Head and Spinal Cord Injury

Question 1

How many deaths per year via TBI?

Answer 1

52,000

Question 2

What percent has long lasting symptoms after TBI?

Answer 2

10%

Question 3

What are the basic mechanisms of brain injury?

Answer 3

primary (localized at impact site, rotational forces, axonal shearing)
secondary (hypotension, hypoxia, anemia, sepsis)

Question 4

What are secondary causes of TBI? HASH

Answer 4

hypotension
hypoxia
anemia
sepsis

Question 5

concussion-

Answer 5

reversible traumatic paralysis of nervous function, immediate effect. Caused by sudden change in movement of head

diffuse axonal injury caused by shearing motion

Question 6

What is the mechanism of a concussion?

Answer 6

rotational motion of the cerebral hemispheres in the anterior posterior plane, around the fulcrum of the fixed-in-place upper brain stem.

maximal rotational forces exerted around the midbrain and diencephalic region

Question 7

What are the clinical manifestations of a concussion?

Answer 7

immediate loss of consciousness
supressed reflexed
fall in BP
transient arrest of respiration
convulsive activity
retrograde amnesia or anterograde amnesia

Question 8

Management of concussion:

Answer 8

ABC's
Imaging recommended in 60
drunk
bleeding tendencies
headache and vomiting

Question 9

What are the grades of concussions in athletics?

Answer 9

1- no loss of consciousness, transient confusion, resolution 15 min
3- loss of consciousness

Question 10

Post concussion syndrome:

Answer 10

interval between head trauma w/ loss of consciousness and development of symptoms, <4 weeks

Question 11

contusions:

Answer 11

heterogenous lesions consisting of areas of punctate hemorrhage, edema and necrosis

Question 12

coup lesion-

Answer 12

contusions of the surface of the brain beneath the point of impact

Question 13

contrecoup lesions-

Answer 13

contusions on the opposite side of impact

Question 14

cooup/contrecoup lesions-

Answer 14

frontal and temporal poles

Question 15

Types of intracranial hematomas?

Answer 15

epidural

subdural

Question 16

Epidural hematoma:

Answer 16

temporal parietal fracture, laceration of the middle meningeal artery or vein, bleeding into epidural space, lens shaped

hematoma on side of trauma
“lucid moment”

Question 17

Subdural hematoma:

Answer 17

tearing of the bridging vein, blood in subdural space
a/w atrophy, coagulopathy, CSF shunts
typically extended over most of cerebral convexity
acute or chronic

Question 18

Acute SDH:

Answer 18

in combination with epidural hemorrhage or contussion
tearing of bridging vein
evolution over many hours
drowsiness, coma; pupillary dilation w/ contralateral weakness then bilateral limb wakness; progressive stupor then coma

Question 19

Chronic SDH:

Answer 19

minor trauma, a/w coagulopathy and brain atrophy
usually in elderly
evolution over days to weeks
headache, progressive alteration in behavior +/- neurological symptoms

Question 20

Itraparenchymal hematoma:

Answer 20

after severe head injury
location: frontal temporal
evolution over 12-48 hours
stupor- coma, dilated pupil, progressive hemiplegia

Question 21

Risk factors for intraparencymal hemorrhage:

Answer 21

coagulopathy

amyloid vasculopathy

Question 22

types of brain herniation:

Answer 22

subfalicine
uncal
tonsillar

Question 23

subfalicine herniation-

Answer 23

side to side
ACA compression, contralateral leg paresis
somnolence

Question 24

uncal herniation-

Answer 24

side to bottom
TRANSTENTORIAL
aniscoma to "blown pupil"
Midbrain and PCA compression
Somnolence, contralateral hemiparesis, occipital infarct
decrebrate posturing (extensor)

Question 25

Tonsillar herniation-

Answer 25

``` bottom through the "hole" somnolence quadriparesis cardiac arrythmias respiratory failure ```

Question 26

Neuro exam of pupils

Answer 26

``` tectal- large fixed pons- pin point midbrain- midpositioned, fixed metabolic- small reactive diencephalic- small reactive III nerve palsy- one is dilated ```

Question 27

Decerebrate posture:

Answer 27

bilateral extensor posture at elbows and wrists bilateral or pontine lesions bilateral supratnetorial lesions involving motor pathways deep metabolic encephalopathies omnious sign

Question 28

Decorticate posture:

Answer 28

bilateral flexion posture elbows and wrists | rostral to brainstem, superior

Question 29

Glasqow coma scale:

