CAISS - Head
Where is a subpial hemorrhage located?
Along he cortical surface
What are the "Named" arteries in the head?
Anterior Cerebral Artery, Basilar Artery, Internal Carotid Artery, Middle Cerebral Artery, Posterior Cerebral Artery, Vertebral artery.
What arteries does the Internal Carotid Feed?
Anterior Cerebral, Middle Cerebral, Posterior Cerebral, Basilar and Vertebral.
What is thrombosis?
Any injury to a vessel resulting in its occlusion (intimal tear / dissection)
How is a Hemorrhagic contusion coded?
As a contusion
What section of the brain is the Anterior or Middle Fossa Coded to?
Cerebrum
What section of the brain is the Supratentorial coded to?
Cerebrum
In the skull; what does "Compound" mean?
Open Fracture
What is the Cranial Nerve II?
Optic Nerve
When are pterygoid plate fractures NOT coded?
When he patient has a LeFort Fracture
When is a cranial nerve coded as a laceration?
When there is Total Loss of Nerve Function Paralysis
When can LOC be coded?
When there is convincing evidence of head trauma and the diagnosis is made by a physician.
When is a Cranial Nerve coded as a Contusion?
When there is subtotal/partial loss of function. Paresis / Palsy
What imaging terms can be used to diagnosis DAI?
White Matter Shearing, Shear Injury or DAI
Patient is diagnosed with a Compound Temporal Fracture and laceration of the Temporal Artery. Can you code both injuries?
Yes
How are Acute on Chronic Bleeds coded?
if the clinician does not differentiate and document the acute from chronic code as NFS to the appropriate section
Define Vasospasm
it is an injury to the artery. It is not an injury itself; therefore not codeable
What is Hypoxemia?
low oxygen in the blood
External rotation of the arms is a brain stem sign of what?
Decerebrate
Focal Brain Injury
Defines a contusion, hematoma, intraventricular hemorrhage, subarchonoid hemorrhage. Bleeding or contusions noted in a specified area of the brain.
Diagnosis of shearing of white matter with immediate prolonged coma;
Diffuse Axonal Injury (DAI)
What makes up the Meninges?
Dura Mater(epidural/subdural), Arachnoid(csf), pia matter(vascular membrane)
What bones are included in a Skull Base Fracture?
Ethmoid, Sphenoid, Orbital Roof, Petrous, Mastoid of Temporal
Sudden weakness on one side of the face & inability to close the eye indicates possible damage to which cranial nerve?
Facial Nerve / CN VII
What GCS is considered unconscious?
GCS 8
What is considered a "Major Vein" in the head?
Galen, Labbe, Trolard, Rosenthal/Internal Cerebral
Define Brain Swelling.
Generic description of a swollen brain.
What is a Diffuse Brain Injury?
Global/Widespread damaging affecting consciousness
Difficulty swallowing could be a sign of damage to what cranial nerve?
Glossopharyngeal Nerve / CN IX
A head injury described as "Extra Axial" should be codes as what type of bleed?
Hematoma NFS
What nerve is tested by watching movement of the uvuala?
Hypoglossal Nerve / CN XII
What brain findings cannot be coded with a Diffuse Axonal Injury(DAI) diagnosis?
IVH, ischemic brain damage, SAH and Subpial hemorrhage
The Common Carotid branches into what arteries?
Internal Carotid and the External Carotid
Define Vessel Thrombosis.
It is a vessel injury that results in occlusion. (Tear, dissection)
How is brain death coded?
It is an outcome or sequela and is not codeable
In the skull how is "Open Fracture" defined
It not only means an open fracture but it also means there is torn dura when this term is used.
What portion of the temporal bone is coded to the Skull base?
Mastoid and Petrous portion
When can Hypoxic Brain Damage be coded?
May be coded with conditions of hypovolemia or hypoxia lead to this damage. Cannot be coded when directly related to a brain lesion.
Compressed ventricles are a sign of what?
Mild Brain Swelling
What tests are used for the Vestibulocochlear nerve?
Observing balance, posture and gate. Rubbing of fingers(sound). Whispering. Tunning Fork.
