review questions exam 2

what are the 3 ranges that are the highest risk for TBI and why?

- 1-2 years (child abuse)

- 15-24 (risk taking)

- elderly (falls)

what is the difference between an open and closed head injury

- open head injury: skull and meninges have been disrupted leaving the brain exposed (from scalp laceration, compound fractures, missile injuries, usually involve focal damage

- closed head injury: brain in contact with skull, no skull fracture or fracture is a closed fracture (bone not exposed to air), focal injury to cerebrum or brainstem to area of brain under the site of impact under the skull

why is increasing ICP so dangerous what can it lead to?

- there is no room for the brain to expand, so it will herniate

what can hypocalcemia lead to?

arrhythmias

what is the quickest way to relieve increased intracranial pressure?

craniotomy

what is heterotopic ossification and what would you look for clinically?

- abnormal bone growth around a joint

- onset of 4-12 weeks after the injury

- loss of ROM

- local tenderness

- palpable mass

- erythema

- swelling

- pain with movement

- common in hips and elbows

what other associated injuries and complications are commonly seen with a TBI

- Cx spine fx

- pelvic fx

- abdominal injuries

- shock

- acute anemia

- fat emboli

- hypothalamic malfunctions

- disseminated intravascular coagulation

- thrombophlebitis

- infection

- seizures

- respiratory complications

- cardiovascular complications

- hydrocephalus

- hypocalcemia

- electrolyte imbalances

- pain

- neuropathic pain

- HO

- CN damage

what is GCS used to assess

level of consciousness

what is a concussion and what GCS score is obtained for diagnosis?

- transient loss of neurological function in the post head injury

- resolves without permanent gross neurological sequela

- GCS exceeds 13 in ER

- cognitive impairment usually resolves in 7 days

what is retrograde amnesia

partial or total loss of the ability to recall events that occurred during the period immediately preceding the head injury

what is post traumatic amnesia

the time lapse between the injury and the point where memory returns

what are the priorities in the acute management of the TBI patient?

- rapid triage

- rescucitation

- stabilization to prevent secondary spinal injuries

- efficient transport

- pharmacological management (drugs to decrease ICP, control BP, drugs to effect motor, behavorial, cognitive functions, control seizures, control spasticity

what is rancho levels of cognitive function scale

a scale used to assess individuals after a head injury and describe the stages of recovery based on cognitive and behavioral function as an individual emerges from a coma (applies only to those who have had a head injury)

what factors can be prognostic indicators of a good outcome after a TBI

- no substance abuse

- high educational achievement

- no previous TBI

- stable work hx

- less severe of an injury

- smaller lesion size and area

- no seizures after the TBI

- better if rehab is started earlier

- less than 40 years of age

- no / short PTA

what is epilepsy and what does it require the presence of? what age groups is it most commonly seen in?

- a chronic disorder of various causes characterized by recurrent seizures

- requires the presence of seizures

- children and elderly most common

what is the most common cause of epilepsy in older >50 adults? what is the most common cause in children/infants?

- cerebrovascular disease

- lack of oxygen during delivery

what are the different types of partial seizures and how do they differ?

Simple partial- NO LOC and unilateral hemispheric involvement, is in a limited area of cortex, has focal motor or sensory sx.'s,

Complex partial- alterations or LOC and bilateral hemispheric involvement, often preceded by an olfactory aura (uncinate fits), appears dazed and confused with rambling mumbling and simple movements or tasks, lasts 45-90 sec. and follows with confusion and disorientation lasting several minutes, usually amnesic

what are the different types of generalized seizures and how do they differ?

Absence- (petit mal) sudden stopping of ongoing conscious activity with only minor convulsive muscular activity or loss of postural control, staring into space, may occur during normal conversation where person may skip words or stop mid sentence for a few seconds, unaware of conscious control

Myoclonic- sudden brief repetitive mm contractions involving one body part or the entire body, jerks range from small movements of face and hands to massive bilateral spasms that simultaneously affect head, limbs and trunk, may crescendo and terminate in a generalized tonic-clonic convulsion

Atonic- drop attacks, brief LOC and postural tone NOT associated with tonic mm contractions, most often in children with encephalopathies, sometimes limited to head, producing head drop

Tonic-Clonic- (grand mal) total loss of control, begins with total LOC and falls are common, generalized rigid state (tonic phase) followed by very rapidly jerking movements (clonic phase), transient physiologic changes occur (hypoxia, lactic acidosis, elevated plasma catecholamine, increased creatine kinase), altered speech, HA, muscle soreness, disorientation, fall injuries, asp PNA, suffocation,

may produce deep sleep, another seizure may begin before recovery of the first,

Tonic- lasts 30-60s, body becomes rigid and are at fall risk, crying,

cyanosis, fixed jaw, hands clenched

Clonic- begins with fast, rhythmic jerky contractions and relaxation of all body mm, especially in the extremities, biting of tongue, lips or inside of mouth, blown saliva and froth on the lips

Status epilepticus- condition where seizures are so prolonged, or so repeated, that recovery does not occur between attacks, medical emergency, death can occur within the first few seizures, often a result of tumor, infection, or drug abuse

how can seizures be diagnosed?

- EEG

- medical history

- MRI

- metabolic studies

- toxicity screening

- neuropsychological testing

what are the treatments available for seizures?

- anti epileptic drugs

- support (behavioral and socioeconomic issues)

- education (side effects)

- ketogenic diet

- surgery (stimulator)

what is the general prognosis for individuals who have seizures?

increased mortality rate compared to general population, 20 fold risk of sudden unexplained death (cardiac arrhthmia, pulmonary, edema or MI)

what are precautions that need to be taken for individuals who have seizures?

- asphyxiation (seizure while eating or breathing, post-epileptic phase)

- drowning while alone (bathing or swimming)

ANS neurons are composed of ______ which extend from the CNS, and ____ neurons, which connect with the target organ

1. preganglionic, 2. postganglionic

sympathetic preganglionic neurons arise from the

interomediolateral cell column (T1-L3)

which cranial nerves have parasympathetic functions?

CN III, VII, IX, X (3,7,9,10)

SNS main functions

- pupil dilation

- bronchodilation

- cardiac acceleration

- inhibition of digestion

- piloerection

- stimulation of glucose release

- systemic vasoconstriction

PNS main functions

- pupil constriction

- bronchoconstriction

- cardiac deceleration

- stimulation of digestion

- salivation, lacrimation

- intestinal vasoconstriction

sympathetic length of preganglionics, NT released

- short

- acetylcholine

parasympathetic length of preganglionics, NT released

- long

- acetylcholine

sympathetic length of postganglionics, NT released

- long

- norepinephrine

parasympathetic length of postganglionics, NT released

- short

- acetylcholine