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25 Cards in this Set
- Front
- Back
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Epidemiology of Head Injury
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Every 5 minutes in US
-one dies, another perm. disabled |
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Causes of Brain injury
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MVA 50%
Falls 21% Violence 12% Sports 10% |
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Causes of Pediatric Head Injuries
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64% of infant less than 1yo injury
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Risk groups for head injury
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m:f 2.5:1
avg age @ injury - 29 ages 15-24 high in persons <5, >64 |
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Predisposing factors to head injury
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Alcohol before injury
History of previous TBI -1 previous 3X risk -2 previous 8X risk |
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Definition of Head Injury
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Injury to the brain
Documented loss of consciousness Amnesia of event Glascow coma scale <15 in first 24 hours May have residual cognitive, memory, behavioral, physical problems |
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What are the mechanisms of Brain Injury
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Impact Loading - 2 solid objects colliding at considerable velocity
-hammer with head, bullet with head, head on dashboard -indents skull even w/o skull fracture -results in cerebral contusions and diffuse axonal injury Impulse Loading - Sudden arresting of accel/decel but no impoact occurs -whiplash, explosions |
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Sources of Brain Injury
Fracture types |
Linear or Comminuted fractures - no displacement toward brain
-low velocity objects Depressed fractures - bone fragments toward brain surface |
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Sources of Brain Injury
Penetrating Wounds |
High velocity, risk of infection
-stick, toy, bullet |
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Sources of brain injury
CLosed head injuries |
Soft brain forced upon hard skull
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Gray Matter Contusions
Coup Contre coupe |
Coup - beneath site of impact
Contrecoupe - remote to site of impact |
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Diffuse White Matter Damage
DAI |
Axons severed b/c of shear forces
-extension synnery |
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Epidural Hemorrhage
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Occurs between skull and dura mater
Skull fractures over middle meningeal artery |
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Subdural Hemorrhage
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Rupture of veins of pia mater
Can be slow, geriatric pop. |
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Subarachnoid Hemorrhage
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Pia vessels rupture
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Intracerebral Hemorrhages
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Ruptured capillaries
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Traumatic injury to extracranial blood vessels
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Carotid artery and Vertebral Artery
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Secondary injury to brain
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Vascular changes
Changes in BV endothelium - abnormal dilation/constriction Compressive Damage - Herniation Increased ICP -Normal adult 1-10 mmHg *Don't lie them flat >20 dysfunctional >40 neurological changes Hydroencepalus Infection Seizures - secondary to pressure or scarring Cascading degeneration (edema) |
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Systemic Secondary mechanisms of BI
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Conditions that compromise oxygen and glucose supply to brain
Most susceptible areas -BG, Cerebellum, Hippocampus Causes - Arterial Hypoxemia, Arterial Hypotension, Anemia, Hyponatremia, Hypoglycemia |
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What is a Stroke?
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Sudden onset of a focal Neurological deficit resulting from vascular disease of brain
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What is a Transient Ischemic Attack?
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<24 hours of sx. 35% of TIA have CVA w/i 5 years.
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What is a Reversible Ischemic Neurological Deficit?
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Sx lasting >24 hours and <3 weeks
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Risk Factors for CVA
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BP
Cardiac Disease Hyperlipidemia Obesity Smoking Drugs Oral Contraceptives (estrogen) Age >65 years M>F Mexicans, Blacks |
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Two main kinds of strokes
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Ischemic Strokes - caused by lack of blood flow
Hemorrhagic strokes - release of blood into extracellular space |
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Thrombus vs Embolus
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Thrombus - clot formed there
Embolous - formed elsewhere and traveled in blood stream -most common in left atrium |
