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Second Exam For CHSO 404 – Questions & Answers
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Second Exam For CHSO 404 – Questions & AnswersBrain injury causes ✔️Ans - direct trauma or vascular changes that result
in lack of perfusion or hemorrhage of brain tissue
-can give rise to hypoxia and edema
-can increase ICP and result in herniation
Brain injury manifestations ✔️Ans - loss of consciousness, altered motor
and respiratory responses, change in the pupils
Traumatic brain injury ✔️Ans - varying impairments depending on
cause, severity, and brain region involved
-may be reversible or self resolving depending on the severity of injury
-head injury and subsequent damage to brain, possibly cranial nerves as
well
-head injury usually refers to a TBI, though it may involve damage to other
structures (i.e. scalp & skull)
-TBI is major cause of death and disability
-common causes - falls, vehicle accidents, violence
-head injuries can be closed (intact skull) or open (skull fracture)
-brain trauma occurs from the injury itself but can often lead to secondary
injury from altered blood flow and intracranial pressure
-symptoms - dependent on whether TBI is diffuse or local, the severity, and
part of brain involved
Cerebrovascular disease ✔️Ans - vascular injuries such as stroke that
may present with similar manifestations as TBI
-cerebrovascular brain injury and neurological dysfunction caused by
disruption of blood flow to the brain
-includes disorders of cerebral vessels, TIAs, stroke
-causes - HTN, HLD
-compromised profusion gives rise to CVD, with underlying causes of
thrombosis (40% of cases), embolism (30%), and aneurysm (20%)
Circle of Willis ✔️Ans - -a protective circulation system that facilitates
blood flow to the brain and allows collateral flow to compromised regions
,Spinal cord injuries (SCIs) ✔️Ans - the result of injuries to cranial nerves
that often accompany TBIs
Seizures ✔️Ans - accompany many neurological conditions, including
TBIs and cerebrovascular disease
Consciousness ✔️Ans - -a state of awareness and orientation to
surroundings, and the ability to respond to stimuli
-determined by the reticular activating system (runs through brain stem to
both hemispheres)
-a continuum - including confusion, delirium obtundation, stupor and coma
-coma refers to the disruption of the conscious state, resulting in a lack of
wakefulness and awareness
-evaluated with the GCS (assesses opening of eyes and verbal/ motor
responses
-varying degrees of changes in pupillary response, motor function, and
respiratory response
-changes depend upon the extent and location of damage
-loss of consciousness implies diffuse brain injury
-focal neurological deficit does not usually disrupt consciousness
Concussion ✔️Ans - -caused by sudden movement of brain as during a
sports injury, car accident, or fall
-most common form of TBI
-diffuse, but not transient and reversible
-associated with temporary loss of consciousness, changes in respirations,
hypotension, bradycardia, and amnesia (depending on length of
consciousness loss)
Cerebral contusion ✔️Ans - -bruising of brain tissue
-associated with small petechial hemorrhages that leak into brain tissue
-present on 20-30% of severe head injuries
-associated with blunt trauma in closed head injuries
-partially reversible, depending on severity
Hematoma ✔️Ans - focal injury involving collection of blood in or around
the brain, often caused by hemorrhage
,Primary brain injury ✔️Ans - -refers to structural damage at the moment
of trauma to neurons, glial cells, and blood vessels
Secondary brain injury ✔️Ans - -occurs as body responds to primary
injury
-includes changes to blood flow (ischemia, hypoxia)
-includes edema and subsequent intracranial pressure, which can lead to
brain cell death or herniation
-can significantly worsen the damage from primary injury, leading to a
large number of TBI deaths
Types of secondary brain injury ✔️Ans - -hypoxic and ischemia injury -
result from decreased oxygen availability in brain tissue - ischemia reduces
availability of glucose and removal of waste products
-cerebral edema - from accumulation of fluids - causes include damage to
BBB or swelling of brain cells due to inadequate waste removal
-ICP - results from fluid accumulation due to inflammatory or edematous
processes - resultant reduction in tissue perfusion can lead to hypoxia and.
neuronal death - ICP can also lead to herniation (brain pushed out of
confined area into area of lower pressure)
Hemorrhage ✔️Ans - -TBI may result in hemorrhage into the cranial
vault from epidural, subdural, or intracerebral sources leading to
accumulation of blood and increased ICP
-epidural - material blood (middle meningeal artery) into extradural space
between skull and outermost brain layer
-subdural - most common meningeal hemorrhage where blood accumulates
between dura mater and arachnoid mater - caused by trauma,
coagulopathy, alcoholism - often found in the connecting veins in the
cerebral cortex
-intracerebral - disruption of the cerebral vessels within the brain
parenchyma, resulting in neurological deficits - commonly found in frontal
and temporal lobes
, Stroke ✔️Ans - -sudden focal neurological deficit from a vascular disease
-non traumatic disruption of the blood supply to an area of the brain
-causes - occlusion of cerebral arteries by ischemia (87% of time) or
hemorrhage (13%)
-ischemic stroke - results from obstructed blood flow; can lead to ischemia,
potentially irreversible necrosis and cerebral infarction; may also be
caused by poor perfusion (shock)
-hemorrhagic stroke - results from intracranial hemorrhage; occurs deep in
the parenchyma or near the surface of brain; often has HTN as an
underlying cause
*stroke is a medical emergency that can cause permanent brain damage or
death
Aneurysm ✔️Ans - -refers to localized dilation in a blood vessel wall that
can rupture and lead to hemorrhage
-most ruptures are due to developmental defects (95%)
-a defect in the tunica media (middle layer) can for a protruding sac
(saccular or berry aneurysm)
-often go undetected through life
-can result in aneurysmal subarachnoid hemorrhage
-has clinical manifestations that range from mild headache to coma and
death
Encephalitis ✔️Ans - -infection and inflammation of brain tissue or
spinal cord
-caused by viruses - equine encephalitis, west nile, herpes, HIV,
cytomegalovirus, rabies, and possibly prion virus
Meningitis ✔️Ans - -infection of meninges (membranes that cover brain)
-caused by bacterial infection - streptococcus pneumonia, neisseria
meningitidis, haempphilus influenzae
-also caused by viruses - enteroviruses, coxsackie virus, adenovirus,
herpes, HIV, Epstein Barr virus, CMV
Parkinson's disease ✔️Ans - -degenerative disease of the CNS
characterized by movement disorder
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