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MedCon Rehab II > Acquired Brain Injury EXAM 1 > Flashcards

Acquired Brain Injury EXAM 1 Flashcards

1
Q

Traumatically induced structural injury and/or phsyiologic disruption of brain function as a result of an external force that is indicated by new onset or worsening of at least one of the following clinical signs immediately following the event

A
  • any pd of loss of dec’d lvls of consiousness
  • any loss of memory for events immediately BEFORE or AFTER injury
  • any alteration in mental state @ the time of the injury
    • confusion, disorientation, slow thinking, etc..
  • Neuro. deficits that may/may not be transient
    • weakness, LOB, change in vision, praxis, paresis/plegia, sensory loss, aphasia
  • Intracranial lesion
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2
Q

Epidemiology of TBI

A
  • CDC–> 1.7 mill people/yr
  • TBI is a contributing factor to a third (30.5%) of all injury related deaths in the US
  • avg age onset is 30
    • ​HIGHEST incidence b/w 15-24
  • ADULTS
    • ​MOST FREQ–> MVA
      • falls
      • trauma
  • CHILDREN
    • ​MOST FREQ–> abuse
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3
Q

Types of TBI:

A
  • Concussion
  • Open/Penetrating Injury
  • Closed
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4
Q

Types of TBI: Concussion

A
  • Transient (1 day) deficit
  • evidenced LT consequences
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5
Q

TBI: Open/Penetrating Injury

A
  • Dura is compromised
  • deficits are focal
  • risk of infection
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6
Q

TBI: Closed

A
  • diffuse (widespread) deficits
  • Dura mater: structural support w/ sharp edges
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7
Q

Coup-Contrecoup

“Impact”

MVA–Whiplash

A

Coup is the head/brain going FORWARD injury

Contrecoup is the head/brain going BACKWARD injury

See pic!!!

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8
Q

Skull Fxs are HIGHLY correlated w/:

A

ICHs

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9
Q

Skull Fx: Two types

A
    1. Non-Displaced (linear)
    1. Depressed/Displaced
      * depressed==caved in
      * displaced==shards of bone into brain
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10
Q

Primary Brain Damage (3)

A
  1. Focal
  2. Diffuse
  3. Assoc’d Hemorrhage
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11
Q

Focal Primary Brain damage has a _______ site

A

Specific site

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12
Q

Focal Primary brain damage caused by __________ or _______ @ impact

A

Distortion or laceration

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13
Q

Focal primary brain damage can be the impact of the ______ on ______

A

impact of brain on the dura/bone

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14
Q

Diffuse Primary Brain damage ===>

A

Axonal shearing

remember diffuse==widespread

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15
Q

Primary brain damage can have this assoc’d w/ it

A

hemorrhage

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16
Q

ICH associated w/ TBI can be in 3 places:

A
  1. Epidural–outside dura
  2. Subdural–b/w dura and brain
  3. Intracerebral –in deep brain
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17
Q

CARDINAL sign of Epidural ICH

A

Concussion

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18
Q

Epidural ICH

A
  • skull fx assoc’d w/ superficial vessel laceration
  • Lucid interval:
    • Concussion–> lucidity–> decline
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19
Q

Subdural ICH

A
  • Bleeding from vessels b/w dura and brain
  • Accel/Decel injuries
  • HIGH mortality rate******
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20
Q

Intracerebral ICHs

A
  • Contusion deep brain
  • Coup/Contrecoup injury
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21
Q

Diffuse Axonal Injury

What is going on here???

A

Axonal Shearing

see pic!!!

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22
Q

MOST COMMON STRUCTURAL ABNORMALITY IN TBI

A

Axonal shearing from Diffuse Axonal Injury

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23
Q

Axonal shearing deficits?

A

minor–> fatal

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24
Q

Axonal shearing and skull fx’s?

