Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key


Play button


Play button




Click to flip

32 Cards in this Set

  • Front
  • Back
Trauma is the leading cause of mortality and morbidity in people aged _______
1-40 and in more than half of them head injury is a significant contributing factor
GCS score -- 3 factors
eye opening, best verbal response, best motor response
max and min GCS scores
max 15
min 3
4 Signs of Basal skull fracture:
Raccoon's eyes (periorbital ecchymoses)

Battle's sign (postauricular ecchymoses)


CSF leakage from nose or ear
Most common focal intracerebral lesion in patient with severe brain injury
Acute subdural hematoma
what is an acute subdural hematoma?
tearing of the bridging veins between the cerebral cortex and the venous sinuses --> subdural hematomas that can occur spontaneously or with mild trauma, especially in the elderly
Epidural hematoma is usually from..?
epidural <-- a skull fracture that lacerates the middle meningeal artery --> and accumulation of blood between the dura and the skull
Classic presentation of an epidural hematoma?
a brief loss of consciousness followed by a lucid interval for several hours and then deterioration in the level of consciousness, with hemiparesis on the siden opposite the hematoma as well as ispilateral pupillary dilation
What do epidural hematomas look like on CT scan?
hyperdense with a biconvex (crescent moon) shape.
Immediate treatement for epidural hematomas?
emergency surgery. Mortality is relatively low (5-10%) provided that the hematoma is diagnosed and treated with surgical drainage within a few hours
Mortality and morbidity for epidurals?
relatively low - 5-10% provided hematoma is dx and tx with surgical drainage in a few hours
What do contusions and intracerebral hematomas looks like on head CT
high-density areas on head CT, representing brusies of the brain parenchyma.
Where do contusions and intracerebral hematomas occur?
typically where areas of sudden deceleration of the head causes the brain to impact on bony prominences. The majority occur in the inferior frontal or temporal lobes
2 types of contusions?
Coup - directly below site of impact

contrecoup - abnormalities located on opposite side of brain as it is thrust against the skull
Tx for contusions and intracerebral hematomas
tx is typically following clinically and with follow-up head CT scans.

Surgery is reserved for patients with significant mass effect and clinical deterioration
Subarachnoid Hemorrhage
-bleeding into the subarachnoid space.

Head trauma is the most common cause of SAH.
Management of patients with SAH
monitoring for cerebral vasospasm, increased intracranial pressure, and acute hydrocephalus
Diffuse axonal injury/ Diffuse axonal shearing is caused by
rotation acceleration and deceleration of the head.
It is most commonly seen in motor vehicle accidents.

It is also the most common presumed cause of coma in patients with closed head injury in the absence of cerebral hemorrhage of other space occupying lesion on head CT scan.
Diffuse axonal injury is characterized by:
gross and microscopic axonal changes in the cerebral white matter and small hermorrhagic lesiions of the corpus collosum and brainstem (Duret Hemorrhages)
A mass lesion of tumor or blood will cause the ICP to rise after which compensatory mechanisms?
decreased CSF and venous blood in skull
4 herniation syndromes
Uncal (Tentorial) Herniation
Cingulate Herniation
Central (transtentorial) Herniation
Tonsillar Herniation
Cause of Uncal (tentorial) herniation:
mass lesion of the middle cranial fossa
Where is the uncus?
the uncus is the inferomedial portion of the temporal lobe
Where does the uncus herniate?
downward into the posterior fossa between the rostral brainstem and the tentorium cerebelli.
Symptomes of Uncal (tentorial) herniation
Typically the 3rd cranial nerve is entrapped --> unilateral dilated pupil.

As the herniation progresses hemiparesis and alteration of consciousness can occur. With eventual brainstem signs and changes in respiratory patterns. Eventually in can lead to death
Cause of Cingulate Herniation?
A mass lesion, usually in the frontal lobes --> displacement of the cingulate gyrus across the falx cerebri in the frontal midline.
Symptoms of Cingulate Herniation?
There are no specific signs or symptoms of Cingulate Herniation but it can frequently be seen on CT scan
Cause of Central (transtentorial) herniation
a large supratentorial mass pushes the diencephalon and midbrain through the tentorial opening
Symptoms of Central (transtentorial) herniation
altered consciousness, bilateral small reactive pupils, and decorticate posturing followed by decerebrate posturing.

Decorticate, or flexor, posturing - present with the arms flexed, or bent inward on the chest, the hands are clenched into fists, and the legs extended.

Decerebrate, or extensor, posturing - the arms are extended by the sides, the head is arched back, and the legs are extended

Cheyne-Stokes respirations (crescendo-decrescendo pattern followed by respiratory pause) can be seen.
Cause of Tonsillar herniation
posterior fossa mass --> herniation of the cerebellar tonsils through the foramen magnum.

Cerebellar tonsils then compress the medulla --> respiratory arrest. Usually fatal
1st thing to do if herniation or increased ICP is suspected?
get a CT
After CT, if herniation or increased ICP is suspected, what should you do?
1) elevate head of the pts bed 30 degrees in order to dispace CSF

2) Hyperventilate pt to achieve a PCO2 between 25 and 30 mmHg, which --> cerebral vasoconstriction an a reduction of intracranial volume which --> decreased ICP

3) Mannitol is an osmotic diuretic that temporarily decreases intracranial volume and pressure

4) Loop diuretics (furosemide) can cause diuresis.

Treat the underlying condtion

ie. surgical drainage or shunt for large parenchymal hemorrhage or epidural hematoma