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Galea Aponeurotica
Connective tissue sheet covering the superior aspect of the cranium
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Cranium
Vaultlike portion of the skull encasing the brain
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Sutures
Pseudojoints that join the various bones of the skull to form the cranium
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Intracranial Pressure (ICP)
Pressure exerted on the brain by the blood and cerebrocpinal fluid
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Meninges
Three membranes that surround and protect the brain and spinal cord. They are the dura mater, pia mater, and arachnoid mater
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Dura Mater
Tough layer of the meninges firmly attached to the interior of the skull and interior of the spinal column
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Pia Mater
Inner and most delicate layer of the meninges. Covers the convolutions of the brain and spinal cord.
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Arachnoid Membrane
Middle layer of the meninges
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Cerebrospinal Fluid
Fluid surrounding and bathing the brain and spinal cord.
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Cerebrum
Largest part of the brain. Consists of two hemispheres seperated by a deep longitudinal fissure. It is the seat of conciousness and the center of the higher mental functions such as memory, learning, reasoning, judgment, intelligence and emotions.
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Cerebellum
Portion of the brain located dorsally to the pons and medulla oblangata. It plays an important role in the fine controls of voluntary muscular movements
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Brainstem
The part of the brain connecting the central hemispheres with the spinal cord. Comprised of the medulla, oblangata, pons and midbrain.
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Midbrain
Portion of the brain connecting the pons and cerebellum within the cerebral hemispheres
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Hypothalmus
Portion of the brain important for controlling certain metabolic activities, including temperature regulation
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Thalamus
Switching station between the pons and the cerebrum in the brain
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Ascending Reticular Activating System
A series of nervous tissues keeping the human system in a state of conciousness
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Pons
Process of tissue responsible for the communication interchange between the cerebellum, cerebrum, midbrain and spinal cord
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Medulla Oblangata
Lower portion of the brainstem containing respiratory, cardiac and vasomotor centers
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Cerebral Perfusion Pressure
Pressure moving blood through the brain. CPP=MAP-ICP
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Autoregulation
Process that controls blood flow to brain tissue by causing alterations in blood pressure
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Monroe Kelly Doctrine
Intracranial volume = Brain volume + CSF volume + blood volume + Mass/lesion volume
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Cranial Nerves
Olfactory - sense of smell
Optic- image from retina to brain
Oculomotor- controls four of 6 occular muscles. most eye motion and eyelid motion
Trochlear - results in coordinated gaze
Trigeminal - innervates and receives sensation from mouth. controls muscles of chewing
Abducens - Responsible for downward eye motion
Facial - facial expression and sensation of anterior tongue
Acoustic - innervates cochlea and vestibule of ear and hearing. Positional sense, motion sensation and balance
Glossopharyngeal - posterior tongue, pharynx, swallowing. baro and chemo receptors
Vagus - Major nerve of parasympathetic system that monitors and controls the heart, respiration, and much of abdominal viscera
Spinal Accessory - Major muscles of neck, some swallowing, vocal cords
Hypoglossal - Voluntary muscle control over tongue
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Maxilla
Upper part of jaw
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Nares
Openings of nostrils
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Pinna
Outer, visible portion of ear
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Semicircular Canals
Three rings of inner ear. Sense motion of head and provide positional sense for body
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Vitreous Humor
Clear, watery fluid filling posterior chamber of eye. Responsible for giving eye spherical shape
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Retina
Light and color sensing tissue lining the posterior chamber of the eye
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Aqueous Humor
Clear fluid filling the anterior chamber of the eye
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Iris
Pigmented portion of the eye. Muscular are that contricts of dilates to change pupil size
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Pupil
Dark opening in the center of the iris through which light enters the eye
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Cornea
Thing, delicate layer covering the pupil and iris
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Conjuctiva
Mucous membrane the that lines the eyelids
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Lacrimal Fluid
Liquid that lubricates the eye
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Hematoma
Blow disrupts blood vessels resulting in accumulation of blood under the skin
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Depression
Blod may tear fascial layers under the scalp and result in a depression with our without skull fracture
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Normal Scalp Contour
Blood can fill the space normally occupied by tissue
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Depressed Fracture
Blood may fill the area vacated by a depressed skull fracture
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Retroauricular Ecchymosis
Black and blue discoloration over the mastoid process (just behind the ear) that is characteristic of a basilar skull fracture. AKA battle's sign
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Bilateral Periorbital Ecchymosis
Black and blue discoloration of the area surrounding the eyes.Usually associated with basilar skull fracture. AKA raccoon eyes
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Coup Injury
An injury to the brain occuring on the same side as impact
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Contrecoup Injury
Injury to the brain occuring on the opposite side of injury.
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Types of Direct Brain Injury
- -Focal
- Cerebral contusion
- Intracranial hemorrhage
- Epidural hematoma
- Subdural hematoma
- Intracerebral hemorrhage
- -Diffuse
- Concussion (mild to moderate diffuse axonal injury)
- Moderate diffuse axonal injury
- Severe diffuse axonal injury (brainstem injury)
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Subdural Hematoma
Collection of blood directly beneath the dura mater
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Epidural Hematoma
Accumulation of blood between the dura mater and the cranium
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Intracerabral Hemorrhage
Bleeding directly into the tissue of brain
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Diffuse Axonal Injury
Type of brain injury characterized by shearing, stretching or tearing of nerve fibers with subsequent axonal damage
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Conussion
Transient period of unconciousness. In most cases unconciousness followed by complete return of function
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Moderate Diffuse Axonal Injury
Concussion with minute bruising of brain tissue. Possible confusion, amnesia, disorientation after unconscious period
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Severe Diffuse Axonal Injury
Significant disruption of axons in both hemispheres and brainstem. Most patients do not survive or have severe deficits. Unresponsive for long periods and may display signs of increased ICP.
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S/S of Brain Injury
- AMS
- Altered level of orientation
- Alterations in personality
- Amnesia (retrograde or anterograde)
- Cushing's triad (increased BP, slow pulse, irregular respirations)
- Vomiting (with or without nausea)
- Body temperature changes
- Changes in reactivity of pupils
- Decorticate or decerebrate posturing
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Retrograde Amnesia
Inability to remember events that occurred before the trauma
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Anterograde Amnesia
Inability to remember events that occur after the trauma
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Cushing's Reflex
Response due to ischemia that causes an increase in systemic BP which mainains cerebral perfusion during increased intracranial pressure
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Cheyne-Stoke's Respiration
Respiratory pattern of alternating periods of apnea and tachypnea
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Cushing's Triad
Increased BP, slow pulse, irregular respirations in response to increased ICP
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Glasgow Coma Scale
Scoring system for monitoring patients with head injuries
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Le Fort Criteria
Classification system for fractures involving maxilla
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Le Forte Facial Fracture
I. Slight instability to maxilla, no displacement
II. Fracture of both maxilla and nasal bones
III. Fracture involving entire face below brow ridge (zygoma, nasal bone, maxilla)
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Hyphema
Blood in anterior chamber of the eye in front of iris
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Acute Retinal Artery Occlusion
A nontraumatic occulusion of the retinal artery resulting in a sudden painless loss of vision in one eye
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Retinal Detachment
Condition that may be traumatic in origin and presents with patient complaint of dark curtain obstructing a portion of the field of view
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Consensual Reactivity
Response of both eyes to changes in light intensity that only affect on eye
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Fasciculations
Involuntary contractions of twitching of muscle fibers
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