Behavioral Science: Traumatic Brain Injury

Question 1

TBI definition

Answer 1

Injury to the head arising from a blunt or penetrating trauma, or from acceleration/deceleration forces resulting in one or more of the following:

• decreased LOC
• amnesia
• neurologic/neuropsychological abnormality
• skull fracture
• diagnosed intracranial lesions
• head injury listed as cause of death on death certificate

Question 2

Mild TBI def

Answer 2

Traumatically induced physiological disruption of brain function at the time of accident AND/OR:
Focal neurological deficits that may or may not be transient BUT:
LOC does not exceed 30 min, GCS score between 13-15 30 min after impact and post-traumatic amnesia does not exceed 24 hours

Question 3

Risk factors for TBI

Answer 3

Male, age 0-4, 15-24, 65+

- lower SES, Rx drug use, alcohol use, race/ethnicity, recurrent TBI

Question 4

Mortality of TBI

Answer 4

men 3x more likely to die than women

highest rates in 65+

Question 5

Leading cause of TBI by age

Answer 5

0-4: assault
15-24: MVC
65+: falls

Question 6

Primary cause of TBI

Answer 6

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

Question 7

Secondary cause of TBI

Answer 7

Ischemia, hypoxia
Vasospasm
Edema
Necrosis, apoptosis
Inflammation
Seizure

Question 8

Diffuse axonal injury

Answer 8

Deceleration of the brain within the skull causing shearing or torsional forces of brain tissue

Question 9

Neurometabolic cascade

Answer 9

• Hypermetabolic glycolytic state
• Decreased cerebral glucose metabolism
• Reduced cerebral blood flow and glucose delivery
• ENERGY CRISIS with mismatch of energy demand to vascular energy supply

Question 10

Classification of TBI based on GCS

Answer 10

Severe: 3-8
Moderate: 9-12
Mild: 13-15

Question 11

Systemic complications following TBI

Answer 11

SO MANY.
Autonomic dysregulation, pulmonary embolus, dysphagia, gastritis, delayed gastic emptying, neurogenic bladder, heterotopic ossification, electrolyte imbalance, hypopituitarism, spasticity, dysesthesia, headache, hydrocephalus, vasospasm, seizures, infxn, depression, anxiety, agitation, delirium sleep dysfunction.

Question 12

Post traumatic agitation

Answer 12

• impulsive, impatient, low tolerance for pain
• explosive, unpredictable anger
• restlessness, pacing, excessive movement
• loud, rapid excessive talking

Question 13

Treatment for post traumatic agitation

Answer 13

• environmental modifications

- Beta blockers, Antiepileptic/anticonvulsants, antidepressants, antipsychotics

Question 14

Psych probs after TBI

Answer 14

Depression, GAD, OCD, PTSD in mild TBI

Question 15

Substance misuse

Answer 15

Pre-injury: 2x rate of substance use compared to gen pop
Immediately post injury: decline in drug and alc
One year post injury: up to 1/3 hospitalized for TBI misuse alc/drugs