TBI 1

Epidemiology

100

This is the leading cause of death in individuals under the age of 45

What is trauma?

200

This is the most common cause of death and injury in automobile accidents.

What is ejection of the occupant from the vehicle (Spitz, 1991)?

300

This substance is detected in up to 86% of TBI patients at time of accident.

What is alcohol?

400

This is the overall most common cause of traumatic brain injury.

What are falls?

500

This is the overall male to female incidence ratio for TBI

What is 2.5:1

Pathophysiology

100

This type of primary injury is defined as bruising of the cortical tissue.

What are contusions?

200

This primary injury is defined as immediate disruption of the axons due to acceleration-deceleration and rotational forces that cause shearing upon impact.

What is diffuse axonal injury

300

A patient demonstrates increased signal uptake at the corpus callosum on MRI - GRE after a traumatic brain injury. It would be graded as this.

What is Grade II Diffuse Axonal Injury? Grade I: involves grey-white matter interfaces most commonly: parasagittal regions of frontal lobes, periventricular temporal lobes less commonly: parietal and occipital lobes, internal and external capsules, and cerebellum often inapparent on conventional imaging may have changes on MRS 3 Grade II: involves corpus callosum in addition to stage I locations observed in approximately 20% of patients most commonly: posterior body and splenium but does advance anteriorly with increasing severity of injury most frequently unilateral may be seen on SWI 3 Grade III: involves brainstem in addition to stage I and II locations most commonly: rostral midbrain, superior cerebellar peduncles, medial lemnisci and corticospinal tracts

400

Brain Swelling occurs early on after acute head injury and is due to increase in intravascular blood volume. Another secondary injury is brain edema and occurs due to an increase in brain volume secondary to an increase in brain water content leading to extravascular fluid. These are the two types of brain edema.

What are vasogenic edema (extracellular edema secondary to damaged blood vessels) and cytogenic edema (due to failing of the cell's energy supply system)

500

This bone-artery combination is involved in 90% of epidural hematomas

What is temporal bone - middle meningeal artery

Recovery Mechanisms

100

Brain plasticity occurs via two mechanisms. This mechanism is described as healthy neural structures not formerly used for a given purpose that are developed or reassigned to do functions formerly subserved by the lesioned area.

What is functional reorganization/unmasking neural reorganization.

200

This term describes when a lesions/damage in one region of the CNS can produce altered function in other areas of the brain not damaged or connected to the primary injury site.

What is diaschisis?

300

This term describes when functions are taken over by brain areas that did not originally manage those functions.

What is vicariation?

400

This term refers to the recovery of function based on activity of uninjured brain areas (latent areas) that normally would contribute to that function (and are capable of subserving that function).

What is redundancy?

500

This term refers to learning new strategies to compensate for deficits and to achieve a particular task.

What is functional or behavioral substitution?

Disorders of Consciousness

100

This structure is composed of cell bodies mainly in the midbrain that projects to widespread areas of the cerebral cortex via both thalamic and extrathalamic pathways and controls consciousness

What is ascending reticular activating system?

200

A patient with a recent TBI has eyes closed without spontaneous purposeful movement and on EEG does not have sleep wake cycles. She is in this type of disorders of consciousness.

What is coma?

300

This disorder of consciousness is defined by inconsistent but reproducible purposeful behaviors such as object manipulation.

What is minimally conscious state?

400

A 34 year old male had a non-traumatic brain injury 6 weeks ago. For the last 5 weeks, he has had sleep-wake cycles on EEG, but does not have awareness of self or environment. This is referred to as this type of DOC.

What is persistent vegetative state?

500

Permanent vegetative state is defined differently based on whether the injury was traumatic or non-traumatic. What is the minimum time duration for a TBI to be defined as permanent vital states.

What is >12 months. IT is 3 months after non-traumatic brain injury.

Medical Management

100

ICP levels up to what mm Hg is considered harmless.

What is 15 mm hg.

200

These are two ways to decrease intracranial pressure.

What are elevation of head of bed 30 degrees, osmotic agents, diuretics, hypertonic solutions, hyperventilation, neurosurgical decompression, and hypothermia.

300

Uncal herniation of the medial temporal lobe occurs when the medial part of the temporal lobe is displaced over the edge of the ipsilateral tentorium. This can lead to both ipsilateral and contralalteral hemiparesis as well as ipsilateral CNIII palsy. CNIII palsy has these symptoms.

What are fixed pupil dilation, ptosis, and "down and out" ophthalmoplegia.

400

This is the level that cerebral blood perfusion pressure should stay above to ensure cerebral blood flow.

What is 60 mm Hg? (calculated as CPP = MAP - ICP)

500

This cranial nerve is the most commonly injured in TBI

What is CN I?