1: Brain Injury Overview Flashcards

1
Q

Primary injury defines and determines

Mechanism of primary injury

A

The primary injury defines the injury as either traumatic or non-traumatic ;
determine the severity of injury, informs surveillance data, and correlates the injury to an expected long-term outcome
The mechanism of injury is mechanical – for example, neurons damaged from a penetrating injury or from a stroke.

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2
Q

Examples of secondary injury

A
The release of excitatory amino acids
Oxidative free-radical production
Release of arachidonic acid metabolites 
Disruption of neurotransmitters
Hypoxia
Anemia
Metabolic abnormalities
Hydrocephalus
Intracranial hypertension
Hemorrhagic activity
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3
Q

Definition of Mild TBI

A

Can have either brief or no loss of consciousness and its presentation may demonstrate vomiting, lethargy, dizziness, and inability to recall what just happened

Can result in local neurological deficits that may or may not be transient
Most are not treated in the hospital or emergency department and therefore may not be diagnosed or under-diagnosed in studies

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4
Q

Definition of Moderate TBI

A

Will be marked by unconsciousness for any period of time up to 24 hours, will have neurological signs of brain trauma, including skull fractures with contusion or bleeding, and may have focal findings on an electroencephalograph (EEG)/computed tomography (CT) scan

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5
Q

Definition of Severe TBI

A

Marked by a period of loss of consciousness of 24 hours or greater

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6
Q

Risk of multiple TBI following 1st

A

After 1st TBI, 2nd is 3x more likely ; after 2nd, 3rd is 8x more likely

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7
Q

Rates of TBI 2001-2010

A

Rates are increasing, deaths are decreasing

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8
Q

TBI and death

A

TBI contributes to 30% of injury related deaths in US

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9
Q

incidence of mild TBI

A

75% of TBI are mild

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10
Q

TBI as chronic disease

A

TBI affects multiple organ systems can cause disease and accelerate disease

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11
Q

TBI as mortality/ morbidity

A
-Life expectancy is reduced by 7 years 
Increased risk of death:
Aspiration pneumonia – 49X
Seizures – 22X
Septicemia – 12X
Circulatory problems – 29X
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12
Q

neurological conditions associated with TBI

A

epilepsy, CTE, sleep disturbance, Alzheimer’s

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13
Q

neuroendocrine disorders associated with TBI

A

Dysfunction of the pituitary gland
Hypothroidism
Growth hormone deficiency/insufficiency
Gonadotropin deficiency

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14
Q

musculoskeletal dysfunctions associated with TBI

A

spasticity
gait dysfunction
post-injury fractures- at risk for heterotopic ossification

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15
Q

mTBI

A

aka concussion aka mild TBI
first identified in 16th century
1839 defined
1990’s - focus of increased study due to the prevalence of mTBI in military conflicts

75% of all TBI are mTBI and may be more due to underrepresentation

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16
Q

mTBI causes….

A

After the primary cause, the transfer of kinetic energy into brain tissues causes metabolic alterations or direct damage to physical structures:

  • Diffuse axonal injury= most common
  • Axonal shearing can disrupt neuronal communication
  • Difficult to visualize with neuroimaging
  • Massive release of the neurotransmitter glutamate
  • High levels become toxic, impacting the amount of fuel available to the brain
  • Constricted blood flow also impacts neurological function
17
Q

mTBI symptoms and how long they last

A

most symptoms resolve in 2 weeks
-physical: headache, fatigue, light / noise sensitivity, seizure, impaired hearing, dizziness, nausea, blurred vision, poor sleep, neurological conditions

  • cognition: inattention, diminished concentration, memory, impaired judgment, slowed processing, executive dysfunction
  • behavioral: depression, anxiety, agitation, irritability, aggression, impulsivity
18
Q

Fatigue and mTBI

A

Fatigue typically arises due to mental rather than physical overexertion and worsens memory and behavioral disturbances. Fatigue is exacerbated by sleep difficulties:
Difficulty falling asleep or waking through the night
Lack of restorative sleep

19
Q

mTBI and vision

A

Blurred vision due to difficulty with subtle eye movements or motor control
Convergence insufficiency, in which eyes cannot focus effectively together

20
Q

mTBI and balance

A

-most common inner ear disorder after mTBI is benign paroxysmal positional vertigo (BPPV), other causes of balance issues include:
Disorders of the inner ear, central nervous system, or musculoskeletal systems
Psychological issues
Orthostatic hypotension
Medication side effects

21
Q

mTBI return to activity

A

REST and slow resumption of normal activities as long as symptoms do not recur
If symptoms recur, return to rest and then advance activity when symptoms have abated

22
Q

mTBI headache

A

most common compmlaint after mTBI
primary reason to seek care
typically occurs with exertion
treated like a migraine (except in acute stage where it is a sign of danger)
- top/front of head
- hypersensitive to light/sound
- extracranial cause - trigeminal nucleus; occipital neuralgia ; cervicalgia

23
Q

mTBI symptom management

A

sleep hygiene to improve sleep (meditation, education, sleeping pills)
physical therapy for dizziness / instability
educate/ treatment of headaches

24
Q

psychological features and mTBI

A

can worsen or create symptoms

25
Q

Persistent Post-Concussive Syndrome (or symptoms)

A

persistence of symptoms weeks to months after mTBI
common characteristics:
- Over age 40, Female, Traumatically injured, Low socioeconomic status, History of substance abuse, Positive mental health history, Pending litigation

15% of mTBIs

Tx = must see neuropsych for differential dx
then treatment is based on symptoms, positive light, resolution focused

26
Q

second impact syndrome

A

RARE

after 1st mTBI, potential for fatal TBI if return to activity when neurologically unstable (neurochemical cascade)

27
Q

Chronic traumatic encephalopathy (CTE)

A

rare and progressive degenerative condition in which diffuse axonal injury causes the release of Tau proteins and causes chronic inflammation. Researchers are still working to identify who is at risk for CTE after mTBI; most who have mTBI will not develop CTE

28
Q

apoptosis and progression of chronic TBI

A

thought that cell death becomes earlier after TBI which causes progressive central nervous atrophy (suspected)

29
Q

post-traumatic immune paralysis

A

right after TBI immune system is severely impaired – related to high prevalence of infections post TBI

30
Q

PTA and TBI level

A

0-1 day - mild
1-7 days - moderate
7+ days - severe

31
Q

GCS and TBI

A

13-15 - mild
9-12 - moderate
3-8 - severe

32
Q

metabolic alterations and mTBI

A

direct physical damage to brain cells which leads to neurological function changes depending on location of injury

33
Q

axonal shearing and mTBI

A

process where axons can be twisted and disconnected
aka DAI
cannot be seen on MRI

34
Q

mTBI and glutamate

A

massive release of this neurotransmitter - this is dangerous as it deregulates use of ATP
brain starved for fuel
decreased energy

35
Q

frontal release and mTBI

A

damage to frontal areas of brain can result in disinhibition and lability

36
Q

occipital neuralgia

A

migraine like headache caused by mTBI

pain in back of head worsens with tension

connections in upper spinal cord and trigeminal nucleus - can radiate pain to forehead and behind eyes

37
Q

cervicalgia

A

simple neck pain associated with mTBI and can cause headache and chronic pain syndromes

38
Q

nystagmus

A

involuntary eye movement - hallmark of BPPV