may or may not have lost consciousness
  • confusion and amnesia
A

concussion

71
Q

In diffuse axonal injury (DAI), MRI shows punctuate hemorrhages in ______ and near the gray-white junction bc of its density difference.

A

large white matter tracts

72
Q

Why is second impact syndrome fatal?

A

once the course begins it’s nearly impossible to stop

73
Q

What is a linear skull fracture?

A

high impact injury causing fracture of the calvarium

74
Q

_____ phenomena result from an object striking the head.

A

Contact

75
Q

How does vasogenic edema occur?

A

excitotoxicity causes BBB compromise –> increased permeability –> brain swelling

76
Q

What physiological process does progressive lethargy and poor responsiveness (obtundation) indicate?

A

an acute rise in ICP

77
Q

What is tonsillar herniation?

A

the cerebellar tonsils are herniated downward into the foramen magnum (coning) due to mass lesion in the posterior fossa

78
Q

In ____, the anterior cerebral artery is often kinked and a stroke frequently occurs.

A

subfalcine herniations

79
Q

In subfalcine herniations, the ______ is pushed away from the expanding mass and herniates beneath the _____.

A

cingulate gyrus; falx cerebri

80
Q

What happens with widespread simultaneous neuronal depolarization?

A

an immediate spike in extracellular K+

81
Q

How does secondary brain injury occur?

A
  • hypoxia
  • altered blood flow
  • release of free radical mediators
82
Q

What do skull fractures in the distribution of the middle meningeal artery cause?

A

an epidural hematoma

83
Q

What is second impact syndrome?

A

death due to 2nd concussion while still suffering from the 1st one

84
Q

Name 4 distinct herniation syndromes.

A
  1. subfalcine herniation
  2. central herniation
  3. uncal herniation
  4. tonsillar herniation
85
Q

What can arise from a basilar skull fracture?

A

meningitis bc of the CSF leaks

86
Q

What can precipitate a herniation syndrome and why?

A

a lumbar puncture in the setting of an intracranial mass lesion due to the differential pressure this creates btw the cranial and subarachnoid space

87
Q

In _____, MRI shows punctuate hemorrhages in large white matter tracts and near the gray-white junction bc of its density difference.

A

Diffuse axonal injury (DAI)

88
Q

What is central herniation?

A

downward central pressure that causes bilateral uncal herniation

89
Q

What causes cytotoxic edema?

A

astrocyte swelling due to K+ influx

90
Q

What is the mortality rate from a subdural hematoma?

A

40-60%

91
Q

At what anatomical locations can brain herniations occur?

A
  • across the falx
  • across the tentorium
  • the foramen magnum
92
Q

This is when excitotoxicity causes BBB compromise –> increased permeability –> brain swelling.

A

vasogenic edema

93
Q

What are the most common s/s of concussion?

A
  • headache
  • dizziness
  • poor attention
  • inability to concentrate
  • memory problems
  • fatigue
  • irritability
  • depressed mood
  • intolerance of bright light or loud noise
  • sleep disturbance
94
Q

Pathologically high levels of glutamate can cause excitotoxicity by _____.

A

allowing high levels of Ca++ into the cell

95
Q

This fracture is diagnosed when comminuted bone fragments are seen that may be driven into the brain.

A

a depressed skull fracture

96
Q

What is a primary brain injury?

A

one that occurs at the moment of impact and is largely irrversible

97
Q

Anyone with a witnessed LOC needs ____.

A

a CT scan

98
Q

This states that the volume of the CSF + volume of blood in the cerebral systems + the volume of brain + volume of any mass lesion MUST = the volume of the intracranial compartment (constant).

A

the Monroe-Kelly doctrine

99
Q

This is injury from inadequate resuscitation.

A

secondary injury

100
Q

In transtentorial (uncal) herniation, the _____ herniates across the tentorial edge and downward into the _____.

A

uncus; posterior fossa

101
Q

What is a concussion?

A
  • mild traumatic brain injury
  • alteration of mental status caused by biomechanical forces
  • may or may not have lost consciousness
  • confusion and amnesia
102
Q

Name 5 causes of brain herniation syndromes.

A
  1. trauma
  2. ischemia
  3. neoplasm
  4. infection
  5. hydrocephalus
103
Q

This is a high impact injury causing fracture of the calvarium.

A

a linear skull fracture

104
Q

What does tonsillar herniation result in?

A

medulla compression –> abnormal cardiac and respiratory responses

aNeuro Exam 2- Lindsey's (23 decks)

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