Patho Week 3
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Questions and Answers

What percentage of traumatic brain injury cases are estimated to be mild?

  • 50%
  • 90%
  • 75% (correct)
  • 25%

    • Which age group has the highest incidence of traumatic brain injury?

  • Adults 25-40 years
  • Elderly over 65 years
  • Adolescents 15-19 years
  • Children 0-4 years (correct)

    • What is the main etiology of an epidural hematoma?

  • Trauma to cerebral cortex
  • Rupture of bridging veins
  • Venous bleed from subarachnoid space
  • Arterial bleed from the middle meningeal arteries (correct)

    • Which of the following clinical manifestations is associated with a severe concussion?

    <p>Hypotension</p> Signup and view all the answers

    Which type of traumatic brain injury results from the pooling of blood between the dura and arachnoid mater?

    <p>Subdural hematoma</p> Signup and view all the answers

    What is a common risk factor for subdural hematomas?

    <p>Head trauma from falls in the elderly</p> Signup and view all the answers

    Which symptom is NOT typically associated with mild traumatic brain injury?

    <p>Severe respiratory distress</p> Signup and view all the answers

    What does the rapid decline in level of consciousness after a lucid interval indicate in cases of epidural hematoma?

    <p>Increased intracranial pressure</p> Signup and view all the answers

    What is the most common clinical manifestation associated with an affected middle cerebral artery (MCA)?

    <p>Contralateral motor weakness</p> Signup and view all the answers

    Which of the following is a risk factor for hemorrhagic stroke?

    <p>Poorly controlled hypertension</p> Signup and view all the answers

    What is a common clinical manifestation of bacterial meningitis?

    <p>Stiff neck</p> Signup and view all the answers

    In the context of multiple sclerosis (MS), what primarily drives the pathogenesis of the condition?

    <p>Autoimmune-driven inflammation</p> Signup and view all the answers

    Which symptom is NOT typically associated with amyotrophic lateral sclerosis (ALS)?

    <p>Severe headache</p> Signup and view all the answers

    What distinguishes a complex partial seizure from a simple partial seizure?

    <p>Impaired consciousness</p> Signup and view all the answers

    Which type of seizure is characterized by sudden loss of muscle tone?

    <p>Atonic seizure</p> Signup and view all the answers

    Which factor is NOT considered a risk factor for seizure disorders?

    <p>Low-fat diet</p> Signup and view all the answers

    What is a key feature of a generalized tonic-clonic seizure?

    <p>Involuntary muscle contractions</p> Signup and view all the answers

    What symptom indicates a left-sided neglect phenomenon associated with a right-sided lesion?

    <p>Lack of awareness of the left side of the body</p> Signup and view all the answers

    Which clinical manifestation is associated with bacterial meningitis and not typically seen in viral meningitis?

    <p>Petechial rash</p> Signup and view all the answers

    Which of the following is NOT a recognized symptom in multiple sclerosis?

    <p>Severe abdominal pain</p> Signup and view all the answers

    What is a distinguishing characteristic of delirium compared to dementia?

    <p>Acute onset</p> Signup and view all the answers

    What is the primary difference between subdural hematomas and epidural hematomas in terms of bleeding type?

    <p>Subdural hematomas typically involve venous bleeding.</p> Signup and view all the answers

    Which of the following is NOT a clinical manifestation of subarachnoid hemorrhage?

    <p>Slow onset of symptoms</p> Signup and view all the answers

    In the context of primary injury from traumatic brain injury (TBI), which scenario illustrates contrecoup damage?

    <p>A brain injury occurs opposite to the site of impact.</p> Signup and view all the answers

    Which of the following describes a primary impact injury in traumatic brain injury?

    <p>An alteration in mental status with normal CT scans.</p> Signup and view all the answers

    What is an example of a secondary pathological process that may occur after a traumatic brain injury?

    <p>Ongoing cerebral ischemia</p> Signup and view all the answers

    Which symptom is commonly associated with elevated intracranial pressure (ICP)?

    <p>Sudden onset of severe headache</p> Signup and view all the answers

    What characterizes a thrombotic ischemic stroke?

    <p>Progression of symptoms over hours to days</p> Signup and view all the answers

    In which situation would an embolic stroke more likely occur?

    <p>As a result of atrial fibrillation</p> Signup and view all the answers

    What is the normal range of intracranial pressure (ICP) in adults?

    <p>10-15 mmHg</p> Signup and view all the answers

    Which risk factor is commonly associated with ischemic strokes?

    <p>Sedentary lifestyle</p> Signup and view all the answers

    Study Notes

    Traumatic Brain Injury (TBI) Epidemiology

    • Approximately 1.7 million deaths, hospitalizations, and emergency department visits occur annually in the US.
    • 75% of TBI cases are classified as mild; remaining cases are moderate to severe, indicating a poorer prognosis.
    • Highest incidence rates found in children aged 0-4 years, adolescents aged 15-19 years, and seniors over 65 years (often due to falls).

