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Neuro Cognitive Disorders > 5: Traumatic Brain Injury > Flashcards

5: Traumatic Brain Injury Flashcards

1
Q

What age group has the highest numbers/rates of TBI related hospitalizations and deaths?

A

ages 75+

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2
Q

What are 6 causes of TBI?

A

1) falls
2) struck by/against events
3) motor vehicle/traffic crashes
4) assaults
5) intentional self-harm
6) blast related injuries

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3
Q

What is the leading cause of TBI-related deaths by age:

1) 65+
2) 25-64
3) 5-24
4) 0-4

A

1) falls
2) intentional self-harm
3) motor vehicle crashes
4) assaults

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4
Q

What about of TBI pts admitted to hospitals are intoxicated?

A

about half

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5
Q

What are the 3 most common causes of TBI sustained by intoxicated adults? Most to least

A

1) MVAs
2) falls
3) assaults

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6
Q

What are 4 factors that can increase risk for TBI?

A

1) SES
2) participation in high risk sports
3) history of TBI
4) incarceration

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7
Q

What is the most common cause of TBI with military?

A

blast injuries

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8
Q

Why is it hard to identify TBI/concussion in military individuals? (3)

A

1) may have occurred simultaneously with other life threatening issues
2) solider may have other issues present (depression, PTSD, etc)
3) blast injuries may not result in outward signs of injury

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9
Q

What are 4 potential mechanism dynamics?

A

1) primary blast
2) secondary blast
3) tertiary blast
4) quaternary blast

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10
Q

What mechanism dynamic is this: instantaneous increase in atmospheric pressure that impacts air and fluid filled cavities of the body

A

primary blast

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11
Q

What mechanism dynamic is this: objects placed in motion by the blast hitting the service member (wood, glass, metal)

A

secondary blast

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12
Q

What mechanism dynamic is this: service member being placed in motion by the blast

A

tertiary blast

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13
Q

What mechanism dynamic is this: other injuries from the blast such as burns, crush injuries, toxic fumes

A

quaternary blast

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14
Q

What are the 2 types of TBI?

A

1) penetrating

2) non-penetrating

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15
Q

What type of brain damage did Phineas Gage have?

A

left frontal lobe

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16
Q

High velocity penetrating brain injury

A

gun shot wound

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17
Q

What are results of a GSW? (3)

A

1) destroys tissue on both sides
2) diffuse bleeding/tissue disruption
3) increased risk of inflection bone fragments, hair, and skin

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18
Q

What are 3 low velocity penetrating brain injuries?

A

1) shrapnel
2) depressed skull fracture
3) knife

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19
Q

What are 4 results of low velocity penetrating brain injury?

A

1) less often fatal
2) can fracture vs. perforate
3) penetrates the skull and carries foreign material in
4) tissue destruction more focal in the site of injury

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20
Q

What are secondary results of low velocity penetrating brain injury?

A

1) infection
2) bleeding
3) fluctuating blood pressure
4) increased intracranial pressure (brain swelling and hydrocephalus)

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21
Q

What is a non-penetrating brain injury?

A

closed head injury

meninges remain intact and foreign substances do not enter the brain

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22
Q

What are the 2 types of closed head injuries?

A

1) nonacceleration injuries

2) acceleration injuries

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23
Q

What is a non-acceleration injury?

A

produced when head is struck by a moving object

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24
Q

Compare nonacceleration to accelaration injuries

A

less severe TBI with nonacceleration

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25
Q

What are the 2 consequences of a nonacceleration injury?

A

1) deformation of the skull

2) localized damage to the meninges and brain cortex at the point of impact (impression trauma)

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26
Q

What is an acceleration/deceleration injury?

A

TBI caused by sudden acceleration or deceleration of the head, the brain and brain stem resulting in diffuse damage caused by their movement within the skull

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27
Q

What are 2 common causes of acceleration/deceleration injuries?

A

1) MVA

2) falls from heights

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28
Q

What are 2 common causes of acceleration/deceleration injuries?

A

1) MVA

2) falls from heights

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29
Q

What are 2 types of acceleration/deceleration injuries?

A

1) linear acceleration injuries

2) angular acceleration injuries

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30
Q

What do linear acceleration injuries cause?

A

stretching and tearing

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31
Q

What do angular acceleration injuries?

A

shearing and twisting

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32
Q

What is a coup injury?

A

brain injury at the point of impact

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33
Q

What is a contre-coup injury?

A

injury to the brain at the side opposite of the initial impact, caused by brain moving and hitting inside the skull

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34
Q

Coup and contrecoup injuries cause:

A

1) focal damage to meninges and blood vessels coursing through the space
2) contusions - particularly in frontal and posterior regions
3) stretching, tearing of axons subcortically

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35
Q

The coup and contrecoup injury damage is sometimes called ____________ ________ and occurs as a consequence of:

A

translational trauma

linear acceleration and deceleration

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36
Q

Translational trauma is more likely to occur in the _______ or _____ of the head vs. the _____. Why?