A

Can occur in the absence of Skull fx

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25
Q

Secondary Brain Damage: 2 Subtypes

A
  1. System Brain Damage
  2. Intracranial Brain Damage
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26
Q

Secondary Brain Damage: Systemic

A
  • arterial hypoxemia
    • airway obstruction/trauma
  • brain loses ability to autoreg. vasodilation
    • ​DEC cerebral perfusion==hypoxia
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27
Q

Secondary Brain Damage: Intracranial

A
  • Cytotoxic edema
    • ​inflammation
  • Vasogenic edema
    • ​inflammation
  • Inc’d ICP
    • from 5-10 mmHg
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28
Q

Brain shift + Herniation is considered…..

A

NEUROSURGICAL EMERGENCY!

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29
Q

Brain shift and herniation: 4 types

A
  1. Uncal herniation
  2. Central herniation
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30
Q

What is an Uncal herniation ?

A

Temporal lobe gets pushed DOWNward thru temporal notch compressing the BS

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31
Q

What is a Central herniation?

A

SAME as Uncal herniation

but diencephalon @ risk

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32
Q

What is a Subfalcial herniation?

*remember Falx cerebri

A

Expanding frontal lobe lesion

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33
Q

What is a Cerebellar herniation ?

A

Cerebellar edema pushes the cerebellar tonsils DOWNward thru foramen magnum

BS compressed

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34
Q

Associated Ortho. cond’s w/ TBI and skull fx

A
  • Occult SCI
    • SCI and TBI common together
  • Temporal fx
  • Myositis ossificans/HO
  • contractures
    • hypERtonia common
  • trauma
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35
Q

Blast Induced Traumatic Brain Injury

A

See table

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36
Q

Blast induced TBI: Primary

Types of injuries

A

injuries from impact or shearing from overpressure wave

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37
Q

Blast induced TBI: Primary

Patterns of Injuries

A

Brain (TBI), viscera, lungs (PE), tymp. memb. rupture or inner ear patho (vestibular, cochlear, BOTH)

38
Q

Blast Induced TBI: Secondary

Types of injuries

A

Injuries from projectiles

shrapnel, debris

39
Q

Blast Induced TBI: Secondary

Patterns of Injuries

A

Fx’s, limb loss, TBI, soft-tissue injuries

40
Q

Blast Induced TBI: Tertiary

Types of Injuries

A

Injuries from displacement of the indiv. by blast wind

41
Q

Blast induced TBI: Tertiary

Patterns of injury

A

TBI, limb loss, fx’s

42
Q

Blast induced TBI: Quaternary

types of injuries

A

other types of injuries

43
Q

Blast induced TBI: Quaternary

patterns of injury

A

burns, crush inj’s, asphyxia, toxin exposure, chronic illness exacerbation

44
Q

What are the lvls of Alertness?

A
  • Normal consciousness
  • coma
  • stupor
  • obtundity
  • delirium
45
Q

alterness: normal arousal/cognition

A

Norm consciousness

46
Q

alterness: unresponsive to stimuli

A

coma

47
Q

alertness: arousal only by vigorous stimuli

A

Stupor

48
Q

alertness: slow responses to stimuli

delayed resp.

A

Obtundity

49
Q

alertness: misinterpretation of stimuli

A

Delirium

50
Q

What are 3 measures used to measure Arousal and Cognition?

A
  1. Orientation
  2. Glasgow Coma Scale
  3. Rancho los Amigos Scale of Cognitive Functioning
51
Q

Testing Orientation

A+O *3

what is this?

A
  • A= Alert
  • O= Orientation
  • *3
    • Person
    • Place
    • Time
52
Q

What is the Glasgow Coma Scale

GCS

A
  • Done in field AND @ 24hrs
  • Predictive, NOT localizing
53
Q

THREE components to the GCS

A
  1. eye opening
  2. Best motor response
  3. Best verbal response
54
Q

GCS grading

A

3-15

55
Q

GCS: 8 or LESS ===>

A

Coma

*NOTE: score of 8 or LESS correlates w/ need for LT care

56
Q

GCS: Eye opening scale

A
  • 4= spont. eye opening
  • 3= open to command
  • 2= open to painful stimuli
    • sternal rub
    • nail bed press.
  • 1= No response
57
Q