    Clinical Manifestations of TBI

    • Common symptoms: headache, sleep disturbances, nausea/vomiting, blurred vision.
    • Cognitive dysfunction: includes attentional impairments, reduced processing speed, drowsiness, and amnesia.
    • Emotional and behavioral disturbances, such as irritability, observed.
    • Severe concussions may lead to seizures, bradycardia, hypotension, and sluggish pupils.

    Types of Traumatic Brain Injury

    • Epidural Hematoma:

      • Arterial bleeding between skull and dura mater, typically due to skull fractures of the temporal or parietal bones.
      • Clinical signs include post-traumatic altered level of consciousness and potential rapid decline following a lucid interval.

    • Subdural Hematoma:

      • Venous bleeding between the dura and arachnoid mater, often following less severe trauma.
      • Symptoms vary based on the timing of the bleed: acute cases present within 1-2 days, while chronic cases manifest after 15+ days.

    • Subarachnoid Hemorrhage:

      • Bleeding into subarachnoid space; often linked to a ruptured aneurysm.
      • Characterized by sudden severe headaches, nausea, meningeal irritation symptoms, and potential cardiovascular dysfunction.

    • Intracerebral Hemorrhage:

      • Often leads to hemorrhagic stroke; involves bleeding within the brain itself.

    Primary and Secondary Injury in TBI

    • Primary Injury:

      • Immediate damage from the trauma, which can be classified as low or high velocity.
      • Includes concussive events, coup (direct) and contrecoup (opposite) injuries, contusions, and diffuse axonal injuries.

    • Secondary Injury:

      • Pathological processes following the initial injury that may worsen condition; includes cerebral edema, intracranial hemorrhage, increased intracranial pressure (ICP), and ischemia.

    Intracranial Pressure (ICP)

    • Increased ICP can lead to poor outcomes in neurological conditions, including death due to compromised cerebral perfusion.
    • Elevated ICP correlates with a 20% mortality rate; normal ICP in adults is between 5-15 mmHg.
    • Common causes include head trauma, intracranial hemorrhage, brain tumors, and cerebral edema.

    Ischemic Stroke Types

    • Thrombotic:

      • Accounts for about 80% of ischemic strokes; develops slowly, often during sleep, with symptoms progressive over hours to days.

    • Embolic:

      • Rapid onset due to embolic occlusion, associated with conditions like atrial fibrillation or recent myocardial infarction.

    Symptoms of Ischemic Stroke

    • Commonly affects the middle cerebral artery; manifestations may include hemiplegia, hemisensory loss, aphasia, and visual neglect for right-sided lesions.

    Hemorrhagic Stroke

    • Caused by intracranial hemorrhage linked to poorly controlled hypertension or traumatic incidents like ruptured aneurysms.
    • Symptoms can mirror those seen in subarachnoid hemorrhage.

    Meningitis

    • Inflammation of the meninges, primarily caused by bacterial infections (e.g., Streptococcus pneumoniae, Neisseria meningitidis).
    • Risk factors include lack of childhood immunizations; clinical signs include fever, headache, nuchal rigidity, photophobia, altered consciousness, and seizures.

    Multiple Sclerosis (MS)

    • Chronic inflammatory disease of the CNS with relapsing-remitting or progressive symptoms.
    • Etiologically linked to autoimmune processes leading to demyelination and axonal degeneration, primarily affecting females aged 17-37.
    • Clinical manifestations include numbness, weakness, visual disturbances, impaired gait, and bladder dysfunction.

    Amyotrophic Lateral Sclerosis (ALS)

    • Progressive degenerative disease impacting upper and lower motor neurons; typically fatal within three years of diagnosis.
    • Characterized by limb weakness, bulbar symptoms (dysarthria, dysphagia), and preserved sensations.

    Seizure Disorders

    • Defined by transient neurological signs due to the abnormal firing of neurons; seizures can be partial (simple and complex) or generalized (absence, atypical absence, myoclonic, atonic, tonic-clonic).
    • Risk factors include alcohol use, brain injury, CNS infections, and metabolic abnormalities.

    Delirium vs. Dementia

    • Delirium: Acute change in consciousness; often reversible, involves hallucinations, and impaired memory.
    • Dementia (Major Neurocognitive Disorder): Gradual onset, often irreversible, with memory impairments and a preserved level of consciousness.

    Alzheimer Disease (AD)

    • A major form of neurocognitive disorder marked by insidious onset and various symptoms related to cognitive decline.
    • Age is a primary risk factor; genetic influences also play a significant role.

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