A

front or back
side
epidural space is greater in front and back so increased risk for movement

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37
Q

What CNs are likely to be damages with acceleration injuries? and how?

A

1) CN 1: Olfactory - stretch or tear
2) CN 3, 4, + 5: extraocular muscles (diplopia)
3) CN 8: tinnitus or vertigo

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38
Q

What are angular acceleration injuries?

A

blows that strike the head off center propel it at an angle from the direction of the blow and cause the head to rotate away from the blow

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39
Q

Angular acceleration forces are ___________ rather than ________

A

rotational

linear

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40
Q

Rotational forces are __________ and __________ forces that are concentrated in _________ structures. Mainly in what 4 structures?

A

twisting and shearing forces
axial

1) midbrain
2) basal ganglia
3) brain stem
4) cerebellum

41
Q

What is shaken baby syndrome?

A

the combination of violent shaking and the child’s weak neck muscles cause the child’s head to bounce back and forth, causing diffuse acceleration injuries to the fragile brain tissues

42
Q

Shearing forces are concentrated at the boundaries between:
They are more severe around major _____ ______ ______ such as (3):
And they can cause:

A 
gray and white matter
white fiber tracts 
     1) internal capsule
     2) corpus callosum
     3) brain stem
more severe damage
43
Q

What is a diffuse axonal injury caused by?

A

both linear and angular injury

44
Q

What is diffuse axonal injury caused by?

A

linear and angular injury

45
Q

What is diffuse axonal injury?

A

damage to nerve cell axons diffusely scattered throughout the brain

46
Q

Diffuse axonal injury is common with __________________ and is responsible for many of the _________ ________________ and _________________ impairments

A

TBI

diffuse cognitive and behavioral impairments

47
Q

When diffuse axonal injury is widespread, what occurs?

A

vegetative state
sleep wake cycles but no purposeful movement, no talking, no visual activation, preserved brain stem but lots of damage to the cortical and subcortical structures

48
Q

Diffuse axonal injury is commonly evident in the __________ _________, _________ ____________, and ____________ ____________ _____________.

A

medial frontal
corpus callosum
superior cerebellar peduncles

49
Q

Twisting and shearing does not result in _______________ _______________ of axons from their neural cell bodies. What happens instead?

A

immediate disconnection

the axons stretch, then within 2-3 hours axons swell and then within several hours the axons split

50
Q

Diffuse axonal injury is a _________ process, meaning what?

A

diffuse

it affects some regions and not others

51
Q

What is it called when intact axon terminals adjacent to areas of damage send fibers into the region?

A

collateral sprouting

52
Q

The cortical tissues can receive (1)____________ and (2)_______________ as the brain moves in the (3)_______ vault during a TBI.

And the (3) vault is uneven, so the (1) and (2) are concentrated where?

A

abrasions and lacerations
cranial

frontal lobes and anterior temporal lobes

53
Q

What is a traumatic hemorrhage?

A

cuts and bruises on the brain surface and twisting and shearing within the brain causing bleeding (hemorrhage) and blood accumulation (hematomas)

54
Q

What are the 4 types of traumatic hemorrhages?

A

1) epidural
2) subdural
3) subarachnoid
4) intracerebral

55
Q

Where do epidural hematomas occur?

What is the main cause?

A

between dura mater and the skull

automobile accidents

56
Q

Epidural hemorrhages can occur where (4) and what are the mortality rates (2)?

A

1) middle meningeal artery = 85%
2) middle meningeal vein = 15%
3) posterior inferior epidural space
4) frontal and superior epidural space

57
Q

Where does a subdural hematoma occur?

A

accumulation of blood between the dura and the arachnoid

58
Q

Subdural hematomas are _______ as common as epidural. They are often caused by/result in:

A

twice

shaken baby syndrome

59
Q

What is the source of a subdural hematoma?

A

cortical blood vessels

60
Q

Which type of hematoma is the common consequence of a TBI?

A

subarachnoid

61
Q

What are the 5 primary physical consequences of TBI?

A

1) stretching
2) shearing
3) laceration
4) contusions
5) hemorrhage

62
Q

What is the secondary consequence of TBI?

A

brain response to trauma

63
Q

What are the 3 types of secondary consequences of TBI/brain responses to trauma?

A

1) cerebral edema
2) traumatic hydrocephalus
3) ischemic brain damage

64
Q

What is cerebral edema?

A

fluid accumulation between brain and skull within ventricles or brain tissue, that develops around the primary site of lesions

65
Q

What is traumatic hydrocephalus?

A

swelling of brain tissues that compresses passages where CSF circulates, which puts pressure on ventricle walls and compresses brain structures and elevates intracranial pressure

66
Q

What are the 4 most deadly consequences of TBI?

A

1) cerebral edema
2) traumatic hydrocephalus
3) hemorrhage
4) herniation

67
Q

What is herniation?

A

when cerebral structures are pushed around rigid partitions in the cranial vault or extrude through cranial orifices

68
Q

What is ischemia?

