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Neuro 1 - Exam 4 > TBI - Lecture 14 > Flashcards

TBI - Lecture 14 Flashcards

1
Q

acquired brain injury

A

injury to the brain at the cellular level resulting in a change in neuronal activity

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2
Q

what does injury to the brain affect

A

physical integrity

metabolic activity

fxnal ability of the neurons

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3
Q

ABI are

A

not hereditary, congenital, degenerative or induced by birth trauma

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4
Q

TBI is a _____ of ABI

A

subset

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5
Q

caused of ABI

A

TBI w/ or w/o skull fx

CVA

AVM

aneurysm

anoxic encephalopathy

intracranial tumors

meningitis, encephalitis

seizure disorders

toxic exposures

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6
Q

TBI is the

A

leading cause of neurologic disability in the US

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7
Q

incidence rate

A

highest

age 15-24

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8
Q

how often does someone sustain a TBI (US)

A

23 s

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9
Q

how many americans sustain a TBI/yr

A

1.4-1.5 mil

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10
Q

how many americans currently live with disabilities resulting from a TBI

A

estimated 5.3 americans

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11
Q

how many people die as a result of a TBI each year

A

> 50k

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12
Q

leading cause of death in children under 5

A

TBI

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13
Q

TBI

A

a non-degenerative, non-congenital insult to the brain from an external force

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14
Q

what can a TBI possibly lead to

A

permanent or temp impairments of cognitive, physical, and psychosocial fxns with an associated diminished or altered state of consciousness

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15
Q

which gender is more at risk for TBI

A

male

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16
Q

highest risk age

A

0-4 and 15-19

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17
Q

highest rates of TBI-related hospitalization and death

A

> age 75

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18
Q

certain military personel

A

at risk

IED exposure

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19
Q

elderly TBI

A

fastest growing group of TBI pts

anticoagulants

elder abuse

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20
Q

elderly –> high risk secondary to

A

medications

decreased balance

decreased strength

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21
Q

how many children sustain brain injuries a year

A

> 1 mill

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22
Q

TBI is the leading cause of death in children

A

<5

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23
Q

how many pediatric injuries are related to brain injuries

A

1/3

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24
Q

pediatric TBIs are often

A

misdiagnoses or misidentified

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25
Q

if TBI occurs b4 attainment of development milestones

A

the child might never attain those milestones

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26
Q

TBI pathology

A

primary and secondary injury

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27
Q

primary injury

A

focal

diffuse

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28
Q

focal

A

penetrating injury

non-penetrating injury

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29
Q

penetrating injury

A

skull fxs

lacerations

gunshot/missile wounds

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30
Q

non-penetrating injuries

A

concussion

contusion

intracranial hemorrhage

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31
Q

diffuse

A

diffuse axonal injury (DIA)

