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Traumatic Brain Injury

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Acute Neuro Care

Abstract

A 25-year-old male was driving in SUV on Yamuna Expressway without seatbelt. He collided against a concrete divider at a speed of 90 km/h. There was no airbag in car and windshield was shattered. His initial GCS was 12 but on arrival to casualty after 1-h transfer, GCS score was 7.

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Author information

Authors and Affiliations

  1. All India Institute of Medical Sciences, New Delhi, India

    Keshav Goyal

  2. INHS Asvini, Mumbai, India

    Rahul Yadav

Authors
  1. Keshav Goyal
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  2. Rahul Yadav
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Editor information

Editors and Affiliations

  1. Division of Neuroanaesthesiology, Department of Anaesthesiology and critical care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

    Prasanna Udupi Bidkar

  2. Senior consultant and Head, Neuroanaesthesiology & Neurocritical care, MGM Healthcare Pvt Ltd, Chennai, Tamil Nadu, India

    Ponniah Vanamoorthy

Multiple Choice Questions

Multiple Choice Questions

  1. 1.

    Indications for craniotomy for acute epidural hematoma (EDH) include all of the following except:

    1. (a).

      Pupillary anisocoria

    2. (b).

      Midline shift greater than 5 mm

    3. (c).

      Hematoma volume greater than 30 cm3

    4. (d).

      Lack of a lucid interval

  2. 2.

    The principal effect of mannitol in the treatment of elevated intracranial pressure (ICP) is:

    1. (a).

      Osmotic fluid removal from the brain

    2. (b).

      Decrease in cerebral blood flow

    3. (c).

      Free radical sequestration

    4. (d).

      Decrease in the cerebral metabolic rate

  3. 3.

    Which of these statements regarding basilar skull fractures is not true?

    1. (a).

      Basilar skull fractures occur in 7–16% of all patients with skull fractures

    2. (b).

      These fractures are often indicated by the presence of pneumocephalus on head CT in the absence of open cranial vault fractures

    3. (c).

      Prophylactic antibiotics have been demonstrated to reduce the risk of meningitis

    4. (d).

      These skull fractures are frequently accompanied by periorbital ecchymoses (raccoon’s eyes) or postauricular ecchymoses (Battle’s sign)

  4. 4.

    Which of the following statements regarding posttraumatic cerebrospinal fluid (CSF) fistulae is true?

    1. (a).

      CSF otorrhea is more likely to resolve spontaneously than CSF rhinorrhea

    2. (b).

      Posttraumatic CSF fistulae occur in 50% of all patients with basilar skull fractures

    3. (c).

      Less than one third resolve spontaneously

    4. (d).

      Meningitis occurs in less than 3%

  5. 5.

    Hypertonic saline has been demonstrated to:

    1. (a).

      Increase cerebral blood flow more than mannitol on an equimolar basis

    2. (b).

      Decrease intracranial pressure (ICP) more than mannitol on an equimolar basis

    3. (c).

      Have a shorter duration of action than mannitol

    4. (d).

      Have a greater risk of nephrotoxicity than mannitol

  6. 6.

    Risk factors for increase in the size of traumatic cerebral contusions/hemorrhages include:

    1. (a).

      Age older than 60 years

    2. (b).

      Elevation of partial thromboplastin time (PTT)

    3. (c).

      Deterioration of Glasgow Coma Scale (GCS) after resuscitation

    4. (d).

      All of the above

  7. 7.

    Which of these statements regarding prophylactic hypothermia in traumatic brain injury (TBI) is true?

    1. (a).

      Prophylactic hypothermia has been clearly demonstrated to benefit outcome from acute TBI in children.

    2. (b).

      Prophylactic hypothermia has a complication rate similar to other brain injury treatments in normothermic patients.

    3. (c).

      Prophylactic hypothermia decreases mortality, but does not improve outcome in adults with acute TBI.

    4. (d).

      Prophylactic hypothermia does not improve mortality or outcome in the treatment of adults and children with TBI.

  8. 8.

    Prophylactic anticonvulsants in the setting of traumatic brain injury (TBI) have been demonstrated to:

    1. (a).

      Decrease the incidence of early posttraumatic seizures

    2. (b).

      Decrease the incidence of both early and late posttraumatic seizures

    3. (c).

      Not alter the incidence of posttraumatic seizures but reduce the severity of posttraumatic seizures

    4. (d).

      Decrease the incidence of late posttraumatic seizures

  9. 9.

    Which of the following statements is true regarding the role of decompressive hemicraniectomy in the treatment of the patient with traumatic brain injury (TBI)?

    1. (a).

      Randomized prospective trials have shown that decompressive hemicraniectomy decreases mortality and improves outcomes

    2. (b).

      Decompressive hemicraniectomy may be effective in treating refractory intracranial pressure (ICP)

    3. (c).

      Decompressive hemicraniectomy has no role in the treatment of increased ICP in the patient with TBI and should only be used to treat the malignant middle cerebral artery (MCA) syndrome

    4. (d).

      Decompressive hemicraniectomy should never be performed in patients younger than 18 years

  10. 10.

    Indications for intracranial pressure (ICP) monitoring include all of the following except:

    1. (a).

      Severe alcohol withdrawal in the traumatic brain injury (TBI) patient

    2. (b).

      Glasgow Coma Scale (GCS) score 3–8 with an abnormal CT scan

    3. (c).

      Normal head CT scan with any two of these features: age older than 40 years, unilateral or bilateral motor posturing, and systolic blood pressure (SBP) <90

    4. (d).

      Patients with abnormal head CT scans with GCS greater than 8 who are undergoing prolonged general anesthesia or pharmacologic muscle relaxants and will not have a neurologic examination that may be assessed

  11. 11.

    Treatments designed to decrease intracranial pressure (ICP) should begin when:

    1. (a).

      ICP increases 10 mmHg from the pressure when the ICP monitor was placed

    2. (b).

      There is a presence of any midline shift on the head CT

    3. (c).

      ICP reaches a threshold of between 15 and 20 mmHg

    4. (d).

      ICP reaches a threshold of between 20 and 25 mmHg

  12. 12.

    Which of the following statements regarding barbiturate-induced coma is true?

    1. (a).

      Has been demonstrated to be beneficial in improving patient outcomes from severe traumatic injury when used in a prophylactic fashion

    2. (b).

      Is less effective than mannitol in lowering increased intracranial pressure (ICP)

    3. (c).

      Rarely induces systemic hypotension when infused at target rates

    4. (d).

      Causes an unacceptable increase in core body temperature

Answers: 1. (a), 2. (a), 3. (c), 4. (a), 5. (b), 6. (d), 7. (d), 8. (a), 9. (b), 10. (a), 11. (d), 12. (b)

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Goyal, K., Yadav, R. (2020). Traumatic Brain Injury. In: Bidkar, P., Vanamoorthy, P. (eds) Acute Neuro Care. Springer, Singapore. https://doi.org/10.1007/978-981-15-4071-4_8

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  • DOI: https://doi.org/10.1007/978-981-15-4071-4_8

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  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-15-4070-7

  • Online ISBN: 978-981-15-4071-4

  • eBook Packages: MedicineMedicine (R0)

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