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Nervous System: Unit II > CNS Injury I-III > Flashcards

CNS Injury I-III Flashcards

1
Q

Types of forces resulting in cerebral trauma

A
  • contact phenomena
  • acceleration
    • translational
    • rotation
  • penetrating
  • secondary injury
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2
Q

Contact phenomenon

A
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3
Q

Layers of Scalp

A
  • S = skin
  • C = subcutaneous tissue
  • A = galea
  • L = loose connective tissue
  • P = periosteum
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4
Q

Common causes of brain injury

A
  • Motor vehicle accidents
  • Violence
  • Recreation
  • Falls (elderly)
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5
Q

Populations @ risk for head injury

A
  • economically disadvantaged populations in major cities
  • males: females = 2:1
  • peak ages:
    • 24-35 yrs
    • 0-4 yrs (child abuse)
    • 65+ (falls)
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6
Q

Contact phenomena head injuries cause & effects

A
  • result from an object striking the head
  • ==> lacerations of the scalp
  • ==> fractures of skull
  • ==> epidural hematomas
  • ==> cerebral contusions
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7
Q

Skull fracture types

A
  • contact phenomenon to skull
  • types: linear, depressed, basilar, diastatic, and growing
    • linear = indicates high-impact injury
    • depressed = comminuted bone fragments
    • basilar = base of skull ==> CSF leaks ==> meningitis
    • diastatic = separates at suture lines
    • growing = infancy; from dural tears
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8
Q

Concussion definition

A
  • =”mild traumatic brain injury”
  • = laternation in mental status, distrubance of equilibrium caused by biomechanical forces which may/may not lead to loss of consciousness
  • hallmarks = confusion & amnesia
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9
Q

Common concussion symptoms

A
  • headache
  • dizziness
  • poor attention, inability to concentrate
  • fatigue, sleep disturbance
  • irritability, depressed mood
  • intolerance of bright light or loud noise
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10
Q

Contact phenomena examples

A
  • clubs, pool cues
  • baseball bats
  • rocks
  • bottles
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11
Q

Types of acceleration injuries

A
  • transalational: head movement in single plane after impact
  • rotational: head movement in multiple planes
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12
Q

Signs of basilar skull fracture

A

•CSF rhinorrhoea •Bilateral periorbital haematomas (Racoon eyes) •Subconjunctival haemorrhage •Bleeding from external auditory meatus •CSF otorrhoea •Battle’s sign •Facial nerve palsy

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13
Q

Consequences of transalation acceleration injuries

A
  • stretching/tearing of veins between brain and dura ==> subdural hematoma
  • brain contusion
  • coup/contrecoup injuries
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14
Q

Characteristics of brain contusion

A
  • often due to transalational acceleration injuries
  • often occurs @ frontal/temporal
  • can lead to swelling, brain shift, increase in intracranial pressure, herniation
  • low mortality alone
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15
Q

Examples of rotational acceleration injuries

A
  • MVA ejection
  • motorcycle accident
  • auto-pedestrian accident
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16
Q

Consequences of rotational acceleration injury

A
  • ==> microscopic tearing of nerve cells @ brain
17
Q

Characteristics of epidural hematomas

A
  • Caused by contact phenomena
  • extradural arterial hemorrhage
  • Associated with skull fractures
  • Classic “lucid interval” after trauma occurs
  • Low mortality rate
18
Q

Characteristics of subdural hematoma

A
  • caused by translational acceleration injuries
  • rupture of bridging veins in subdural space
  • associated with brain contusions
  • high mortality rate
19
Q

Characteristics of Coup/contrecoup injury

A
  • often caused by translational acceleration injury
  • brain contusions + shearing forces on brain/veins in both the rostral and caudal directions due to impact and rebound
20
Q

Common consequences of rotational acceleration injury

A
  • diffuse axonal injury ==> microscopic tearing of nerve cells in brain
  • under a microscope = “axonal spheroids”
  • patients are usually in chronic vegetative state
21
Q