A

lack of oxygen to brain tissues

69
Q

What are 4 results of ischemic brain damage?

A

1) injury to cardiac and respiratory systems
2) elevated intracranial pressure
3) cerebral vasospasm
4) decreased auto-regulation of blood pressure/lower blood pressure

70
Q

Ischemic brain damage is more common in _______ TBI than _____________ or _______

A

severe

moderate or mild

71
Q

What is this level of consciousness?

appearance of wakefulness, awareness of the self and environment

A

alert

72
Q

What is this level of consciousness?

severe drowsiness requiring moderate stimulation, but drifts back to sleep

A

lethargy

73
Q

What is this level of consciousness?

dulled responses to stimuli, sleeps more than normal and drowsiness between sleep states

A

obtunded

74
Q

What is this level of consciousness?

eye opening with some visual tracking, inconsistent command following, may gesture

A

minimally conscious state

75
Q

What is this level of consciousness?

eye opening, but not responsive to stimuli, has sleep wake cycles

A

vegetative state

76
Q

What is this level of consciousness?

sleep like appearance and behaviorally unresponsive to all external stimuli, no sleep wake cycles

A

coma/unconscious

77
Q

What is the coma a result of?

A

widespread cortical/subcortical damage

brainstem process affecting the upper pons and midbrain

78
Q

What type of lesion won’t cause a coma?

Unless what?

A

unilateral lesion

unless it affects the bilateral deep structures by mass effect

79
Q

__________ of a coma is a prognostic indicator

A

duration

80
Q

The Glasgow coma scale divides pts into what 3 categories?

A

1) severe head injury (3-8)
2) moderate head injury (9-12)
3) mild head injury (13-15)

81
Q

What is post-traumatic amnesia and what is it an indicator of?

A

time between injury and recovery of continuous memory

severity and fair predictor of outcome

82
Q

What is the Galveston Orientation and Amnesia Test (GOAT) designed to evaluate? What does it give an estimate to?

A

orientation to person and place

estimates intervals prior to and after brain injury for which there is no recall

83
Q

What are 10 categories to assess cognitive and behavioral characteristics?

A

1) arousal/alertness
2) behavior
3) vocalization
4) attention
5) memory
6) executive ability
7) orientation
8) compensatory strategies
9) pragmatics
10) insight/awareness

84
Q

What are the 2 least conscious Rancho Los Amigos levels?

A

1) comatose

2) semi-comatose

85
Q

What are 6 pt related variables to consider with TBI?

A

1) age
2) substance abuse
3) intelligence
4) socioeconomic status
5) premorbid personality disorders
6) emotional disturbances

86
Q

What is the recovery pattern of a CVA? (2)

A

1) curvilinear - rapid with gradual slowing

2) relationship between initial severity and permanent level of impairment is strong

87
Q

What is the recovery pattern of TBI? (2)

A

1) stepwise - little or no change alternate with rapid improvement
2) very difficult to determine permanent level of impairment in first weeks post onset

88
Q

How is the recovery pattern of a TBI predictable? (3)

A

1) loss of consciousness
2) return to consciousness
3) oriented/increased appropriateness

89
Q

What are areas of communication deficits that occur due to TBI? (5)

A

1) verbal expression
2) comprehension
3) reading
4) writing
5) pragmatics

90
Q

What are effects of TBI within verbal expression?

A

1) mutism
2) language of confusion
3) anomia
4) word fluency
5) perseveration

91
Q

What are effects of comprehension within comprehension? (3)

A

1) implied meaning
2) understanding the big picture
3) selecting the most important pieces of information

92
Q

What are effects of pragmatics within pragmatics? (5)

A

1) turn taking
2) eye contact
3) personal space
4) topic maintenance
5) inappropriate behavior

93
Q

What are speech related deficits of TBI? (9)

A

1) dysarthria
2) hypernasality
3) slow rate
4) imprecise consonant production
5) pitch variability
6) decreased breath support
7) abnormal stress patterns
8) decreased loudness variability
9) reduced intelligibility

94
Q

What are the 5 cognitive deficits of TBI?

A

1) orientation
2) attention
3) memory
4) executive function
5) awareness

95
Q

What are 5 effects of TBI within attention?

A

1) focused
2) sustained
3) selective
4) alternating
5) divided

96
Q

What are 3 effects of TBI within memory?

A

1) retrograde or anterograde amnesia
2) working memory
3) short term memory

97
Q

What are 7 effects of a left CVA?

A

1) focal damage
2) speech is often relevant
3) syntactic difficulties
4) no disorientation
5) cognitive deficits not typical
6) communication better than demonstrated language skills
7) no significant behavioral/personality changes

98
Q

What are 8 effects of language of confusions (TBI)?

A

1) bilateral damage, diffuse
2) typically irrelevant
3) confabulation
4) little or no syntactic difficulties
5) disoriented
6) cognitive deficits
7) communication worse than demonstrated language skills
8) significant behavioral/personality changes

Neuro Cognitive Disorders (13 decks)

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