CSD 444: Exam 1 Questions With Complete Solutions
1.) Cerebral Edema Correct Answers Swelling in the brain.
Accumulation of fluid causes brain tissue to swell.
• Fluid may accumulate between the brain and skull, within the
ventricles, or within brain tissues.
• Edema almost always surrounds the primary site of brain
injury, but can occur throughout the brain, especially following
a diffuse injury
• Cerebral Edema is a contributor to increased intracranial
pressure
• Edema and increased intracranial pressure usually becomes
significant within 4 to 6 hours post injury and peaks in 24 to 36
hours
2 TBI types Correct Answers A. Penetrating head injury or
open head injury - occurs when the skull is fractured or
perforated and the meninges torn or lacerated (e.g. missile)
Meninges: 3 layers- dura mater, arachnoid mater, and pia mater
B. Nonpenetrating head injury or closed head injury - occurs if
the skull and meninges remain intact (e.g. fall)
2.) Traumatic Hydrocephalus Correct Answers Swelling of
brain tissues can compress the passages through which CSF
moves between the ventricles and from the ventricles to the
subarachnoid space.
The CSF pressure within the ventricles increases, causing
- expansion of the ventricles
- compression of brain structures
,- and elevation in intracranial pressure
3.) Increased Intracranial Pressure Correct Answers increased
pressure inside the cranial vault. pressure increased inside skull
is most dramatic /deadly consequence
Most frequent cause of death from TBI
Typically due to cerebral edema, traumatic hydrocephalus or
hemorrhage
• The pressure build-up compresses and displaces brain tissues,
with increasing neurologic impairment as the pressure increases.
• Brain and skull can tolerate low increases in pressure
• IF extreme, elevated pressure distorts, compresses, stretches
and pushes
• Prolonged EIP causes brain damage, coma, death, typically
due to herniation : tissue pushed through cranial openings
• Increased intracranial pressure is the most frequent cause of
death from TBI, and one of the primary concerns in medical
management of TBI is monitoring and controlling intracranial
pressure.
• To monitor intracranial pressure a pressure transducer is
inserted into the CSF through a hole in the skull
4 major types of hematoma Correct Answers 1. Epidural
hematoma
2. Subdural hematoma
3. Subarachnoid hematoma
4. Intracerebral hematoma
,4.) Ischemic Brain Damage Correct Answers Blood supply is
blocked; brain tissue dies
• More common in severe TBI
• Typical sites of damage: basal ganglia and main cerebral
arteries
• INFARCTION: is tissue death (necrosis) caused by a local
lack of oxygen, due to an obstruction of the tissue's blood
supply; resulting lesion is referred to as an infarct
5.) Alterations in the Blood Brain Barrier Correct Answers o
Regulation of movement of substances between blood and brain
is disturbed
o More common in severe TBI
o Normally excluded substances enter brain
Proteins
Neurotransmitters
• Contribute to accumulation of fluid, cerebral edema and loss of
function
Acceleration injuries Correct Answers (moving head injuries) -
produced when the unrestrained head is struck by a moving
object or the moving head strikes a stationary object.
Acceleration injuries can also occur when the rapidly moving
head abruptly changes direction without striking a surface
(shaken baby syndrome).
• When TBI is caused by acceleration, the brain and brainstem
receive indirect damage, most of it is caused by their movement
inside the skull
, • This movement of the brain inside the skull is the result of
forces generated either when
- the head is rapidly moving through space and comes to a
sudden stop (striking the ground after a fall),
OR
- the head is at rest and is suddenly accelerated (struck by a
blunt object)
Acute medical evaluation for TBI Correct Answers First
responders and emergency room personnel will evaluate an
acute TBI patient using the Glasgow Coma Scale (GCS) (READ
TEXT p. 308)
*Assesses 3 areas
*A high GCS score is better
3 areas:
best eye response
best verbal response
best motor response
EMT or doctor will add up the scores from all three areas;
patients are ranked into three levels of severity based on GCS
score. (added up scores below)
3-8 Severe Head Injury
9-12 Moderate Head Injury
13-15 Mild Head Injury
Additional secondary consequences of TBI Correct Answers •
INFECTION caused by germs, bacteria, carried by foreign
objects, hair, skull bone fragments, skin into the brain
1.) Cerebral Edema Correct Answers Swelling in the brain.