Goal of treatment in head injuries

A
  • save any neurons that have reversible damage
  • minimize secondary effects/mitigate symptoms
22
Q

Importance of controlling ICP

A
  • increased ICP ==> CSF in spinal subarachnoid space OR venoconstriction @ CNS capacitance vessels ==> blood displacement into jugular venous system
  • ==> herniation of brain (which is non-compressible) ==> brain damage
  • also: if ICP > MAP, then there will not be blood flow to brain ==> syncope & eventaully cell death
23
Q

Common signs/symptoms of increased ICP

A
  • sudden change in neurological condition
  • headache, nausea, vomiting ==> progressive lethargy and LOC
24
Q

Herniation syndromes (4)

A
  • subfalcine herniation
  • central herniation
  • uncal transtentorial herniation
  • tonsillar herniation
25
Q

Characteristics of subfalcine herniation

A
  • cingulate gyrus is pushed away from the expanding mass and herniates beneath the falx cerebri.
  • The anterior cerebral artery is often kinked, which may result in a stroke in distribution of this vessel.
26
Q

Characteristics of central herniation

A
  • Occurs when there is downward pressure centrally
  • can result in bilateral uncal herniation
  • results in loss of consciousness.
27
Q

Characteristics of uncal transtentorial herniation

A
  • the uncus herniates across the tentorial edge, and downward into the posterior fossa
  • herniation compresses the midbrain and its ipsilateral cerebral peduncle
    • ==> ipsilateral third nerve palsy (test pupillary light reaction, could be fixed and dilated)
    • ==> contralateral hemiparesis (paralysis of one side of body)
  • Rarely, uncal herniation can compress the opposite cerebral peduncle against the tentorial edge, resulting in a hemiparesis that is ipsilateral to the mass lesion and herniated uncus.
28
Q

Characteristics of tonsillar herniation

A
  • cerebellar tonsils herniate downward into the foramen magnum (coning)
  • medulla is compressed → abnormal cardiac and respiratory responses, including Cushing’s reflex (bradycardia and hypertension) in the setting of high intracranial pressure.
  • Tonsillar herniation most commonly is encountered in the setting of a mass lesion in the posterior fossa.
29
Q

Critical avoidance in context of intracranial mass lesion

A
  • DO NOT PERFORM A LUMBAR PUNCTURE
  • lumbar punctures can precipate herniation syndromes due to pressure differentials created during the procedure
30
Q

Categories included in the GCS

A
  • Eye opening
  • Best verbal response
  • Best motor response to pain/verbal command
31
Q

GCS: Eye opening grading

A

None - 1

To pain - 2

To loud speech - 3

Spontaneous - 4

32
Q

GCS: Verbal response grading

A

None - 1

Incomprehensible sounds - 2

Inappropriate words - 3

Confused/Disoriented - 4

Oriented - 5

33
Q

GCS: Motor response grading

A

None - 1

Extension to pain - 2

Abnormal flexion to pain - 3

Withdraws from pain - 4

Localizes pain - 5

Obeys command - 6

34
Q

Scoring guidelines & utility of GCS

A
  • < 8 ==> intubation
  • GCS = good predictor of mortality
  • correlates w/likelihood of good outcome vs. moderate to sever disability vs. death
  • correlates w/likelihood of intracranial mass lesion
35
Q

Concussion: GCS definition

A

GCS = 13-15 ==> mild traumatic brain injury

36
Q

Most common symptoms of concussion (5)

A
  1. Headache
  2. Dizziness
  3. Lack of awareness of surroundings
  4. Muddled thinking
  5. Nausea and Vomiting
37
Q

Common signs of concussion

A
  • Vacant stare
  • delayed responses
  • inattention
  • disorientation
  • loss of consciousness.

Nervous System: Unit II (19 decks)

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