What is a subdural hematoma?
- Rupture of the bridging veins in the brain caused by a sudden change in velocity of the brain w/ respect to crainal vault (a blow to the head)
- There is a much slower spread of blood due to the decreased pressure in veins as compared to arteries
When do the major symptoms of a subdural hematoma begin?
What causes "poisoning" of the tissue after a subdural hematoma?
Leakage of blood into the gray matter of brain -> multiple hematomas can lead to decreased brain maturity (pt may come across as silly or childish)
Subdural hematomas predispose the pt to _____________.
Subarachnoid hemmorhagic stroke
What are the signs of a subdural hematoma?
- Similar to the epidural hematoma:
- Non-communicating hydrocephalus
What is a brain parenchymal injury?
Trauma to the brain tissue
A concussion is characterized by what?
- Sudden & transient neurological deficit secondary to mechanical forces
- Loss of conciousness
- Retrograde amnesia
- Fxnal impairement of the reticular formation of the brain (causes the amnesia)
A loss of consciousness due to a concussion has a direct correlation b/w ____________ & ____________.
duration of loss of conciousness & severity of neurological injury
What is retrograde amnesia?
Loss of memory about events just prior to & immediately after the injury
What is a contusion?
- Hemorrhage into the superficial brain parenchyma due to a blunt trauma -> leads to real anatomical changes in the brain
- Traumatic subarachnoid hemorrhage may result from contusion
What are the 2 types of contusions?
Coup & contra coup
What is a coup?
Happens when the person's head is not moving & is hit by a moving object -> damage is on the side/site of contact
What is a contra-coup?
Happens when the person's head is not moving & is hit by a moving object-> damage occurs in the brain on the opposite side of contact
What is diffuse axonal injury?
Elongation or tears of axons in the white matter due to and acceleration/deceleration injury (whiplash)
Diffuse axonal injury affects what part of the brain?
Corpus callosum & ventricular areas
What are axonal spheroids?
- Little vessicles filled w/ amyloid precusor protein (APP)
- They indicate the degeneration of damage axons
- Common cause of future dimentia
What is a laceration?
- Rupture or tear of the brain tissue causing irreversible changes
- The most serious
What are the complications of a basilar skull fracture?
- Opening of the cranial fossa to the outside may result in infection (meningitis)
- If there is a shift of the basal skull, breakage of the vessels & nerves may occur
Fracture of the orbital plate results in what?
- Periorbital subcutaneous hemmorrhage
What is rhinorrhea?
Leakage of CSF thru the nose due to fracture of the orbital plate
What is periorbital subcutaneous hemorrhage?
- Bilateral bruising around the eyes due to fracture of the orbital plate
- Raccoon or panda bear sign
Fracture of the occipital or temporal bone may result in what?
What is otorrhea?
Leakage of CSF thru the ears due to fracture of the occipital or temporal bone
What is battle sign?
post auricular bruising/hematoma due to fracture of the occipital or temporal bone
What is RA?
- Systemic, chronic inflammatory disease that affects principally the jts & sometimes many organs/tissue throughout the body
- M:F 1:4
- 1% of population
RA has a predilection for which part of the spine?
What is the leading cause of death in RA?
What MUST be present in an RA diagnosis?
Joint swelling & inflammation
RA is characterized by what?
- Non-suppurative proliferative synovitis (not caused by infection)
- In time leads to the destruction of articular cartilage & progressively disabling arthritis
What is the etiology of RA?
- There is a genetic predisposition associated w/ genetic markers HLAB-DR4 & DR1
What is rheumatoid factor?
- Formation of IgG & IgM antibodies against Fc part of the IgG immunoglobin.
- IgG attacks itself
What is pannus?
- Hyperplasia of the synovial cells that looks like granulation tissue
- Results in the destruction of the cartilage & underlying bone tissues
What joints are MC affected by RA?
- Small joints of the hands (2-5 MCP) and foot
- Usually symmetrical
The inflammatory pattern of pain in RA includes what?
- Pain & joint stiffness in the morning
- Minimal pain in the evening as the day progresses
- Pain relieved by exercise
Advanced RA leads to what?
- Severe deformity of the hands w/ destruction of jts
- Local osteopenia
- Peri-articular osteopenia
- Destruction &/or fusion of the carpal bones
- Swan neck deformity
- Boutinniere deformity
- Foot involvement
- Knee involvement
- Hip involvement
- Rheumatoid nodules
Severe deformity of the hands due to RA is characterized by what?
- Ulnar deviation of the hands w/ destruction of jts
- Atrophy of the lubricales & interossei muscles
- Wrist arthritis
- Ganglionic cyst aka tenosynovitis or tendonitis- due to inflammation of the tendon
What is swan neck deformity?
- Hyperextension of the PIP
- Hyperflexion of the DIP
What is boutinniere deformity?
- Hyperflexion of the PIP
- Hyperextension of the DIP
Foot involvement due to advanced RA is characterized by what?
- Destruction of bones in the foot joints (MTP's except 1st) causing sharp fragments
- Calluses at the MTP's & PIPS
- Hammer (cock) toes
- Hallux valgus
- Flat foot
What is hammer (cock) toes?
Hyperflexion of the PIP's
What is hallux valgus?
- Increased laxity of ligaments b/w the heads of the metatarsals
- Heads of the metatarsals separate-> deformity
- Could be caused by RA or wearing heels
Knee involvement in advanced RA is characterized by what?
- Accumulation of exudates within the joint
What is the normal amount of fluid in the knee?
Should exercise be recommended to someone with advanced RA in the knee? Why?
- While exercise is recommended to remove fluid from jts, its not recommended for the the knee b/c the jt is unstable- movement should be passive, not against resistance
- Treatment is puncture to remove the fluid
Hip involvement in advanced RA is characterized by what?
Accumulation of fluid in the joint -> compression of ligaments of the femur head -> compression of the vessels & blood supply -> aseptic osteonecrosis of the femur head -> not curable
What are Rheumatoid nodules?
- Fibronoid necrosis
- Means that the disease has dramatically progressed
- Nodules may be hard or soft, small or large, moveable or immoveable
- MC location is just distal to the olecranon (less commonly on the sole of foot, on top of head, eyes, or lungs)
What is Caplan's syndrome?
RA lung nodules w/ interstitial fibrosis in pneumoconiosis
What is Felty's syndrome?
RA of adults including neutropenia (leukocytopenia) & hepatosplenomegaly