ABPN Brain Injury Medicine flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Diffuse axonal injury

Shear injury from rotational acceleration-deceleration at gray-white junctions, classically involving the corpus callosum, dorsolateral brainstem, and parasagittal white matter; a major cause of prolonged coma.

Cerebral perfusion pressure

CPP equals mean arterial pressure minus intracranial pressure; adult target is roughly 60-70 mmHg to maintain adequate cerebral blood flow after severe TBI.

Monro-Kellie doctrine

The intracranial vault has fixed volume containing brain, blood, and CSF; an expanding mass is initially offset by displacing CSF and venous blood before ICP rises steeply.

Chronic traumatic encephalopathy

Neurodegenerative tauopathy defined by perivascular hyperphosphorylated tau tangles at the depths of cortical sulci, associated with repetitive head impacts, distinct from Alzheimer pathology.

Second-impact syndrome

Malignant cerebral edema and catastrophic deterioration occurring when a second head impact happens before recovery from an initial concussion; a rationale for graded return-to-play protocols.

Glasgow Coma Scale

Score of eye opening (1-4), verbal response (1-5), and motor response (1-6); severe 3-8, moderate 9-12, mild 13-15, assessed after resuscitation.

Anoxic-ischemic encephalopathy

Brain injury from global hypoperfusion or hypoxia, as in cardiac arrest, with selective vulnerability of hippocampal CA1, neocortex, cerebellar Purkinje cells, and basal ganglia.

Post-traumatic amnesia

Period after injury during which the patient is unable to form continuous memories; duration >24 hours indicates at least moderate injury and >7 days indicates severe injury.

FOUR score

Coma scale adding brainstem reflexes and respiratory pattern to eye and motor responses; useful when the patient is intubated because it avoids a verbal component.

Confusion Assessment Method

Bedside delirium instrument requiring acute onset with fluctuation plus inattention, plus either disorganized thinking or altered level of consciousness.

Canadian CT Head Rule

Clinical decision rule identifying mild TBI patients who need head CT based on loss of consciousness, amnesia, vomiting, age, and mechanism of injury.

Hyperosmolar therapy

Use of mannitol or hypertonic saline to create an osmotic gradient that draws water from brain tissue and lowers intracranial pressure; monitor osmolarity and renal function.

Decompressive craniectomy

Surgical removal of part of the skull to allow brain swelling and lower refractory intracranial pressure; reduces mortality but may increase severe disability in survivors.

Post-traumatic seizure prophylaxis

Antiseizure medication, typically phenytoin or levetiracetam, given for the first 7 days after severe TBI to prevent early seizures; it does not prevent late epilepsy.

CRASH steroid trial

Randomized trial showing corticosteroids increased mortality in severe TBI, establishing that steroids are contraindicated in this setting.

Constraint-induced movement therapy

Rehabilitation approach restricting the less affected limb while intensively training the affected limb, improving upper extremity function in selected hemiparetic patients.

Coma Recovery Scale-Revised

Standardized assessment for disorders of consciousness that grades auditory, visual, motor, oromotor, communication, and arousal functions to distinguish vegetative from minimally conscious states.

Spasticity management ladder

Graded approach to increased muscle tone: positioning and stretching first, botulinum toxin for focal tone, and intrathecal baclofen or systemic agents for diffuse tone.

Dysexecutive syndrome

Frontal lobe injury pattern with impaired planning, disinhibition, apathy, and poor insight; IQ may be preserved despite significant functional impairment.

Amantadine

Dopaminergic agent that accelerates functional recovery in disorders of consciousness during the first four weeks of treatment; benefit may wane after discontinuation.

Apathy versus depression

Apathy lacks dysphoria and is characterized by reduced goal-directed behavior; it may respond to dopaminergic agents and is often under-recognized after TBI.

Heterotopic ossification

Abnormal bone formation in soft tissue near joints after TBI, presenting with warmth, swelling, and reduced range of motion; alkaline phosphatase rises early.

Paroxysmal sympathetic hyperactivity

Episodic tachycardia, hypertension, tachypnea, fever, diaphoresis, and dystonia after severe TBI; treat triggers and use beta-blockers, gabapentin, or clonidine.

Cerebral salt wasting

Hyponatremia with volume depletion after brain injury from renal sodium loss; distinguished from SIADH, which is euvolemic, and treated with volume and sodium replacement.

Post-traumatic hypopituitarism

Deficiency of one or more pituitary axes after moderate-severe TBI; screen cortisol, thyroid, and gonadal function when symptoms suggest endocrine dysfunction.

Decision-making capacity

Task-specific clinical determination requiring understanding, appreciation, reasoning, and ability to express a choice; it is not a global or permanent status.

Substituted judgment

Surrogate decision standard applying what the patient would have wanted based on known prior wishes, used when the patient lacks capacity and prior preferences are documented.

Mandated reporting

Legal obligation for clinicians to report suspected abuse, neglect, or exploitation of vulnerable adults, including those with acquired brain injury, to designated agencies.

Glasgow Outcome Scale-Extended

Eight-category functional outcome measure ranging from death through vegetative state and lower to upper good recovery, commonly used in TBI trials and rehabilitation.

Informed consent

Authorization for treatment requiring disclosure of diagnosis, proposed intervention, alternatives, and material risks, plus patient voluntariness and decision-making capacity.

Therapeutic hypothermia in TBI

Cooling strategy that has not shown outcome benefit in severe adult TBI randomized trials; normothermia and aggressive fever treatment are targeted instead.

Vestibular rehabilitation

Exercise-based therapy for dizziness and balance dysfunction after concussion; benign paroxysmal positional vertigo responds to canalith repositioning maneuvers.