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Comparing CT and MRI, the most sensitive neuroimaging technique to detect diffuse axonal injury after a traumatic brain injury is
A. T1-weighted MRI scan
B. T2-weighted MRI scan
C. Diffusion-weighted MRI scan
D. CT scan
C. Diffusion weighted MRI scan
Standard CT and MRI scans are often unremarkable after isolated diffuse axonal injury (DAI) in patients with significant cognitive and behavioral problems; however, fluid-attenuated inversion recovery diffusion weighted and gradient echo MRI sequences are more sensitive in detecting evidence of DAI after a TBI
The duration of _______ and GCS score have been used to predict neurobehavioral outcome in TBI patients
Coma
PTA is used as a measure of injury severity
source: DeLisa
This syndrome results from an inability to auto regulate intracranial and cerebral perfusion pressure after repeated concussions and is a hypertensive emergency that may result in death
Second Impact Syndrome
This type of tremor is 5 to 8 Hz, worse with activity, not present at rest, and exacerbated by stress
Essential tremor
A 22yo male is brought to the ED with a head injury after MVC. Initial GCS score is 9 and bilateral temporal contusions are found on CT scan. He is started on Phenytoin for seizure prophylaxis. How long should this medication be continued?
1 week
Studies support the use of Phenytoin for early post-traumatic seizure prophylaxis for the first week post-injury only
In a person with traumatic brain injury, which phenomenon does NOT limit the interpretation of functional magnetic resonance imaging data?
A. Cerebral dominance
B. Adequacy of cerebral blood flow
C. Ability to follow multistep commands
D. Medication effects
C. Ability to follow multistep commands
Functional magnetic resonance imaging (fMRI) is based on regional blood flow and local metabolic activity, taking advantage of the differing magnetic properties of oxygenated and deoxygenated hemoglobin. Several factors may impact the interpretation of fMRI data, including the subject’s ability to fully cooperate, medication effects, adequacy of cerebral blood flow, cerebral dominance, and inadvertent movement during image acquisition. Only simple tasks can be performed in the scanner, limiting its utility.
Unlike the GOAT, this way of measuring PTA allows for cuing to assist individuals with language or severe memory impairments, and does not require the patient to verify information about events relating to the injury
Orientation-Log (O-log)
This is the most common cited influential risk factor for determining who is likely to sustain a TBI
Alcohol intake before the TBI
In the TBI Model System database as of 2001, approximately 50% of those screened for blood alcohol level (which includes about 80% of cases) were legally intoxicated at the time of injury
At a clinic follow up visit, your TBI patient is noted to have increased tone in the lower limbs with difficult passive movement giving him this score on the Modified Ashworth Scale
3
MAS
0 - no increase in muscle tone
1 - slight increase in muscle tone, usually a catch
2 - marked increase in tone but easily moved
3 - increased muscle tone with difficult passive movement
4 - rigid without movement
This medication is found to be advantageous for its use in treating dysautonomia and severe spasticity after brain injury because it has minimal effect on blood pressure and little to no sedating side effects
Dantrolene Sodium
works at the level of the muscle sarcomere, thus fewer systemic side effects
In TBI, which modality evaluates metabolite information and aids in a prognosis of outcome at 6 months postinjury?
A. Transcranial magnetic stimulation
B. Magnetic resonance spectroscopy
C. Apolipoprotein E
D. Positron emission tomography
B. Megnetic resonance spectroscopy
Magnetic resonance spectroscopy (MRS) provides information about the neurochemical status of the brain and may indicate the extent of brain damage; therefore, it provides important data for evaluating expected outcome. Studies found that MRS studies correlated with outcomes 6 months later.
Of the three items in GCS, ______ is the best acute predictor of outcome
C. best motor response
Best Motor Response (1-6), Best Verbal Response (1-5), Eye Opening (1-4)
Which type of brain injury patients are most likely to have deep vein thromboses?
A. Nonpenetrating traumatic brain injury
B. Penetrating brain injury
C. Hypoxic brain injury
D. Intraparenchymal hemorrhage
C. Intraparenchymal hemorrhage
In a large study, patients with both penetrating (10.5%) and nonpenetrating (6.4%) traumatic brain injury had lower rates of deep vein thrombosis than did patients with nontraumatic brain injuries. Among the latter group, patients with brain tumors had the highest incidence (21.2%), whereas those with hypoxic brain injury had 9.6% incidence and those with intraparenchymal hemorrhage had 14.6%.
