39. Neuropsych Sequelae of TBI

Question 1

mechanisms of injury that occur as a result of TBI?

Answer 1

• contusions
• diffuse axonal injury (inertial)
• impact forces (coup/contre-coup)
• secondary injuries
• neurochemical vulnerability (dysreg of nT systems)

Question 2

when in the course of the TBI do secondary injuries appear?

Answer 2

later in the course.

Question 3

distribution of TBI by age group?

Answer 3

peak in late teens/20s/30s (driving) and again in old age (falls)

Question 4

definition of TBI. what does it result in?

Answer 4

def: force acting on the brain
result: disturbance in level of consciousness
(LOC not required)

Question 5

good news and bad news about TBI?

Answer 5

GOOD: decr rate of mortality from TBI over past 30 yrs (we are saving more people)
BAD: incr number of young, otherwise healthy ppl with chronic neuropsych disabilities

Question 6

is there a direct correlation between severity of TBI and clinical course?

Answer 6

generally there is a correlation, but sometimes people do much better/worse than severity of injury would predict.

Question 7

what 3 datapoints do we use to categorize severity of TBI?

Answer 7

• duration of LOC
• Glasgow score
• duration of post-injury amnesia

Question 8

difference between Mild TBI and Complicated Mild TBI?

Answer 8

Complicated Mild has + findings on imaging

Question 9

relationship between neuropsych syndromes and TBI

Answer 9

TBI greatly increases risk of dev neuropsych syndromes (approx 50% will dev a neuropsych disorder)

Question 10

how do contusions affect neural pathways?

Answer 10

can cause damage to white matter tracts: not as well preserved after TBI. seen on a scan compared to healthy control.

Question 11

someone is anticoag and hits their head: recommendation?

Answer 11

definitely should be evaluated: even small bumps to someone who is anticoagulated can cause cranial hemorrhage

Question 12

DAI (though diffuse) primarily affects what parts of hte brain?

Answer 12

sub-cortical white matter, corpus callosum

Question 13

DAI: evolution?

Answer 13

damage at time of injury and evolves over time: have scans from 1d, 1w, and 4y post-injury and there is progressive loss of projections from corpus callosum to cortical areas.

Question 14

what is the difference between a primary and a secondary injury?

Answer 14

Primary: occurs immediately (contusions, hemorrhage, DAI)
Secondary: evolves over time (release of nTs, edema, ischemia, hypoxia, incr ICP)

Question 15

3 major categories of neuro psych sequelae as a result of TBI?

Answer 15

• dys-executive problems (social comportment, less motivation, decline in exec cognitive function like memory, attention, information processing)
• other cog deficits
• psychiatric disorders

Question 16

what is the most common cognitive complaint after TBI?

Answer 16

memory. most commonly working memory, short term memory, encoding

Question 17

in addition to memory and loss of exec function, what other problem is seen post-TBI?

Answer 17

dementia

Question 18

what does this post-TBI dementia resemble?

Answer 18

alzheimer’s. neuronal loss, gliosis, tau deposition

Question 19

what predicts the neuro (psych/cognitive) sequelae?

Answer 19

the profile of the injury, the area damaged

Question 20

lateral orbitofrontal circuit: controls what?

Answer 20

social comportment.

impulsivity, irritability, affect, awareness

Question 21

anterior cingulate and medial frontal circuits control what?

Answer 21

motivation. (interest, initiative, drive)

Question 22

dorsolateral prefrontal circuit controls what?

Answer 22

Exec functions: planning, problem solving, working memory