Brain Injuries Flashcards

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1
Q

Traumatic Brain Injury ( TBI) Description and Definitions

A

-loss of consciousness, posttraumatic amnesia, disorientation and confusion, or, in more severe cases, neurological signs
* Complex changes in physical, cognitive, neurobehavioral due to
brain damage
* Damage occurs post birth
* Not associated to congenital or degenerative disease

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2
Q

Mild TBI:

A
  • Loss of consciousness of <30 minutes
  • Posttraumatic amnesia of <24 hours and disorientation and confusion
  • Glasgow Coma Scale (GCS) score of 13 to 15.
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3
Q

Moderate TBI

A
  • Loss of consciousness of 30 minutes to 24 hours
  • Posttraumatic amnesia of 24 hours to 7 days
  • GCS score of 9 to 12
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4
Q

Severe TBI:

A

Loss of consciousness of more than 24 hours
* Posttraumatic amnesia of more than 7 days
* GCS score of 3 to 8 (American Psychiatric Association, 2013)

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5
Q

Primary brain damage

A

Focal lesions
Diffuse lesions

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6
Q

Diffuse lesions

A
  • Occur throughout multiple brain areas and may result from an explosion, motor
    vehicle accidents, or sport collisions. Often at speeds of 15mph or more.
  • Motor vehicle accidents typically result in both coup and contrecoup injuries
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7
Q

Focal lesions

A
  • Limited in scope and are associated with direct impact of short duration such as occurs with gunshot
  • Occurs throughout multiple brain areas and may result from an explosion, motor vehicle accidents, or sport collisions
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8
Q

Secondary damage

A

Occurs within hours and days of impact. Factors leading to secondary damage may include inflammatory responses, raised intracranial pressure, and decreased cerebral blood flow or
ischemia

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9
Q

General Medical Complications

A

1st wk symptoms following mild TBI: dizziness, fatigue, memory difficulties, headaches
* Coma
* Hydrocephalus -Buildup of fluid in the cavities ands pressure
-Seizures
-Deep vein thrombosis following TBI is up to 54%
-Dysautonomia - severe TBI

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10
Q

TBI Etiology

A

 Falls (most common)
 Motor vehicle accidents (most common severe TBI)
 Violence
* TBI ER visits most common below the age 5 and > age 85
* 61% of vehicle accidents involved males
* 1/3 to 1/2 intoxicated time of injury

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11
Q

Diagnostic Testing

A
  • Glasgow Coma Scale (GCS)
  • Disability Rating Scale (DRS) – expanded on GCS info; good validity &
    reliability
  • Rancho Los Amigos Scale, aka Levels of Cognitive Functioning
  • CT scan & MRI
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12
Q

TBI

A
  • Physical
  • Cognitive
  • Communicative
  • Neurobehavioral changes.
    -all different
    -Impact all Occupational performance
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13
Q

Diagnostic Testing: Glasgow Coma Scale

A

Rating of:
* Eye opening,
* Motor responses, &
* Verbal responses
*To assess level of consciousness
*Used to quantify severity of brain injury & predict outcome
*Beset known & widely accepted scale of coma

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14
Q

Cerebellar or intention tremors

A

-slow tremors that occur at the end of purposeful movement associated with ataxia,hypotonia, and balance disorders
-occur in trunk-
-4-6 sec

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15
Q

-Resting tremors

A

Correlated with striatal damage and involve a pill-rolling movement at rest, occurring at a
similar rate

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16
Q

Essential tremors

A

Slow constant tremors that typically affect more distal musculature, occur at a frequency of 8 to 12 per second, and increase with anxiety and maintained positions.

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17
Q

Physiologic tremor

A

Present in every person and occurs at the same rate as essential tremor. It can be exacerbated by fatigue, stress, strong emotions, caffeine, and fever

18
Q

Cognitive Deficits

A

Among the most common, difficult, and long-lasting consequences, both adults and children.
* Retrograde and anterograde amnesia affect learning and cognitive rehabilitation.
* Retrograde amnesia, or memory loss prior to the accident,
* Anterograde amnesia, defined as the inability to learn new long-term
declarative information, is typically the last to improve.
* Motor learning is often functional during rehab process, despite memory loss
 Sustained attention and concentration
 Initiation & termination of activities
 Reasoning skills
 Executive functions & abstract thought
 Generalization
 Processing of information or comprehension
 Memory
 Visual (more common than visual perceptual deficits)
 Visual perceptual
 Self-monitoring and impulse control
-Safety awareness & judgment

19
Q

Psychosocial Deficits

A

 Perseveration
 Poor control of temper
 Aggression / irritability
 Apathy
 Depression
 Suicide
 PTSD

20
Q

Neurobehavioral Status

A

 Natural part of the recovery process
 Occur as a result of cognitive deficits interacting with brain dysfunction
 Typically seen whether it’s a mild, mod, or severe injury
 Includes:
-Impulsivity, irritability, poor control of temper, aggression, disinhibition, &
apathy
 Comprehensive behavior management program

