Behavioral science - TBI Flashcards
Mild TBI
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
Which accounts for greatest percentage of total TBIs
Car accidents Blunt trauma assault falls unknown causes
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
What is a concussion?
Mildest form of mild TBI (often used interchangeably with mid TBI)
What is the greatest risk factor for acute TBI?
Alcohol use
Men are more likely to get TBIs and die from them
statistically one TBI increases odds of having another
primary or secondary causes of TBI pathophysiology
Diffuse axonal injury
Vascular tear
Focal cortical contusions
Intracranial, extracerebral hemorrhage
primary
primary or secondary causes of TBI pathophysiology?
Ischemia, hypoxia
secondary
primary or secondary causes of TBI pathophysiology?
Edema
secondary
primary or secondary causes of TBI pathophysiology?
Ischemia, hypoxia Vasospasm Edema Necrosis, apoptosis Inflammation Seizure
secondary
Glasgow coma score of 7
Severe TBI (3-8)
Glosgow coma score 11
Moderate TBI (9-12)
Gosgow coma scale for mild TBI
13-15
What causes energy crisis after TBI?
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
Recovery stages 1
Coma - unresponsive, eyes closed, no sign of wakfullnes RLAS level 1
Recovery stage 2
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
Recovery stage 3
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
Recovery stage 4
confusional state - interactive, begin to communicate and use objects appropriately
in post-traumatic amnesia - associated with post-traumatic agitation
Recovery stage 5
post-confusional state - resolution of post-traumatic amnesia and agitation
Recovery stage 6
social competance stage - can regain autonomy/independence and return to community
What is the biggest prognostic indicator of recovery duration?
time spent in confusional state (recovery stage 4)
When does most recovery happen after TBI
first three months although recovery can be seen up to 2 years out
What is post-traumatic agitation? what are the diagnostic criteria?
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
What is the mainstay of treatment for post-TBI care?
environmental modification, education»_space;» medications
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?
anterior cingulate ctx
Pt exhibits inability to perform executive functions what brain region is affected?
dorsolateral prefrontal ctx
Pt. exhibits inability to act appropriately in social settings, is either unaware, or is unable to correct their behaviors what brain region is affected?
lateral orbitofrontal ctx
What regions of the brain are particular susceptible to damage from TBI?
Areas involved in emotional regulation: frontal cortex, temporal cortex, hippocampus and corpus collosum
