Don't be basic basics
Motor vehicle accidents
HOWEVER: in geriatric population, most common cause is falls
What is the difference between primary and secondary injury?
Primary: direct disruption of the brain parenchyma that happens immediately, not amenable to medical intervention
Secondary: Cascade of biochemical, cellular and molecular events that leads to ischemia, cerebral swelling, axonal injury and inflammation.
Consciousness is a function of which brainstem structure?
Reticular activating system
Where is the most common area to develop heterotropic ossification in a TBI patient?
Hips
Posturing due to lesions higher than cerebellum
Decorticate posturing
Most common cause of TBI in the pediatric population
Falls
Account for 72.8% of pediatric TBIs, followed by transportation related injuries, sports, then assault
I can present with a lucid interval followed by rapid deterioration.
EDH
Duration of PTA in your patient was 6 days. What is the likely severity of their TBI?
Moderate
Immediate management of TBI includes keeping CPP at what level?
>60mmHg.
BONUS 100 points: What is the calculation for CPP?
By what two mechanisms does plasticity occur?
1. Neuronal sprouting/regeneration
2. Unmasking neural reorganization
HINT: Remember PUN! Plasticity = Unmasking + Neuronal Sprouting
A patient is described as confused, but appropriate. Their ranchos level is?
Rancho level VI
CT findings show blood within the cisterns, brainstem and subarachnoid space within 24hours of injury. What am I?
SAH
Finish the statements:
Severe disability is unlikely when PTA lasts:___
Good recovery is unlikely when PTA lasts:____
<2 months, >3 months
What is the difference between immediate, early and late post traumatic seizures?
Immediate = within the first 24hours
Early = within the first week
Late = occurs after the first week
What is second impact syndrome?
Sustaining another head injury prior to recovery from a previous concussion. Can lead to rapid deterioration due to intracranial swelling and increase in ICP.
This is due to disruption of axons in the brain due to acceleration-deceleration and rotational forces that cause sheering
Diffuse axonal injury
This is the leading cause of morbidity, including impairments in cognition, behavior, arousal and coma in TBI.
DAI
BONUS 100 points: What structure in the brain is most often damaged with DAI?
Using the GOAT, the end of PTA is defined as:
the date when the patient scores 75 or higher in the GOAT on 2 consecutive days.
BONUS 100 points: According to the O-long, when is a person said to be out of PTA?
You have been consulted on a higher level TBI patient and you notice that they have had decreased appetite and altered eating habits. An MBS earlier in their hospital stay is normal. What is the likely cause?
Cranial nerve I dysfunction.
Most common HIV-associated brain malignancy?
CNS lymphoma
Name at least 3 mechanisms to describe secondary injury
Ischemia
Excitotoxicity from massive neurotransmitter release
Apoptosis
Vasogenic edema
Cytogenic edema
A mechanism to explain spontaneous return of function; injury to one region in the brain alters function in a distant region. Functions of the distant site will parallel recovery of the focal lesion.
Your patient has resumption of the sleep wake cycle on EEG, opens their eyes spontaneously, startles to auditory stimuli, and is not aware of their environment. What state are they in?
Vegetative state.
BONUS 100 points: Define persistent vegetative state.
Diagnose the condition based on the following:
Increased serum sodium, increased serum osmolality, decreased urine osmolality, isovolumetric.
Answer: Diabetes insipidus
BONUS 100 points: How do you treat?
What is the purpose of using Bromocriptine in TBI population and what is its mechanism of action?
Used as a neurostimulant, releases ENDOGENOUS dopamine. This is different from amantadine and leadopa/carbidopa as these increase exogenous dopamne.