These class of exercises consists of many repetitions of slow exercises and is used to treat ataxia
Frenkel exercises
This medication is a Dopamine agonist used to improve executive skills in TBI
Bromocriptine
24 yo female presents to the ED after a fall from a horse. CT scan shows subdural hematoma as well as naso-orbital-ethmoid fractures. As a result of her injuries, this patient suffered damage to this most commonly injured cranial nerve in head trauma.
CN 1
Olfactory Nerve damage resulting in anosmia
When patients with traumatic brain injury (TBI) ask about returning to driving, you tell them
A. persons with TBI must wait at least 1 year postinjury before resuming driving
B. only an on-road evaluation is necessary to determine fitness for driving
C. clinical assessment should include sensorimotor impairment, vision, and cognitive function
D. persons with brain injury should not drive and the physician must notify the state of their status
C. clinical assessment should include sensorimotor impairment, vision, and cognitive function
Independent driving after TBI is an important aspect of rehabilitation. People who resume driving after TBI had better objective community reintegration outcomes than nondrivers. There is not a mandated time frame for resumption of driving.
Which alternative treatment is established conclusively as efficacious for recovery in persons with moderate TBI?
A. S-adenosylmethionine
B. Hyperbaric oxygen treatments
C. Homeopathic remedies
D. Cytidine diphosphate-choline (Citicholine)
D. Cytidine diphosphate-choline (Citicholine)
In a single-blind study of 216 patients with moderate to severe brain injury, those receiving cytidine diphosphate-chlorine showed improvement in cognitive and motor status and had shorter stays in the intensive care unit.
Daily Double
The medications shown as most efficacious for posthypoxic myoclonus include
A. clonazepam and valproate
B. phenytoin and primidone
C. ethanol and tetrabenazine
D. phenobarbital and methysergide
A. clonazepam and valproate
Clonazepam and valproate, as well as piracetam, are first-line treatments for posthypoxic myoclonus. Ethanol and methysergide are effective in some patients but are not first-line treatments. Phenytoin, primidone, phenobarbital, and tetrabenazine have not been shown to be helpful.
This medication is regarded as first line therapy for use in a TBI patient who has impaired speed of processing, inattention, and decreased arousal
Methylphenidate (Ritalin)
Current evidence shows Methylphenidate as first line
Amantadine is also commonly used, but has a worse side effect profile and there is some controversial evidence that it may lower seizure threshold
This is a rare complication after a large skull bone defect in which the brain recedes from the above skin and as a result, various neurologic symptoms present themselves and paradoxical herniation or increased midline shift may be seen on imaging
Trephined Syndrome
"Sinking Flap Syndrome"
Daily Double
After a traumatic brain injury, what is the key factor for motor improvement in a patient who is 2 years postinjury?
A. Vicariation
B. Sprouting
C. Sensorimotor reorganization
D. Diaschisis
C. sensorimotor reorganization
Neural vicariation (functions taken over by brain areas not originally managing that function) may be maladaptive and, along with sprouting, accounts for improvements seen earlier in recovery than the 2 years stated here. Diaschisis is the loss of function and electric activity caused by cerebral lesions in areas that are remote from the lesion but are neuronally connected to it. The primary sensorimotor cortex and associated systems constantly change in connectivity and cortical representation under normal circumstances in response to experience, with repetition as a crucial component to maintaining these associations. The nonlesioned motor cortex, under use-dependent stimulation, becomes rededicated during training to support the impaired motor behavior.
The usual time of onset of Diabetes insipidus after TBI is around ____ days after injury
10 days
The usual onset for diabetes insipidus is 10 days after trauma when the ADH stored in the posterior pituitary gland is depleted
Decerebrate posturing is a poor prognostic factor in TBI and commonly seen when this portion of the brain is injured
Brainstem
This medication has the best evidence for its use to accelerate the pace of functional recovery in patients with disorders of consciousness after severe TBI
Amantadine