Answer 29

looks at eyes open, verbal response, and motor response <8- severe 9-12- moderate 13-15- mild

Question 30

Late complications of severe head injury:

Answer 30

seizures, greatest in patients w/ severe head injury residual neurological deficit (CN injury I, IV, VII, VII) CSF fistulas CNS infections Post traumatic cognitive and psychiatric disorders

Question 31

Mechanisms of SCI:

Answer 31

primary: mechanical injury, followed by petechiae, necrosis and vasogenic edema secondary: ischemia, ionic derangements, inflammation, NT accumulation

Question 32

Spinal Shock:

Answer 32

lasts less than 24 hrs, can be 2 weeks ``` areflexia loss of sensation flaccid paralysis below lesion flaccid bladder with retention of urine lax anal sphincter brady cardia and hypotension - neurogenic shock ```

Question 33

Anterior cord syndrome

Answer 33

``` back and neck pain bilateral paresis or paralysis (UMN pattern) flaccid paraplegia/quadriplegia loss of pain and temp sensation urine and bowl incontinence ```

Question 34

Central cord Syndrome:

Answer 34

mid to lower cervical cord hyper extension injury decreased pain/temp sensation and muscle weakness in upper extremities bilaterallt in patients with cervical spondylosis Arm> leg weakness lower extremity function recovery > upper

Question 35

Brown sequar syndrome

Answer 35

common result from a gun shot or stab wound (injury to 1/2 of spinal cord) loss of pain and temp contralateral UMN signs loss of kinethesia and discriminative touch (ispilateral)

Question 36

Conus Medullaris

Answer 36

lesion in the sacral portion of the spinal cord

Question 37

Cauda Equina

Answer 37

severe injuries below L2 level of spine can injure lumbar, sacral and coccygeal nerve roots. decreased sensation over buttocks and perineal region, bilateral leg pain and weakness, bowel and bladder sydfunction. horse tail lesion in multiple nerve roots

Question 38

What are cuases oc conus medullaris and cauda equina?

Answer 38

central disc herniation, epidural meds, schwannoma, meningioma, trauma, epidural abscess, arachnoiditis and CMV polyradiculitis

Question 39

Spinal cord lesiosn:

Answer 39

transverse- lower extremities hemicord- one leg motor loss and other leg pain and temp loss central cord (small)- lateral arm pain and temp loss central cord (large)- motor loss from neck down - genitals posterior cord- vibration and position loss from neck down anterior cord- motor loss from neck down

Question 40

Tx of SCI:

Answer 40

Stabiliation of the spine methylprednisone DVT prophylaxis

Question 41

Myelitis

Answer 41

infectious | tx with surgery, rehab, DVT

Question 42

What is the most common cause of death in young people?

Answer 42

trauma

Question 43

What provides and indication of the severity of the injury?

Answer 43

amnesia and mental status

Question 44

Clinical signs of basillar skull fracture:

Answer 44

bruising of orbit (raccoon sign), blood in the external auditory meatus (battle sign) and leakage of CSF from ear or nose CN palsies may also occur

Question 45

tx of basillar skull fracture symptoms:

Answer 45

acetazolamide

Question 46

What happens as spacticity increases following a SCI?

Answer 46

flexor or extensor spasms or both, of legs become troublesome, especially if pt develops bed sores or UTI. Paraplegia with the legs in flexion or extension may eventually result.

Question 47

unilateral cord lesion leads to an ipsilateral motor disturbance with accomanying impairment of proprioception and contralateral loss of pain and temperature appreciation below lesion

Answer 47

Brown sequard syndrome

Question 48

What is the tx for a cord compression?

Answer 48

immobilization and early decompressive laminectomy and fusion (w/in 24 hrs) and early tx with corticosteroids - methylprednisone may improve neurological recovery

Question 49

What patients arre at a particular risk of spinal cord trauma?

Answer 49

pts with rheumatoid arthritis, down syndrome or any acquired or congenital neck abnormality these are associated with atlantoaxial (C1-C2) instability

Question 50

Incomplete spinal cord lesions:

Answer 50

intact sensation in the perianal region, intact anal sphincter tone, or slight flexor toe movement

Question 51

What heralds the recovery of spinal shock?

Answer 51

return of the bulbocavernosus reflex

Question 52

What is the most common mechanism of central cord syndrome?

Answer 52

hyperextension injury to the neck