tbi, sci' s lecture part 2
TRANSCRIPT
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Categories of Diffuse Brain Injury
5
DAIMild (coma > 6 -24 hrs)
Persistent residual cognitive, phsychologic,
sensorimotor deficit
Decorticate and decerebrate posturing
Experience prolonged period of stupor
Permanent deficit in memory, attention,
abstraction, reasoning, problem solving,executive function, vision or perception
and language.
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DecorticateDecorticate vsvs DecerebrateDecerebrate
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Moder teModer te
WidespreadWidespread i ir ent erebr l ortex, diencephalon,i pair ent cerebral cortex, diencephalon,
tearingofaxons bothhemispheretearingofaxons bothhemisphere
TransitorTransitor decorticationdecortication orordecerebrationdecerebration..
Unconsciousness lastingdaysor weeks.Unconsciousness lastingdaysor weeks.
Onawakening theperson isconfusedandsuffer longOnawakening theperson isconfusedandsuffer longperiodofpostperiodofpost--traumatictraumaticanterogradeanterograde and retrogradeand retrograde
amnesia.amnesia.
Categoriesof Diffuse Brain Injury
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SevereSevere (LO week)(LO week)
Severemechanical disruptionsofaxons inSeveremechanical disruptionsofaxons in
both hemisphere, diencephalonand brainstem.both hemisphere, diencephalonand brainstem.
Immediate autonomic dysfunction that disappearImmediate autonomic dysfunction that disappear
in few weeks.in few weeks.
IIII -- daysafter injury.daysafter injury.
compromisedcoordinatedmovements withverbalcompromisedcoordinatedmovements withverbaland writtencommunication, inability to learnand reason,and writtencommunication, inability to learnand reason,
inability tomodulatebehavior.inability tomodulatebehavior.
ategoriesof Diffuse Brain Injury
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Compound FractureCompound FractureObject strikes the head
with great force or
head strike the objectforcefully temporal or
occipital blow upward
impact of cervical
vertebrae (basilar skull
fracture)
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Penetrating InjuryPenetrating InjuryMissile (bullets) or
sharp projectile
(knives, axes,screwdriver)
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CENTRIPETA APPR ACH
(outside to inside)
Scalp
Cranium
Subdural
Subarachnoid
Intra-parenchymal Intra-ventricular
- Epidural
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Subgaleal
Subdural
Epi-arachnoidSubarachnoid
Parenchymal Hemorrhage
Intra-ventricular
Cephalohematoma
Subperiosteal uter Table
Epidural (Extradural)
Subperiosteal Inner Table
Traumatic Hemorrhage:
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EPID RA HEMAT MAEPID RA HEMAT MA
Source of BleedingSource of Bleeding
Arterial (high pressure)
Venous (lo pressure)
High flo , lo pressure
Diploic veins (Fx)
Marro sinusoids
MENINGEA VESSE S
D RA SIN S
THERS
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Epidural Hematoma:
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Trauma -> fracture & concussion
Tearing/stripping of both layers
from inner table
aceration of outer periosteallayer
aceration of meningeal vessels
Inner (meningeal dura) intact
Blood bet een naked bone anddura
NORMAL art rial pr ur
continu to di ct
EPID RA HEMAT MA
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EPID RA HEMAT MAEPID RA HEMAT MA
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EPID RA HEMAT MAEPID RA HEMAT MASignificant trauma
Fracture & concussion (l.o.c)
Delayed neurologic Sx (hrs. ater)
Herniation, coma and death
Lucid Int rval pt Wakes Up
40% pts.
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SUBDURAL HEMATOMASUBDURAL HEMATOMA
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SUBDURAL HEMATOMASUBDURAL HEMATOMA
HEMATOMA TYPESOF INJURY ONSETOFS/S CLINICALMANIFESTATION
Acute Severe Head Injury ithin hours Rapid deterioration to dro siness,
agitation, stuporous, coma, signs of
brain stem compression, pupil
dilation contralateral hemiparesis.
Subacute Moderate Head
Injury
2 hours to eeks
after
ucid , Dro siness, stuporous coma,
Increase ICP
Chronic Mild Head Injury eeks - months
after
Dull headache, slo ness in thinking,
apathy, dro siness, contralateral
hemipareresis, progressive
neurologic changes, aphasia,
papilledema, C changes.
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INTRACEREBRA HEMAT MAINTRACEREBRA HEMAT MA
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