GCS: Best MOTOR response

A
  • 6= obeys command
  • 5= localizes
  • 4= w/draws
  • 3= Decorticate (flex) posturing
  • 2= Decerebrate (ext, all the e’s) posturing
    • ​WORSE vs. decorticate
  • 1= No response
58
Q

GCS: Best VERBAL Response

A
  • 5= Oriented
  • 4= responsive BUT disoriented
  • 3= inappropriate
  • 2= Moans
  • 1= No response
59
Q

GCS score range

A

3-15

*8 or LESS defines coma

*8 or LESS correlates w/ need for LT care

60
Q

Rancho Los Amigos Scale for Cognitive Functioning

*Listed out*

A
  • I= No response
    • coma lvl
  • II= Genarlized response
    • coma lvl
  • III= Localized response
    • coma lvl
  • IV= Confused- agitated
  • V= Confused- inappropriate
  • VI= Confused- appropriate
  • VII= Automatic Appropriate
  • VIII= Puroseful Appropriate
61
Q

Rancho lvl 1

A

No response

*coma lvl

indiv. in deep coma and does NOT respond to ANY outside stim. (verbal, touch)

62
Q

Rancho lvl 2

A

generalized response

*coma lvl

indiv. sleeps most of the time, awake for only brief pds.

responses and body mvmts are reflexive and non-purposeful

63
Q

Rancho lvl 3

A

Localized response

*coma lvl

indiv. is alert for more than brief pds

he/she reacts to commands incosistently, BUT resp’s are specific to the type of stim. (touch may produce a w/drawal)

64
Q

Rancho lvl 4

A

Confused-Agitated

indiv’s behavior shows marked confusion and agitation as awareness inc’s

behavior may be aggressive and inappropriate, and speech incoherent

individual is NOT able to participate in Tx due to lack of attention, and cannot perform ADLs (brush teeth, eat)

65
Q

Rancho lvl 5

A

Confused- Inappropriate

indiv. shows INconsistent ability to follow commands, but LT memory is returning

well-known skills such as eating return, however, complex tasks are difficult as are NEW skills and concentration

66
Q

Rancho lvl 6

A

Confused-Appropriate

indiv. begins demonstrating goal-directed behavior w/ assistance

individual is now aware of their diff’s and familiar people

retention of re-learned skills is improved, and can be used in other situations

67
Q

Rancho lvl 7

A

Automatic Appropriate

indiv. performs ADLs w/ more ease and is able to learn NEW skills

noticeable impairment still exists in ST memory and problem solving ability

68
Q

Rancho lvl 8

A

Purposeful Appropriate

indiv is able to function w/in the community even w/ continued impairment in cognitive ability, and social and emotional ability

69
Q

Frontal Lobe Syndrome

*Think of what happened to Phineas Gage!!!

A
  • Exacerbation of premorbid behaviors
  • Emotional lability
    • unstable mood
  • Disinhibition
  • Loss of executive function
  • Highly distractible
  • Confabulation***
    • making up stories
    • memory gaps
70
Q

Memory Changes: Amnesia

3 types

A
  1. Retrograde
  2. Anterograde
  3. Post-traumatic
71
Q

Retrograde Amnesia:

Think “before”

A
  • Loss/disturbance memories for events that occured before an event
  • EX:
    • ​after person suffers brain damage MVA, he/she may be unable to remember events that occured before the BI, such as being in the car
72
Q

Anterograde Amnesia:

Think “after”

A
  • Loss/disturbance memory events that occur after an event
  • EX: after person suffers brain damage from head injury, he/she may be unable to remember events that occur AFTER BI, such as being in hospital
73
Q

Post-traumatic Amnesia

think “forming memories”

A
  • inability to form consistent day-day memories
  • often actively confused/disoriented
74
Q

