Neurotrauma Quiz – June 2015

• Q1. Which of the following is not an inclusion criterion for patient selection in RESCUE – ICP trial?

  • Requiring ICP monitoring with raised ICP (>25 mmHg >1–12 h), refractory to initial medical measures

  • Patient may have an immediate operation for amass lesion but not a decompressive craniectomy

  • Abnormal CT scan

  • A devastating injury not expected to survive for 24 h

• Q2. Which of the following is not correct regarding modified marshal grading?

  • Grade 1: diffuse injury with no visible pathology

  • Grade 3: diffuse injury and brain swelling

  • Grade 4: diffuse injury and midline shift >5 mm

  • Grade 5: diffuse injury with non-evacuated mass lesion (EDH, SDH, ICH > 25cc)

• Q3. Which of the following is not true regarding surgical steps used following decompressive craniectomy in RESCUE – ICP trial?

  • Wide decompressive craniectomy (>15 cm in diameter)

  • Opening the dura and leaving it open

  • Documenting the size of the created bony window in the data collection proforma

  • Avoiding tight bandage or positioning patient head on craniotomy side, after decompression

• Q4. Which of the following is not an inclusion criterion for patient selection in STICH (Trauma) trial?

  • Patient should be present within 72 h of injury

  • Traumatic ICH more than 10 cc on CT scan

  • No associate significant surface hematoma (EDH, SDH)

  • Treating neurosurgeon should be in equipoise

• Q5. What is not true about STICH (Trauma) trial?

  • Primary objective is to determine whether a policy of early surgery in patients with traumatic intracerebral hemorrhage improves outcome compared to a policy of initial conservative treatment

  • Another objective is to confirm appropriate thresholds for intracranial pressure (ICP) and cerebral perfusion pressure (CPP) for clinical management of head injured patients with TICH

  • 840 patients recruited between October 2009 and March 2013

  • Outcome will be measure at 3, 6, 9, 12 months via a postal questionnaire using extended Glasgow Outcome Scale

• Q6. DECRA trial was criticized on the following aspects except?

  • 27% of patients randomized to surgery had bilateral nonreactive pupils, compared to only 12% of patients in medical group

  • The DECRA trial contains no data or valuable information to inform modern management of TBI and thus should be ignored by practitioners treatment options for severe TBI

  • The medical and surgical teams were aware of study-group assignments but assessors were not

  • The median ICP during the 12 h before randomization was 20 mmHg

• Q7. RESCUE-ICP trial differs from DECRA trial on the following aspects except?

  • ICP threshold were 25 mmHg vs. 20 mmHg

  • Duration of refractory raised ICP (>1 h vs. 15 min)

  • Acceptance of contusions

  • Shorter follow vs. longer follow up

• Q8. All is true about the evidence-based medicine, except?

  • Class 1: Systemic reviews of prospective randomized controlled trials

  • Class 2: Observational studies

  • Class 3: Case control studies

  • Technology assessment includes device accuracy and reliability

• Q9. Which of the following is not true about CRASH 3 trial?

  • Aim of study were to provide reliable evidence about the effect of tranexamic acid (TXA) on mortality, disability, risk of vascular occlusive events in patients with TBI

  • To be included in study patients should be admitted within 8 h of injury with intracranial bleeding on CT scan and GCS should be10 or below

  • Treatment consistent of 1 g loading dose of TXA followed by maintenance 1 g dose over 8 h

  • Patient recruitmentwas takenplace inover 30 countries,was started on April 2012 and will be end on 31 December 2016

• Q10. Indian institution has participated in the following trials except?

  • STICH Trial

  • RESCUE-ICP Trial

  • CRASH Trial

  • CRASH 3 Trial

• Q11. According to the CRASH trial, which of the following statements about outcome at 6 months among patients hospitalized with TBI who received 1 g methylprednisolone vs. placebo care is not correct?

  • Risk of death were higher in corticosteroid group than placebo

  • Risk of death were higher in placebo group than corticosteroid group

  • Risk of severe disability were higher in corticosteroid group than placebo

  • There was no clear evidence that the relative risk of death or disability at 6 months differed substantially between groups when stratified by injury severity or time since injury

• Q12. Which of the following is not true about neural-stem trial for chronic spinal cord injury?

  • First FDA approved trial

  • It requires transplantation of stem cell in white matter of patient's spinal cord

  • Stem cells works with replacing damaged cells, neuroprotection or the creation of an environment conducive to regeneration by endogenous cells

  • Total 4 patients recruited

• Q13. What is true about The Neurotrauma Society of India except?

  • First established as Neurotraumatology Committee under NSI in 1992

  • Neurotrauma Society was officially announced on 18th August 1999

  • The Logo depicts head and the spine and prepared in 1992

  • First issue of The Indian Journal of Neurotrauma was published in 2004

• Q14. Mild traumatic brain injury includes all except

  • Any period of loss of consciousness for up to 15 min

  • Any loss of memory for events immediately before or after the accident for as much as 24 h

  • Any alteration of mental state at the time of the accident (e.g., feeling dazed, disoriented, or confused)

  • Focal neurological deficit(s) that may or may not be transient

• Q15. According to brain trauma foundation, which of the following statement is incorrect regarding the use of steroid in severe traumatic brain injury?

  • Level 1 evidence which do not support use of steroids in moderate to severe TBI

  • High dose methylprednisolone is associated with increased mortality secondary to increased risk of infection and gastrointestinal bleeding and is contraindicated

  • Steroids were introduced in early 1960s as a treatment for brain edema

  • Glucocorticoid within 24 h associated with 74% increased risk of first late seizure