Neuroscience and Brain Injury: Key Concepts and Functions

What is the primary function of the brain?

Integration of sophisticated sensory and motor activities and thoughts.

What are the four main lobes of the cerebrum and their functions?

Frontal (smell, memory, higher IQ functions), Parietal (sensory discrimination, spatial awareness, speech), Temporal (auditory, emotional equilibrium), Occipital (vision and event memory).

What is the role of the hypothalamus?

Integrates sympathetic and parasympathetic responses to stimuli, regulates temperature, and hormone secretion.

What is the function of the thalamus?

Primitive appreciation of pain, temperature, and tactile stimulation.

What does the basal ganglia do?

Transmits motor tracts and links pyramidal pathways.

What is the function of the corpus callosum?

Provides intricate connections between cerebral hemispheres.

What are the three main parts of the brain stem?

Midbrain, Pons, and Medulla.

What is the role of the medulla in the brain stem?

Controls vital center activities such as cardiac, vasomotor, and respiratory functions.

What is the function of cerebrospinal fluid (CSF)?

Surrounds the brain and spinal cord, serving as a buffer for injury/infection.

How is cerebrospinal fluid produced?

By the choroid plexus in the ventricles.

What is the normal range for intracranial pressure (ICP)?

0-15 mm Hg (or 4 to 15 mm Hg).

What happens if ICP exceeds 20-25 mm Hg?

Compensatory responses are impacted, and brain herniation may occur.

What are the types of cerebral edema?

Vasogenic, cytotoxic, and interstitial.

What is the Munro-Kelli hypothesis?

An increase in one component of the intracranial vault must be balanced by a decrease in another to maintain constant volume.

What is the significance of the Circle of Willis?

It is a critical arterial structure that supplies blood to the brain.

What is a TIA?

Transient Ischemic Attack, a temporary blockage in the carotid artery.

What is the role of the autonomic nervous system?

Regulates involuntary body functions to maintain homeostasis.

What are the two divisions of the autonomic nervous system?

Sympathetic and Parasympathetic nervous systems.

What is the primary neurotransmitter of the sympathetic nervous system?

Epinephrine.

What is the primary neurotransmitter of the parasympathetic nervous system?

Acetylcholine.

What does a positive Babinski reflex indicate?

It may indicate increased ICP.

What is decerebrate posturing?

Rigid extension of all limbs, indicating severe brain injury or damage.

What is decorticate posturing?

Flexion to the core, indicating damage near the cerebral hemispheres.

What factors influence intracranial pressure?

Coughing, Valsalva maneuver, and position changes.

What are common complications of brain injuries?

Seizures, brain death, and organ donation considerations.

What nursing assessments are critical for a patient with suspected brain injury?

Level of consciousness, pupil assessment, and SAMPLE history.

What does the term 'cerebral edema' refer to?

Brain swelling due to increased intracellular water.

What is the importance of recognizing psychosocial history in neurological assessments?

It helps identify factors that may affect patient care and recovery.

What is the normal range for Cerebral Perfusion Pressure (CPP)?

80-100 mm Hg

What is the minimum CPP required to ensure cerebral oxygenation?

> 70 mm Hg

What happens if CPP is less than 60 mm Hg?

It is dangerous and can lead to cerebral hypoxia and possibly brain death.

How is CPP calculated?

CPP = MAP - ICP

What does MAP stand for?

Mean Arterial Pressure

What is the formula for calculating MAP?

MAP = SBP + 2(DBP)/3

What is the effect of increased CO2 on blood flow?

Increased CO2 leads to increased metabolism, acidosis, and hypoxia, which increases blood flow.

What is a Traumatic Brain Injury (TBI)?

A brain insult resulting from mechanical disruption of brain tissue due to external impact.

What are the leading causes of TBIs?

Transportation-related accidents, falls, violence, and sports accidents.

What is a contusion in the context of TBI?

Bruising of soft tissue, considered a moderate to severe head injury.

What is the significance of the Glasgow Coma Scale (GCS)?

It is used to determine the severity of a brain injury.

What are the signs of a basilar skull fracture?

Battle's sign, raccoon eyes, otorrhea or rhinorrhea, and positive halo sign.

What is an Epidural Hematoma?

Accumulation of blood between the skull and the dura mater, requiring emergent surgical evacuation.

What distinguishes a Subdural Hematoma from an Epidural Hematoma?

Subdural Hematomas can be acute (less than 48 hours) or chronic (over 2 weeks) and expand quickly.

What are the signs and symptoms of an Intracerebral Hematoma?

Headache, decreased LOC, dilation of one pupil, and hemiplegia.

What is a concussion?

The most common type of TBI, often resulting from sports or falls, with no bleeding or bruising.

What is Diffuse Axonal Injury (DAI)?

Injury caused by shearing forces disrupting neurons, often seen in high-speed acceleration-deceleration incidents.

