Trauma to the Nervous System

Question 1

localized force gives what type of skull fracture?

Answer 1

depressed

Question 2

diffuse force gives what type of skull fracture?

Answer 2

linear

Question 3

contusion

Answer 3

superficial hemorrhage at the top of cortical gyri

Question 4

most common location for contusion

Answer 4

basal or ventral surface of frontal and anterior temporal lobes

Question 5

cause of contusion

Answer 5

angular or rotational acceleration of brain

Question 6

coup

Answer 6

point of impact

Question 7

remote area in brain

Answer 7

contrecoup

Question 8

preservation of optimal cerebral blood flow despite fluctuation in systemic bp

Answer 8

cerebral autoregulation

Question 9

MAP range for cerebral autoregulation

Answer 9

60 to 140 mmHg

Question 10

cushing’s response/reflex

Answer 10

elevation of systemic bp to preserve cerebral blood flow in the setting of severely inc ICP

Question 11

parasympathetic response accompanying cushing’s reflex

Answer 11

bradycardia and slowed RR

Question 12

cingulate gyrus pushed under falx cerebri

Answer 12

subfalcine herniation

Question 13

medial temporal lobe compressed against midbrain

Answer 13

uncal herniation

Question 14

pupil signs of uncal herniation

Answer 14

fixed and dilated ipsi pupil

Question 15

shifting of lower brainstem and cerebellar tonsils down foramen magnum

Answer 15

tonsillar herniation

Question 16

bridging cortical veins lacerated

Answer 16

acute subdural hematoma

Question 17

tx for acute subdural hematoma

Answer 17

surgical removal of hematoma

Question 18

more susceptible to subdural hematoma

Answer 18

elderly atrophic brain

Question 19

repeated mild head injuries can give

Answer 19

chronic subdural hematoma

Question 20

in a confused elderly pt, always consider which dx?

Answer 20

chronic subdural hematoma

Question 21

rupture of meningeal artery/vein or venous sinus

Answer 21

epidural hematoma

Question 22

MMA lacerated in which scenario

Answer 22

temporal bone fracture

Question 23

describes intracranial volume as sum of brain, vascular, and CSF volumes

Answer 23

Monro Kellie doctrine

Question 24

tx for inc ICP

Answer 24

mechanical hyperventilation (gives dec pCO2 and leads to vasoconstriction), mannitol/osmotic diuretics

Question 25

ABCs for critically injured patients

Answer 25

airway
breathing
circulation

Question 26

brief transient LOC w/out persistent neuro deficit

Answer 26

concussion

Question 27

trauma induced alteration in mental status +/- LOC that typically includes a brief period of confusion/amnesia

Answer 27

updated definition of concussion

Question 28

movement of brain within skull

Answer 28

postconcussion syndrome (takes days-wks to resolve)

Question 29

sxs of postconcussion syndrome

Answer 29

HA, neck ache, impaired concentration or memory, positional dizziness or vertigo

Question 30

does post-concussion syndrome show up on imaging

Answer 30

no, CT and MRI are normal

Question 31

spinal shock

Answer 31

UMN signs are absent for weeks-months, patient is hypotonic and areflexive w/ paralysis

Question 32

quadriplegia w/ respiratory paralysis w/ possible bradycardia, hypothermia, fluctuating bp

Answer 32

high C spine lesion

Question 33

elderly pts w/ advanced degenerative arthritis of spinal column who fall forward and hyperextend neck

Answer 33

central cervical cord syndrome

Question 34

sxs of central cervical cord syndrome

Answer 34

weakness of upper limbs - medial CST and cervical anterior horn cells effected

Question 35

inc neuro recovery for spinal cord injuries if what is administered

Answer 35

high dose IV steroids (dexamethasone) w/in 8 hrs of injury

Question 36

regrowth of severed nerve occurs at what rate

Answer 36

1 inch per month

Question 37

prognosis is poorer for nerves that are severed where?

Answer 37

more proximally

Question 38

traumatic neuroma

Answer 38

misdirected regrowing axons form painful/swollen bulbous ending