Compression due to transetentorial herniation causing a blown pupil is injury to what nerve?
Oculomotor Nerve / CN III
What is the mnemonic device for cranial nerves?
On Old Olympus's Towering Top A Finn And German Viewed Some Hops
In the skull how is "Compound" defined.
Only in the skull does it mean "open fracture"
When do you code to the cerebellum?
Only when cerebellum, infratentorial or posterior fossa are mentioned.
Provider diagnosis the patient with a "Closed Head Injury" how do you code this?
100099.9; NFS
How many cranial nerves are there?
13
At what age are brain severity injuries adjusted?
10 & younger
Diagnosis of DAI requires a coma over how many hours?
6
At O2 level is hypoxemia considered?
92% or less
For a scalp laceration to be considered "Major" what must be true?
>10cm and into the subcutaneous
Testing the lateral movement of your eye is testing which cranial nerve?
Abducens Nerve / CN VI
What is Decorticate?
Abnormal Flexion caused by hemispheric damage above midbrain. (pulled toward the core)
Coding of brain injuries should be done when?
At 24 hours or at initial confirmed diagnosis if later than 24 hours.
Given evidence of head injury; what can be used to corroborate a diagnosis of basilar skull fracture?
Battle Signs, CSF (Otorrhea/Rhinorrhea) or Raccoon Eyes
What are the regions of the brain?
Brain Stem, Cerebellum, Cerebrum
What does "Closed Cisterns" imply?
Brain Swelling
What makes up the "Other Arteries" in the head?
Branches of the Named arteries.
How are Cerebrum Brain Contusions coded?
By number and laterally
What terms cannot be used to calculate an AIS in the head?
Closed Head Injury and Traumatic Brain Injury
How are multiple hematomas or bleeds in the brain coded?
Code each individual if they are separate. Code unilateral or bilateral as specified.
How is coma coded with multiple brain findings?
Code only once to the finding that will result in the highest ISS.
If a single fracture involves both base and vault; how do you code?
Code the most severe. If equal code to the point of origin.
How should all skull fractures be coded?
Code to Vault unless specified as base.
Where does the pterygoid plate code to?
Codes to the skull base
Diffuse Brain Injury
Concussion and DAI make up this type of injury. It is widespread and does not impact only one area of the brain. This type of injury had an impact on level of consciousness
What is used if a nerve is not named?
Cranial Nerve NFS
What does AIS define as part of the Head
Scalp, Skull, Brain, Intracranial Vessels, Cranial Nerves.
Absent brain stem Cisterns is a sign of what?
Severe Brain Swelling
How is a GSW to the head with an entrance and exit wound coded?
Single penetrating injury to the specific anatomical structure. IE Cerebrum, Cerebellum, Brain Stem
What affects the Injury Severity Score of brain lesions?
Size, Location, Multiplicity
What could periorbital ecchymosis be a sign of?
Skull Base FX or Orbital FX
What impact does the Olfactory Nerve, CN I impact?
Smell
What is a Focal Brain Injury?
Space occupying lesion in which the brain will shift or herniate
Define Brain Edema
Specific type of brain swelling. It indicates increased brain water content. Should only be coded if the provider describes it as such or CT mentions hypodensity.
What nerve is being tested when resistance is added to shrugging shoulders?
Spinal Accessory Nerve / CN XI
What portion of the temporal bone is coded to a Vault fracture?
Squamous portion
Why are brain injuries coded in the first 24 hours?
Surgical and other interventions can increase the size of a contusion or hemorrhage which would inflate the severity.
What arteries does the External Carotid feed?
Temporal, Occipital, Maxillary, Facial
Can you code DAI based on imaging DX of DAI?
To be able to code DAI it must also meet the definition in the AIS dictionary
Facial spasms, shooting or jabbing pain is a possible indication of which cranial nerve?
Trigeminal Nerve / CN V
Compression on the tentorium causing double vision is an injury to which nerve?
Trochlear Nerve / CN IV
What nerve is damaged if the patient has no gag reflex or impaired sensation in the tongue?
Vagus Nerve / CN X