What management strategies are used for DAI?

Lower ICP, increase CPP, stabilize vital signs, and provide diligent neuro assessments.

What is the incidence of TBIs in Canada?

55,000 people per year.

What is the most common cause of TBIs in individuals over 75?

Falls.

What is the typical management for a Subdural Hematoma?

Surgical evacuation of the hematoma and monitoring of LOC and neurologic assessments.

What is the role of autoregulation in cerebral blood flow?

Cerebral arteries vasoconstrict or vasodilate to maintain constant blood flow at 750 mL/min.

What is the significance of ICP in relation to CPP?

ICP (Intracranial Pressure) must be subtracted from MAP to calculate CPP.

What is the impact of hypoxia on cerebral blood flow?

Hypoxia can lead to increased blood flow due to vasodilation.

What are the common symptoms of a Subdural Hematoma?

Headache, lethargy, absent-mindedness, vomiting, seizures, stiff neck, pupil changes, and hemiparesis.

What is the prognosis for severe Diffuse Axonal Injury?

Prognosis is poor and may include prolonged coma or death.

What are the signs of increased ICP?

Drowsiness, headache, confusion, agitation, and seizures.

What is the typical GCS score for a person with a severe brain injury?

A GCS score of 3-8 indicates severe brain injury.

What was Greg's Glasgow Coma Scale (GCS) score upon arrival at the ER?

GCS 3/15

What are the signs of increased intracranial pressure (ICP)?

Cushing's Reflex, increased systolic BP, widening pulse pressure, reflexive bradycardia, bradypnea or apnea.

What is the purpose of an External Ventricular Drain (EVD)?

To monitor ICP and help control ICP via drainage of cerebrospinal fluid (CSF).

What are the four causes of secondary injury in TBI?

Ischemia, neuronal death, cerebral swelling, inflammation.

What interventions are aimed at reducing ICP?

Maintaining normal temperature, blood pressure, oxygen, and carbon dioxide levels.

What is the normal range for ICP?

Less than 20 mm Hg.

What is Cushing's Reflex indicative of?

Profound compromise of brain stem function due to increased ICP.

What are the types of brain herniation?

Uncal, central, tonsillar, and transcalvarial herniation.

What is the role of osmotic diuretics in TBI management?

To reduce cerebral edema and intracranial pressure.

What nursing actions should be taken for a patient with an EVD?

Ensure EVD is level with the patient's auditory meatus, monitor drainage, and perform neuro checks.

What is the significance of a GCS score of 12 mm Hg in ICP monitoring?

It reflects a normal balance between brain tissue, blood, and cerebrospinal fluid.

What are common long-term effects of TBI?

Memory loss, difficulty with concentration, slower response time, impulsivity, and emotional lability.

What is status epilepticus?

A single generalized tonic-clonic seizure or series of seizures lasting 10 minutes or longer without return of consciousness.

What are the nursing actions post-ventriculoperitoneal (VP) shunt placement?

Monitor for signs of infection, ensure proper shunt function, and assess neurological status.

What is diabetes insipidus (DI) and who is at risk?

A condition of improper water balance due to decreased ADH production, common in TBI patients.

What is the syndrome of inappropriate antidiuretic hormone (SIADH)?

A condition where excess ADH causes water retention, leading to fluid overload and hyponatremia.

What are common nursing cues for SIADH?

Monitor for fluid overload, decreased urine output, and increased urine concentration.

What medications are used to manage TBI?

Osmotic diuretics (Mannitol), sedatives (Propofol, Midazolam), pain medications (Morphine, Fentanyl), and anticonvulsants (Phenytoin).

What are the signs of obstructive hydrocephalus?

Blockage of CSF flow leading to increased intracranial pressure and potential brain damage.

What is the role of neuro checks in TBI management?

To assess neurological status and detect changes in consciousness or brain function.

What is the impact of environmental factors on TBI recovery?

Safe housing, neighborhood safety, and minimizing noise/light can aid in recovery.

What is the significance of maintaining neck alignment in TBI patients?

To prevent further injury and maintain cerebral perfusion.

What are the potential complications of TBI?

Seizures, diabetes insipidus, SIADH, and obstructive hydrocephalus.

What nursing interventions can help prevent urinary retention in TBI patients?

Accurate monitoring of intake and output, bladder catheterization, and regular assessments.

What does a GCS score of 5/15 indicate?

Severe impairment of consciousness and neurological function.

What is the purpose of maintaining the head of the bed elevated in TBI patients?

To reduce intracranial pressure and improve cerebral perfusion.

What is the role of physical therapy in TBI recovery?

To assist with mobility, relearning basic skills, and improving overall function.

What should be monitored in patients receiving sedatives for TBI?

Respiratory function, sedation levels, and potential side effects.

What is the significance of pupil size and reactivity in TBI assessment?

Changes can indicate increased ICP or brainstem dysfunction.