Accumulation of fluid causes brain tissue to swell.
• Fluid may accumulate between the brain and skull, within the
ventricles, or within brain tissues.
• Edema almost always surrounds the primary site of brain
injury, but can occur throughout the brain, especially following
a diffuse injury
• Cerebral Edema is a contributor to increased intracranial
pressure
• Edema and increased intracranial pressure usually becomes
significant within 4 to 6 hours post injury and peaks in 24 to 36
hours
2 TBI types Correct Answers A. Penetrating head injury or
open head injury - occurs when the skull is fractured or
perforated and the meninges torn or lacerated (e.g. missile)
Meninges: 3 layers- dura mater, arachnoid mater, and pia mater
B. Nonpenetrating head injury or closed head injury - occurs if
the skull and meninges remain intact (e.g. fall)
2.) Traumatic Hydrocephalus Correct Answers Swelling of
brain tissues can compress the passages through which CSF
moves between the ventricles and from the ventricles to the
subarachnoid space.
The CSF pressure within the ventricles increases, causing
- expansion of the ventricles
- compression of brain structures
,- and elevation in intracranial pressure
3.) Increased Intracranial Pressure Correct Answers increased
pressure inside the cranial vault. pressure increased inside skull
is most dramatic /deadly consequence
Most frequent cause of death from TBI
Typically due to cerebral edema, traumatic hydrocephalus or
hemorrhage
• The pressure build-up compresses and displaces brain tissues,
with increasing neurologic impairment as the pressure increases.
• Brain and skull can tolerate low increases in pressure
• IF extreme, elevated pressure distorts, compresses, stretches
and pushes
• Prolonged EIP causes brain damage, coma, death, typically
due to herniation : tissue pushed through cranial openings
• Increased intracranial pressure is the most frequent cause of
death from TBI, and one of the primary concerns in medical
management of TBI is monitoring and controlling intracranial
pressure.
• To monitor intracranial pressure a pressure transducer is
inserted into the CSF through a hole in the skull
4 major types of hematoma Correct Answers 1. Epidural
hematoma
2. Subdural hematoma
3. Subarachnoid hematoma
4. Intracerebral hematoma
,4.) Ischemic Brain Damage Correct Answers Blood supply is
blocked; brain tissue dies
• More common in severe TBI
• Typical sites of damage: basal ganglia and main cerebral
arteries
• INFARCTION: is tissue death (necrosis) caused by a local
lack of oxygen, due to an obstruction of the tissue's blood
supply; resulting lesion is referred to as an infarct
5.) Alterations in the Blood Brain Barrier Correct Answers o
Regulation of movement of substances between blood and brain
is disturbed
o More common in severe TBI
o Normally excluded substances enter brain
Proteins
Neurotransmitters
• Contribute to accumulation of fluid, cerebral edema and loss of
function
Acceleration injuries Correct Answers (moving head injuries) -
produced when the unrestrained head is struck by a moving
object or the moving head strikes a stationary object.
Acceleration injuries can also occur when the rapidly moving
head abruptly changes direction without striking a surface
(shaken baby syndrome).
• When TBI is caused by acceleration, the brain and brainstem
receive indirect damage, most of it is caused by their movement
inside the skull
, • This movement of the brain inside the skull is the result of
forces generated either when
- the head is rapidly moving through space and comes to a
sudden stop (striking the ground after a fall),
OR
- the head is at rest and is suddenly accelerated (struck by a
blunt object)
Acute medical evaluation for TBI Correct Answers First
responders and emergency room personnel will evaluate an
acute TBI patient using the Glasgow Coma Scale (GCS) (READ
TEXT p. 308)
*Assesses 3 areas
*A high GCS score is better
3 areas:
best eye response
best verbal response
best motor response
EMT or doctor will add up the scores from all three areas;
patients are ranked into three levels of severity based on GCS
score. (added up scores below)
3-8 Severe Head Injury
9-12 Moderate Head Injury
13-15 Mild Head Injury
Additional secondary consequences of TBI Correct Answers •
INFECTION caused by germs, bacteria, carried by foreign
objects, hair, skull bone fragments, skin into the brain