21
Q

Cranial Nerve Dysfunction

A

 Absent pupillary reflex to light (CN III)
 Damage to midbrain
 Fixed or dilated pupil
 Pressure on the oculomotor nerve,
 Homonymous hemianopsia (CN II)
 Loss of sense of smell (Anosmia) (CN I)
 High-frequency hearing loss (CN VIII)
 Glossopharyngeal (IX) / vagus nerves (X)
 Dysfunction results in an absent or depressed gag reflex
 Dysphagia

22
Q

Visual Deficits from Optic Nerve II

A

 Visual rather than perceptual deficits
 Diplopia
 Problems with accommodation and convergence
 Visual field deficits
 Saccadic dysfunction
 Strabismus
 Condition in which the eyes do not properly align with each other when looking at an object
 Binocular or oculomotor deficits
 Refractive deficits
 Eyelid movement dysfunction
 Nystagmus
 Involuntary, rapid, rhythmic movement (horizontal, vertical, rotatory, or mixed, i.e., two
types) of the eyeball.
 Ptosis
 Drooping of the upper eyelid due to paralysis or disease

23
Q

Precautions

A

 Acute stages: intracranial pressure (ICP) must be monitored
 In the later stages, fall precautions to avoid further injury and supervision to assist in daily tasks.
 Note that there are likely other injuries present

24
Q

TBI Course and Prognosis

A
  • Highly individual; factors include: age, gender, preinjury hx
  • May reduce life span by 9 yrs
  • Prognosis factors: trauma score, GCS score, biomarkers, presence / absence of hypoxia, length of coma, duration of amnesia
  • Abuse associated with mortality of children < 1yr old
25
Q

Acute Phase medical management

A

Focus: preservation of life, prevention
 Endotracheal tube
 CAT scan
 Possible surgical decompression
 Indwelling urinary catheter
 Close attention to skin integrity is essential,
 Nasogastric tube
 About one-third of those hospitalized with TBI aspirate food
 Respiratory therapy
 Prophylactic medication

26
Q

Rehabilitation:

A

-in the acute phase may begin as soon as
neurological stability is achieved
 Prevent joint deformity
 Provide graded sensory stimulation
 Maximize the person’s function
 Minimize additional physical or psychosocial impairments
 Prevent complications
 Accommodation, compensatory techniques when max potential
achieved
 Caregiver Education

27
Q

Tumors of CNS Primary site vs Secondary site

A

Site of origin, even when the tumor has spread to other parts of the body
or brain (secondary site)

28
Q

Malignant tumors

A

 Abnormal cells that multiply rapidly
 Metastasize
 Brain tumors rarely metastasize beyond the brain

29
Q

Benign tumors

A

 Not cancerous, does not spread
 May become life threatening, continue cell growth = increased pressure on structures

30
Q

Tumors of the CNS Etiology

A
  • Brain tumors = chemical changes in brain cells
  • Most brain tumors develop for no apparent reason
  • High levels of ionizing radiation
  • Exposure to neurogenic / carcinogenic substances
31
Q

Tumors of the CNS Signs and Symptoms

A
  • Up to 50% experience sleep disturbance
  • Fatigue (most significant problem)
  • Headaches
  • Depression / anxiety / mood changes
  • Pain
  • Cognitive Dysfunction
32
Q

Tumors of the CNS Medical / Surgical Management

A
  • Surgery
  • Chemotherapy
  • Radiation therapy
  • Stereotactic radiosurgery (precision)
  • Steroids / anti-epileptic drugs
  • Reduce brain edema and ameliorate the person’s symptoms
  • Complementary / alternative therapies
  • Meant to treat symptoms
33
Q

Anterograde amnesia

A

memory loss that occurs when you can’t form new memories.

34
Q

Contrecoup injury

A

occurs at sites remote to the actual impact site on the head.

35
Q

Decerebrate rigidity
Decorticate rigidity

A

-involuntary extensor positioning of the arms, flexion of the hands, with knee extension and plantar flexion when stimulated as a result of a midbrain lesion.
- abnormal posturing characterized by
-Stiffness with bent arms/straight/clenched
-Sign of severe brain damage.

36
Q

Dysautonomia

A
37
Q

Heterotopic ossification

A

disrupts ANS

38
Q

Metastasis

A

development of secondary malignant growths at a distance from a primary site of cancer

39
Q

Hydrocephalus

A

accumulation of cerebrospinal fluid occurs within the brain. This typically causes increased pressure inside the skull

40
Q

Nystagmus

A

condition where your eyes make rapid, repetitive, uncontrolled movements.

41
Q

Retrograde amnesia

A

form of memory loss that affects the ability to access memories formed before the onset of amnesia.