Concussion aka

A

Silent Epidemic

75
Q

Concussions—-Silent Epidemic

Some data…

A
  • CDC–> concussions resulting in LOC acct for 8-19% concussions
  • w/ 1.6 to 3.8 mill concussions occurring ea. yr
    • only 1/2 recognized/reported
  • NOTE: # of people w/ TBI not seen in ED or receive no care is unknown
76
Q

FACTS: Concussion

A
  • Concussions per every 100,000 games and/or practice collegiate lvl:
    • Football-27
    • Ice hockey-25
    • Men’s soccer- 25
    • Women’s soccer- 24
    • Wrestling- 20
    • Women’s basketball- 15
    • Men’s basketball- 12
77
Q

What about helmets

*concussion

A

DO NOT protect from accel/decel forces

ONLY FOCAL INJURY (or the traumatic initial blow) NOT the coup/contrecoup

78
Q

S/S Concussion

A

Thinking/Remembering

Physical

Emotion/Mood

Sleep

***SEE PIC

79
Q

S/S concussion: Thinking/Remembering

A
  • diff thinking clearly
  • feel slowed down
  • diff concentrating
  • diff remembering new info
80
Q

S/S concussion: Physical

A
  • HA–fuzzy/blurry vision
  • Nausea or vomiting early on, dizziness
  • sensitive to noise/light—balance probs
  • tired, no energy
81
Q

S/S concussion: Emo/Mood

A
  • irritable
  • sad
  • MORE emo
  • nervous/anxious
82
Q

S/S concussion: Sleep

A
  • sleep more than usual
  • sleep less than usual
  • trouble falling asleep
83
Q

IMMEDIATE signs concussion

w/in secs to mins***

*I.S.G.D.E.M.A

A
  • Impaired attention
    • vacant stare, delayed resp., inability to focus
  • Slurred or incoherent speech
  • Gross incoordination
  • Disorientation
  • Emotional rxns out of proportion
  • Memory deficits
  • Any loss of consciousness
84
Q

LATER signs of concussion

*w/in hrs to days

A
  • persistent HA 71%
  • dizziness/vertigo 55%
  • poor attn and concentration 57%
  • memory dysf 43%
  • nausea/vomiting
  • fatigue easily 50%
  • irritability
  • intolerance bright lights 47%
  • intolerance loud noises
  • anxiety/depress.
  • sleep disturbances
85
Q

Concussion aka

A

“Bell Ringer”

“Got your bell rung”

86
Q

Bell Ringer facts :

A
  • Study showed 64 high school football players w/ concussions “resolving” w/in 15mins by sideline tests
  • avg time for full recovery by neurocog. testing is 7 days
  • IF asymptomatic by 5mins returned to neurocog. baseline by day 4
87
Q

How would you define Post-concussive syndrome from minor head trauma?

A

NO skull fx OR ICH

unconscious for <2 hours

88
Q

Post-concussive syndrome from minor head trauma S/S

A
  • persistent HAs 25%
  • anxiety 19%
  • insomnia 15%
  • non-specific dizziness 14%
  • Others
    • fatigue, HA, poor concentration, memory disorder, irritability, spatial disorientation
89
Q

Post-concussive Vestibular dysf.

*PT wheelhouse!!!

A
  • s/s include:
    • vertigo
    • dizziness
    • imbalance
  • dizziness or imbalance 2* to mild TBI ranges 24%-83%
  • vestib s/s can last >6 months
90
Q

Chronic Traumatic Encephalopathy

what about it????

A

Controversy b/w this and having ALS

91
Q

Chronic Traumatic Encephalopathy

CTE

What did they find w/ this and ALS?

A
  • Neuropath. study of athletes (12) w/ mult. concussions
    • 2 dx’d w/ ALS
    • neuropath studies demonstrate CTE
      • abnormal tau PRO ID’d
  • 3 athletes w/ CTE ALSO developed progressive motor neuron disease w/ profound weakness, atrophy, spasticity, and fasciculations several yrs BEFORE death
92
Q
A

MedCon Rehab II (5 decks)

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