Acquired Brain Injury Flashcards
Types of ABI
Skull fractures Closed head injury (no fracture) - brainstem damage - contusions - difuse white matter lesions - injured blood vessels - damaged cranial nerves - CSF lead secondary to torn dura - diffuse axonal injury Penetrating wounds of brain and skull Traumatic injury to extracranial blood vessels
Rotational Brain Injury
rotatory effect as brain swirls in response to high speed direction change
- causes major brainstem trauma
- brainstem is sheared and sliced by bony protrusions from the base of the skull
Diffuse Axonal Injury
head goes forwards at high speed
brainstem and spinal cord is stretched
causes disturbance to axon function
Secondary Damage ABI
intracranial haemorrhage cerebral oedema cerebral ischaemia infection arterial hypotension anaemia hyponatraemia seizures
Intracerebral Haemorrhage
bleeding into the cerebral substance
affects temporal and frontal lobes
rapidly expanding space occupying lesion
associated with other serious cerebral injury
Extradeural Haemorrhage
bleeding between the skull and dura meter
commonly temporal
increases pressure on the brain, causes midline shift
Subdural Haemorrhage
blood between dura mater and arachnoid layer of the meninges
immediate and direct pressure on the brain
Subarachnoid Haemorrhage
bleeding into the subarachnoid space
result of trauma or ruptured aneurysm
Concussion
Chronic Traumatic Encepholopathy
- neurodegenerative disease as a result of repeated blows to the head
- causes brain damage which can lead to dementia
- worsens over time
Cerebral Aneurysm
blister on the artery
ruptures - causes major complications, normally fatal
common for 40-60 year olds
Managed by clipping artery to stop blood flow to that area or via embolisation
Cerebral Tumour
Features
- gradual raised ICP - swelling of optic disc, non severe headache
- brain shift - vomiting, reduced conscious state, pupillary dilation
- epilepsy
- neurological dysfunction
Medical Management Head Injury
avoid cerebral ischaemia need to maintain blood flow monitor ICP position head 30 degrees upwards sedation/induced coma CSF drainage barbiturates steroids decompressive craniectomy hypothermia to reduce ICP
Glasgow Coma Scale
assess level of consciousness assesses eye opening, motor response, verbal response 1. alert 2. drowsy 3. stuperosed 4. deeply stuperosed 5. coma
What contributes to reduced consciousness?
- diffuse lesions affecting the cerebral hemispheres or reticular activating system
- space occupying lesions which cause brain distortion and shift, raised ICP, hydrocephalus, tentorial and tonsillar herniation
Physio - Major Impairments ABI
cognitive dysfunction behavioural changes perceptual dysfunction loss of motor control abnormal tone weakness and loss of dexterity altered righting and equilibrium reactions loss of co-ordination adaptive motor behaviour sensory loss/changes visual deficits vestibular dysfunction secondary changes musculoskeletal and cardiovascular systems
Physio - Assessment ABI
subjective history respiratory function conscious state functional mobility strength ROM and muscle length tone/synergies cranial nerve function coordination cognition and perception memory
