Behavioral science - TBI

Question 1

Mild TBI

Answer 1

Traumatically induced physiological disruption of brain function (loss of consciousness, loss of memory for events immediately before or after the accident, alteration in mental state) at the time of accident

AND/OR

Focal neurological deficits that may or may not be transient

loss of consciousness does not exceed 30 minutes

Glasgow Coma Scale score is between 13-15 (thirty minutes after impact)

post-traumatic amnesia does not exceed 24 hours

Question 2

Which accounts for greatest percentage of total TBIs

Car accidents
Blunt trauma
assault
falls
unknown causes

Answer 2

over all - falls (~40%)

0-4 assault
4-24 motor vehicle accident
>65 falls

Men are more likely to get TBIs and die from them

Question 3

What is a concussion?

Answer 3

Mildest form of mild TBI (often used interchangeably with mid TBI)

Question 4

What is the greatest risk factor for acute TBI?

Answer 4

Alcohol use

Men are more likely to get TBIs and die from them

statistically one TBI increases odds of having another

Question 5

primary or secondary causes of TBI pathophysiology

Diffuse axonal injury
Vascular tear
Focal cortical contusions
Intracranial, extracerebral hemorrhage

Answer 5

primary

Question 6

primary or secondary causes of TBI pathophysiology?

Ischemia, hypoxia

Answer 6

secondary

Question 7

primary or secondary causes of TBI pathophysiology?

Edema

Answer 7

secondary

Question 8

primary or secondary causes of TBI pathophysiology?

Ischemia, hypoxia
Vasospasm
Edema
Necrosis, apoptosis
Inflammation
Seizure

Answer 8

secondary

Question 9

Glasgow coma score of 7

Answer 9

Severe TBI (3-8)

Question 10

Glosgow coma score 11

Answer 10

Moderate TBI (9-12)

Question 11

Gosgow coma scale for mild TBI

Answer 11

13-15

Question 12

What causes energy crisis after TBI?

Answer 12

Hypermetabolic state due to glycolytic state then leads to state of decreased cerebral glucose metabolism then leads to state of reduced cerebral blood flow and glucose delivery ===> ENERGY CRISIS (mismatch of energy demand to vascular energy supply)

Usually resolves between 6-10 days
associated with spike in glutamate ==> leads to cascade of other metabolic problems and diffuse altered NT levels

Question 13

Recovery stages 1

Answer 13

Coma - unresponsive, eyes closed, no sign of wakfullnes RLAS level 1

Question 14

Recovery stage 2

Answer 14

Vegitative state - no consioousness of self or environment but exhibit some involuntary motor movements (e.g. spontaneously open eyes), some evidence of sleep wake cycle appears in vegetative state

unable to localize pain or follow commands

Question 15

Recovery stage 3

Answer 15

minimally conscious state - defined by inconsistent simple purposeful behaviors

begin to follow commands but inconsistently and unable to communicate reliably (some words though)

can localize pain

Question 16

Recovery stage 4

Answer 16

confusional state - interactive, begin to communicate and use objects appropriately

in post-traumatic amnesia - associated with post-traumatic agitation

Question 17

Recovery stage 5

Answer 17

post-confusional state - resolution of post-traumatic amnesia and agitation

Question 18

Recovery stage 6

Answer 18

social competance stage - can regain autonomy/independence and return to community

Question 19

What is the biggest prognostic indicator of recovery duration?

Answer 19

time spent in confusional state (recovery stage 4)

Question 20

When does most recovery happen after TBI

Answer 20

first three months although recovery can be seen up to 2 years out

Question 21

What is post-traumatic agitation? what are the diagnostic criteria?

Answer 21

subtype of delirium after TBI that takes place in the confusional recovery state (under post-trauamatic amnesia)

excessive aggression, akinesthesia, disinhibition, emotional lability

occurs in the absence of other physical or medical or psychiatric conditions

can be continuous or intermittent

Question 22

What is the mainstay of treatment for post-TBI care?

Answer 22

environmental modification, education&raquo_space;» medications

Question 23

Pt exhibits inability to perform motivated behavior (decreased initiation of tasks or lack of motivation to engage in activity, apathy) what brain region is affected?

Answer 23

anterior cingulate ctx

Question 24

Pt exhibits inability to perform executive functions what brain region is affected?

Answer 24

dorsolateral prefrontal ctx

Question 25

Pt. exhibits inability to act appropriately in social settings, is either unaware, or is unable to correct their behaviors what brain region is affected?

Answer 25

lateral orbitofrontal ctx

Question 26

What regions of the brain are particular susceptible to damage from TBI?

Answer 26

Areas involved in emotional regulation: frontal cortex, temporal cortex, hippocampus and corpus collosum