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Neuro Module > Traumatic Brain Injury > Flashcards

Traumatic Brain Injury Flashcards

(48 cards)

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1
Q

Definition of traumatic brain injury

A

damage to brain resulting from external mechanical forces

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2
Q

Epidemiology of traumatic brain injury

A

trauma most common cause of death 1-45 yo; 50% are deaths from head injury

20% of head injuries cause brain injury

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3
Q

Etiology of traumatic brain injury

A

direct impact, rapid acceleration, blast waves, penetration by projectile (bullets, knifes, etc.)

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4
Q

intra-axial vs extra-axial brain injury

A

intra-axial = acceleration/deceleration injury (shearing, coup/countrecoup); in brain parenchyma

extra-axial = direct force; in epidural, subdural, subarachnoid

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5
Q

coup-countrecoup

A
  • head strikes fixed object, causing brain to collide with inside of skull at impact site and opposite side of site
  • result in cerebral contusions (bruising)
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6
Q

Primary vs secondary traumatic brain injury

A

Primary: immediate injury effects

Secondary: molecular cascade of neurochemical reactions in brain post-injury; last for hours to days

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7
Q

epidural injury mechanism

A

direct trauma, usually with skull fracture, min to hours

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8
Q

Important history information with traumatic brain injury

A

mechanism, LOC, HA, visual changes, focal neural complaints, neck pain, seizures

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9
Q

Leading cause of brain injuries

A

falls

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10
Q

where contusions likely to occur?

A

basilar temporal area

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11
Q

subdural injury mechanism

A

lower force (eg. fall), less likely skull fracture, veins, hrs to days

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12
Q

subarachnoid injury mechanism

A

spontaneous/high force, small vessels rupture, secs-mins

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13
Q

Secondary brain injury can result in

A

neuronal cell death, cerebral edema, increased ICP

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14
Q

PE of traumatic brain injury

A 
Neuro exam
Glasgow Coma Scale
External findings (hematoma, depressions, lacerations)
Signs of increased ICP
Signs of basilar skull fracture
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15
Q

Signs of increased ICP

A

fixed/dilated pupils
decorticate/decerebrate posturing
Cushing response (bradycardia, HTN, less respiratory drive)

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16
Q

Signs of basilar fracture

A
  • Battle sign
  • Raccoon eyes
  • Hemotympanum, otorrhea, rhinorrhea (may be CSF)
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17
Q

galea

A

periosteum on top region of skull

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18
Q

decorticate vs decerebrate posturing

A

decorticate is abnormal flexion rigidity and decerebrate is abnormal extension rigidity

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19
Q

Glasgow Coma Scale classes

A 
Mild = 13-15
Mod = 9-13
Severe = 8 or less
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20
Q

Tx according to Glasgow Coma Scale?

Study These Flashcards
A

GCS < 8 = intubate

GCS 14 or less = CT

21
Q

What does Glasgow scale 3 or less indicate?

Study These Flashcards
A

70-100% mortality

22
Q

First line diagnostic studies for head injury

Study These Flashcards
A

1) CT

2) Lumbar Puncture

23
Q

ER tx and dx of traumatic brain injury

Study These Flashcards
A
  1. Maintain vitals
  2. Neuro exam GCS
  3. Assess for systemic trauma
  4. Check labs (CBC, lytes, glucose, coags, etoh, urine drug screen)

For severe TBI - head elevation, Mannitol or IV hypertonic saline

24
Q

What greatly effects accuracy of Glasgow Coma Scale?

25
Different ways to treat increased ICP
Mannitol, hyperventilation, sedation
26
Why monitor glucose?
too high - osmotic (water to brain, worsening edema) too low - seizures
27
Definition of concussion
trauma-induced alteration in mental status
28
Definition of mild TBI
- injury to brain caused by contact and/or acceleration/deceleration forces - GCS score 13-15 measured at ~30 min post-injury
29
Etiology of mild TBIs
most common MVA and falls others - occupational accidents, recreation accidents, assaults
30
Hallmark sx of concussion
confusion, amnesia, +/- LOC
31
Sx hours to days after concussion
mood and cognitive disturbances, sensitivity to light and noise, sleep disturbances
32
PE of concussion/mild TBI
should be normal - Eval head for hematomas, lacerations, or ecchymosis - Neck and C-spine exam - Full neuro exam
33
Most sensitive and specific concussion assessment
SAC (standardized assessment of concussion)
34
Decisions to CT a mild head injury patient
dangerous mechanism, severe HA, vomiting, seizures, LOC, altered mental status
35
Concussion Grading Scale
Grade 1, 2, 3 (mild, mod, severe) based upon presence and duration of LOC But LOC doesn't predict clinical course and long-term cognitive impairment SHOULD NOT BE USED! for young athletes
36
Discharge criteria for concussion
GCS = 15 No ongoing symptoms Normal exam and CT No predisposition to bleeding
37
Admission criteria for concussion
``` GCS < 15 Seizures Abnormal CT Coagulopathy No responsible person available ```
38
Treatment of concussion
- Tylenol prn HA (not NSAIDs or narcotics) | - Physical/cognitive rest for 24-48 hrs with gradual return to work/school/play
39
Discharged concussion patient should return to ED if...
- Inability to awaken the patient - Severe/worsening headaches - Somnolence or confusion - Restlessness, unsteadiness, or seizures - Difficulties with vision - Vomiting, fever, or stiff neck - Urinary or bowel incontinence - Weakness/numbness of any part of body
40
Complications of concussions
postconcussion syndrome (resolve in wks to months) chronic traumatic encephalopathy (neuropsycho deficits from repeated injury) Post-traumatic HA, epilepsy, vertigo
41
Definition of post-concussion syndrome
common symptom complex sequela of mild TBI
42
Epidemiology of post-concussion syndrome
30-80% of mild TBIs | Severity of TBI doesn't correlate
43
Pathophysiology of post-concussion syndrome
Theories: 1) Structural/Biochemical: global atrophy, regional volume loss, white matter abnormalities 2) Psychogenic: symptoms similar to somatization seen in psych disorders
44
Treatment of post-concussion syndrome
- Simple reassurance; most improve 1-3 months - Symptomatic tx (dizziness, HA, insomnia) - Education of family, teachers, employers, etc.
45
Prognosis of post-concussion syndrome
First 7-10 days: sxs and disabilities greatest 1 month: sxs improved and in many cases resolved 3 months: vast majority of patients have largely recovered 1 year: 10-15% have ongoing sxs
46
Clinical features of Chronic Traumatic Encephalopathy
Cognitive impairment: memory loss, dementia Neuropsych sx: behavior and personality changes, depression, suicidal Neurodegenerative sx: Parkinson's and other speech and gait abnormalities
47
Dx of Chronic Traumatic Encephalopathy
Typically on autopsy: cerebral atrophy, fenestrated cavum septum pellucidum, tau protein Advanced neuroimaging studies (SPECT, PET and fMRI): white matter abnormalities, new radiopharmaceutical that binds to tau proteins but need further studies
48
Prevention of Chronic Traumatic Encephalopathy
Better helmets Changed return to play rules ↓ number of contact practices Rules changes

Neuro Module (13 decks)

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