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32
Q

skulls fxs

A

the more the severe the TBI, the more likely for skull fxs

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33
Q

skulls fractures have

A

higher risk of seizures and intracranial hemotoma

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34
Q

what is secondary to CSF leak –> skull fx

A

rhinorrhea or otorrhea

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35
Q

contusions

A

hemorrhage

edema

tissue distortion

scarring

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36
Q

what do contusions produce

A

focal cognitive and sensori-motor deficits

increased risk of seizures

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37
Q

types of intracranial hemorrhages

A

extra-axial

intra-axial

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38
Q

extra-axial hemorrhages

A

epidural

subdural

subarachnoid

39
Q

intra-axial hemorrhage

A

intra-parenchymal

intra-ventricular

40
Q

imaging –> intracranial hemorrhage

A

CT scan

MRI

41
Q

CT

A

preferred over MRI initially

better at detecting bony fxs, hematomas, SAH

easily accesible, faster, cheaper

42
Q

MRI

A

more beneficial for detection of severe TBIs

43
Q

epidural hematoma

A

mass effect

associated with skull fx common

44
Q

where does a EDH occur

A

b/w skull and dura mater

45
Q

where is a EDH most common

A

middle meningeal artery

46
Q

EDH enlarges

A

fairly slowly

47
Q

EDH can be dangerous d/t

A

increase in ICP

48
Q

subdural hematoma occurs

A

b/w dura and arachnoid

49
Q

SDH onset

A

variable

50
Q

SDH is most commonly

A

traumatic in nature

51
Q

SDH is

A

rupture of vein that bridge the subdural space

52
Q

SDH v. EDH

A

SDH is more common

53
Q

morbidity and mortality

A

greater in SDH than EDH

54
Q

SDH is more common in people w/

A

brain atrophy - tension on bridging veins

higher risk of falls

anticoagulants

55
Q

anticoagulants –> SDH

A

increase risk of hemorrhage even with minor injuries

56
Q

subarachnoid hemorrhage location

A

b/w the arachnoid and pia

57
Q

SAH seen

A

to a degree in most serious brain injuries

58
Q

SAH –> sudden onset of

A

loss of consciousness

59
Q

SAH has

A

increased risk of vasospasm

increased risk of hydrocephalus

60
Q

SAH requires

A

immediate intervention

dangerous

61
Q

intra-parenchymal

A

IPH

intracerebral or intracerebellar

62
Q

intra-ventricular

A

IVH

usually seen with SAH

63
Q

diffuse axonal injury (DAI)

A

acute stretching and shearing of axons

64
Q

what are DAI caused by

A

shearing injury and accelerating and decelerating forces to the brain

65
Q

DAI is a

A

microscopic diagnosis

66
Q

where is DAI most often seen

A

corpus callosum

subcortical white matter

cerebral peduncles

brainstem

67
Q

DAI in the midbrain

A

particularly repsonsible for initial LOC

68
Q

DAI is associated with

A

shaken baby syndrome

69
Q

DAI grading

A

mild

moderate

severe

70
Q

mild DAI

A

coma lasting 6-24 hrs

mild-mod memory impairment and disabilities

71
Q

moderate DAI

A

coma > 24 hrs

f/b confusion and long lasting amnesia

w/drawl to purposeful mvts

mod-severe memory, behavioral, cognitive and intellectual deficits

72
Q

severe DAI

A

deep prolonged coma lasting months w/ flexion and extension posturing

severe deficits in all areas

73
Q

DAI diagnosis

A

may see nothing on radiologic exam

petechial hemorrhages seen 20% of the time on CT scan

MRI is more sensitive imaging

74
Q

MRI –> DAI

A

diffusion weighted imaging

FLAIR

gradient ECHO

diffusion tensor imaging

75
Q

secondary injury

A

increased ICP

cerebral edema

hypoxia or anoxia

ischemia

hemorrhage, hematoma, herniation, mass effect

hypotension

neurochemical and cellular changes

electrolyte imbalances

76
Q

ICP levels

A

ideal

abnormal

likely to have neurological damage

fatal

77
Q

ideal

A

0-10

78
Q

abnormal

A

20-40

79
Q

likely to have neurological damage

A

> 40

80
Q

fatal

A

> 60

81
Q

increases ICP can cause

A

decreased cerebral BF

decreased CPP

herniations

82
Q

interventions for increased ICP

A

surgical

pharmacological

83
Q

surgical interventions –> ICP

A

decompressive surgery

CSF drainage

decreased intracranial volume

84
Q

decompressive surgery

A

craniotomy

craniectomy

85
Q

decreased intracranial volume

A

raise the HOB

hyperventilation (temp)

86
Q

pharmacological

A

mannitol

barbiturate coma

87
Q

hypoxia and edema

A

systemic brain damage

intracranial brain damage

88
Q

systemic brain damage

A

arterial hypoxemia d/t airway obstruction or trauma

loss of brain’s ability to autoregulate vasodilation –> decreased cerebral perfusion

89
Q

intracranial brain damage

A

cytotoxic edema

vasogenic edema

90
Q

brain shift and hernitation

A

neurosurgical emergency

91
Q

uncal herniation

A

temporal lobe gets pushed downward through the temporal notch

compressing the brainstem

92
Q

central herniation

A

diencephalon is at risk

same as uncal herniation

93
Q

cerebellar herniation

A

cerebellar edema pushes the cerebellar tonsils downward through the foramen magnum

compressing the brainstem

94
Q

subfascial herniation

A

caused by an expanding frontal lobe lesion

Neuro 1 - Exam 4 (12 decks)

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