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1

______ is the accumulation of fluid (.e.g, in the brain) that can lead to there being not enough space for the braint o swell into.

Oedema

2

Describe how the Glasgow Coma Scale is used to assess the depth of a patients coma. (describe how and what it measures)

The glasgow coma scale is a brief test of simple visual, verbal and motor abilities.

Visual - does the patient open their eyes? ranked from 1 (not at all) ->2 (to pain) ->3 (to speech)-> 4 (spontaneous)

Verbal - do they respond verbally? ranked from 1-5: none, incomprehensible, inappropriate, confused, orientated.

Motor - Do they respond to a motor command (e.g., can you move X) ranked from 1-6: none, extension, abnormal flexion, withdrawal, localises pain, obeys command

3

What GCS rating combined with Coma durations suggest Mild, Moderate and Severe traumatic brain injuries, respectively?

 

What level of disability are each of these categories predictive of?

 

 

MILD

  • GCS: greater than 13
  • Duration: less than 30 minutes
  • Predicts: good recovary

MODERATE

  • GCS: 9-12
  • Duration: less than 6 hours
  • Predicts: moderate disability

SEVERE

  • GCS: less than 8
  • Duration: greater than 6 hours after admission
  • Predicts: severe disability

 

 

4

What rating on the Glasgow Coma Scale is predictive of greater mortality?

A GCS score of less than 7.

5

At what score on the Glasgow Coma Scale is the unconsciousness considered to be a "Coma"?

less than or equal to 8.

 

however it is important to recognise that "coma" is a continuum from no coma -> shallow coma -> deep coma ...and that people come out of coma gradual in stages.

6

Post-traumatic amnesia severity can be categorised based on it's duration.

at what duration would PTA be considered:

  • very mild
  • mild
  • moderate
  • severe
  • very severe
  • extremely severe

  • very mild < 5 mins
  • mild  5-60 mins
  • moderate 1-24 hours
  • severe  1-7 days
  • very severe 1-4 weeks
  • extremely severe > 4 weeks

7

Another word for severe bleeding is_____

Haemorrhage

8

What are the four main complications of a closed head injury?

  1. Oedema (accumulation of fluid, not enough space for brain to swell into)
  2. Haemorrhage (bleeding) and resulting hematoma (accumulation of blood)
  3. Skull fractures (protrude into the brain and can result in infection)
  4. Post-traumatic epilepsy (due to scar tissue)

9

What are (or can be) the cognitive symptoms of traumatic head injury? (its neuropsychological profile)

  • Orientation
  • attention
  • memory
  • behavioural slowing
  • sensory function
  • verbal retrieval
  • executive functioning

10

What personality changes can result from traumatic brain injury?

  • Lack of initiative & loss of spontaneity
  • Temper outbursts & mood alterations
  • egocentricity
  • poor self-awarenss (of deficits)
  • deppression (usually after 6 months post-injury)

11

Describe the duration of loss of consciousness(LOC) post-traumatic amnesia (PTA) and 'complaints' consistent with a mild traumatic head injury (i.e., concussion)

  • LOC: less than or equal to 30 mins
  • PTA: less than or equal to 24 hours
  • Complaints: less than or equal to 3 months (changes in the brain are microscopic)

12

What are the common complaints of a mild traumatic head injury (i.e., a concussion)?

How long does it usually take complaints to emerge?

How long does recovary usually take?

PHYSICAL

  • Dizziness, headaches, noise sensitivity, vision (e.g., blurred)

COGNITIVE

  • Orientation (initial person/time/place), Attention (concentrating) and Memory

PERSONALITY

  • Patience/temper, anxiety and deppression.

Symptoms/complaints emerge a few days after injury (When people attempt to resume regular activity)

Recovary can take 3 months and symptoms tend to disappear gradually.

13

What is the timeline of recovery for traumatic brain injuries?

During what time period are the most recovery gains made?

Max level of recovery reached around 2 years post-THI

Most gains made during the first 6 months.

14

a _______ is when a temporary obstruction occurs in an artery resulting in temporary hypoxia.

 

is short lasting resulting in transient deficits.

Transient Ischemic Attack (TIA)

15

______ is when there is an permanent obstruction in a blood vessel resulting in prolonged hypoxia resulting in necrosis (i.e., an infarction)

 

Obstructive Ischemic Stroke

16

What are the symtoms of a Transient Ischemic Attack (TIA)?

Physical - dizziness

Cognitive - orientation, sensation & perception, language, motor skills (weakness)

17

_____is a Type of Obstructive Ischemic Stroke whereby plague forms elsewhere in the body and travels to the brain where it blocks a blood vessle

Embolic

18

_____is a Type of Obstructive Ischemic Stroke whereby fatty deposits built up in vessle walls block/narrow blood vessles in the brain (accident occurs over 30minutes)

Thrombotic

19

The space between the surgace of the brain and the skull is called the _______

subarachnoid space

20

_____ referes to inside the brain itself

Intracerebral

21

What are the common cognitive symptoms of a CVA?

  • Orientation - self, place, time
  • Attention - 
  • Motor function - slowing, paralysis, unsteady, coordination
  • Executive function - trouble planning, organising, responding to novel situations
  • Memory - mostly STM (LTM usually alright) misplace things, getting lost, struggle to live independently - structure is important

22

What are the common cognitive symptoms of a CVA?

  • Orientation - self, place, time
  • Attention - 
  • Motor function - slowing, paralysis, unsteady, coordination
  • Executive function - trouble planning, organising, responding to novel situations
  • Memory - mostly STM (LTM usually alright) misplace things, getting lost, struggle to live independently - structure is important

23

How do the symptoms of a left hemisphere stroke differ from those of a right hemisphere stroke?

 

(i.e., lateralisation)

for the 98% of people with left language lateralisation:

  • damage to the left hemisphere affects receptive and expressive language.
  • damage to the right hemisphere affects visual-spatial ability (perceptual, estimating distances between points)

24

What personality changes can result from a CVA?

 

(and the hemisphere where possible)

  • Depression (left hemisphere stroke)
  • Apathy/indifference (right hemisphere)[tone expression]
  • Euphoria (right hemisphere stroke)
  • Impulsiveness
  • Emotional lability - exagerrated or incongruent responses
  • Lack of initiation - not being able to start a behaviour
  • Perseveration - Not being able to stop a behaviour
  • Poor judgement - leading to inappropriate or dangerous behaviour

25

What are Lack of initiation and
Perseveration, respectively?

  1. Not being able to start a behaviour
  2. Not being able to stop a behaviour

26

What is the recovary timeline for CVAs?

When does most of the recovery occur?

Plateau at 6 months

Improve most rapidly for the first few weeks

 

(i.e., quicker initial recovery and quicker plateau than brain injury patients.)

27

what is "epilepsy"?

A cluster of symptoms

  • Recurring seizures (reversable alterations of consciousness) [ arousal alertness, awareness
  • Hyperventilation
  • Migraine

28

the ______ posits a negative linear relationship between age of brain lesion and outcome expectancy

Kennard Principle

29

_______ is not being able to start a behaviour

lack of initiation

30

_____ is not being able to stop a behaviour

perseveration