Brain Injuries Flashcards
Acquired brain injuries (ABI) -
They can be classed as:
An acquired brain injured is an injury caused to the brain since birth (after birth)
It can be: traumatic and non-traumatic
Stats of acquired brain injuries-
Men are 1.5 times more likely than women to be admitted for head injury
Female head injury admissions have risen by 23% since 2005-6
Peak age 16-25
ABI admissions have increased by 10% since 2005-6
Traumatic brain injury -
TBI
Brain injury caused by trauma to the head (including effects upon the brain of other possible complications of injury, notably hypoxemia and hypotension, and intracerebral haematoma)
TBI classification
Minor brain injury -
Moderate brain injury -
Minor - loss of consciousness is less than 15minutes
Post traumatic amnesia less than 1 hour
Moderate - less of consciousness 15mins-6 hours
Post traumatic amnesia 1 hour - 24 hours
TBI classification
Severe brain injury -
Very severe brain injury -
Severe - loss of consciousness 6-48 hours
Post traumatic amnesia 24hours -7days
Very severe - loss of consciousness more than 48 hours
Post traumatic amnesia more than 7 days
Causes of TBI -
RTA
Slipping and falling
Something falling or being thrown that strikes the head
Being shaken violently
Sports-related events or activities
Acts of violence
What are the types of TBI?
Open (or penetrating) wounds eg bullet
Crushing injuries eg head injury admissions machinery
Closed head injury - this is when the brain is damaged inside the skull, not affected from the outside
Can see this with RTA if violent shaking for example
Closed TBI
What can happen between the meninges?
Fluid and blood may be found at different areas - this can help with diagnosis, depending on which meninges it sits between
Eg, subarachnoid haemorrhage - blood found in subarachnoid space between Pia and arachnoid matter
Closed TBI
Diffuse axonal injury -
Caused by a combination of acceleration and deceleration and contact forces
It affects individual nerve fibre
Shearing force from the contact severs the nerve - disrupting communication therefore nerve cells die and produce oedema which increases pressure which can restrict blood flow around the brain
Can happen when brain shaken eg RTA head flung backwards and forwards
What is a haematoma ?
Pool of blood/a bruise inside skull which can increase pressure inside the brain
What is cerebral atrophy?
Loss of nerve cells in brain and the connections between them
Caused by stroke, TBI or disease
What is a neuropsychological assessment ?
For patients who are stable and going into early stages of rehab
Series of tests - assesses multiple aspects of the mind
Helps develop rehab plan and track their progress throughout
Glasgow coma scale -
Measures level of alertness
Measures eye, motor and verbal response
Scale of 3-15
15 - fully awake
3 - deep in comma
3-8 - indicate severe brain injury
Immediate signs and symptoms of a TBI -
Difficulty concentrating or confusion
Changes in consciousness
Headaches and dizziness
Vomiting and nausea
Changes in mood, behaviour or personality
Changes in eyes/dilated pupils
Hallucinations
Swelling at sit of suspected brain injury
Inability to remember
Difficulty breathing
Any fluids leaking from the nose, eyes or ears
Difficulties with language or speech
Changes in vision, especially blurred vision
What can be done to relieve pressure if someone has a TBI?
Craniotomy - done in more severe cases as part of skull is removed
cranioplasty or burr holes
Causes of non-traumatic brain injury -
Tumour
Stroke
Brain haemorrhage - int/ext bleeding caused by damage to a blood vessel
Encephalitis (swelling)
Carbon monoxide poisoning
Hydrocephalus
Meningitis
Non-traumatic
Hypoxic injury -
Anoxic injury -
Hypoxic - when there is a still a partial supply of oxygen, but at a level which is inadequate to maintain normal brain function - cerebral hypoxia
Anoxic - a complete interruption of the supply of oxygen to the brain - cerebral anoxia
Non traumatic
Causes of anoxic brain injury -
Cardiac or respiratory arrest
Irregular heart rhythm or poor function of heart muscle after a heart attack resulting in inefficient supply of blood to brain
Very low BP following massive trauma (eg stabbing)
Suffocation
Choking
Strangulation
Very severe asthma attack
Near drowning
Exposure to high altitudes
Smoke inhalation
Carbon monoxide inhalation
Poisoning
Drug overdose
Electric shock
Attempted suicide
Non traumatic
Medical treatment of anoxic brain injury -
Varies depending on cause
In all cases - efforts will be directed at restoring normal heart beat, BP and good O2 supply to brain
Usually admitted to an intensive care unit and put on a ventilator
May need drugs to maintain adequate BP and normal heart beat
Seizures are quite common
Patients may undergo medically induced cooling, referred to as a therapeutic hypothermia
Non traumatic
Immediate signs and symptoms of anoxic brain injury-
Confusion
Loss of consciousness
Feeling woozy or dizzy
Intense headache
Vomiting
Changes in behaviour or sensation
Medical treatment of acquired brain injuries -
Varies depending on cause and medical need
Emergency department
Neurosurgical unit - neurosurgery
ICU
General hospital ward
Brain injury unit
Specialist neuro rehab unit
Community care
Signs and symtpoms of acquired brain injuries -
Dependent on area of brain affected
Frontal lobe - personality
Temporal - speech, motor, LT memory
Occipital - sight, facial recognition
Parietal - motor, sensory
Brain stem - autonomic NS
Cerebellum - balance, coordination
*can involve all four limbs!!!!
Hidden LT affects of acquired brain injuries -
Changes within behaviours and personality
Difficulty with previously unchallenging tasks
Changes in relationships
Difficulty with short/long term memory
Trouble recognising familiar faces or people
New fears/phobias
Psychological symptoms such as unexplained depression or anxiety
Frequent headaches
Unexplained pain in the limbs
Coma and reduced awareness states
Vegetative state -
Severe
Have sleep-wake cycles but no conscious awareness of themselves or their surroundings
Coma and reduced awareness states
Minimally conscious state -
Shows distinct but limited signs of awareness and response to stimulation
Very difficult to remain aware or responsive for any length of time or in a predictable way
Coma and reduced awareness states
Locked in syndrome -
This is a rare condition in which a person is aware of themselves and their surroundings but is unable to move or speak
Often people can move their eyes or eyelids, and therefore may be able to communicate by blinking
Mortality rate using Glasgow coma scale
3-
4-
5-
6-
7-13 -
3- 65%
4- 45%
5- 35%
6- 24%
7-13 - 10-15%
Prognosis of patients with brain injury, what does prognosis depend on?
Prognosis depends on:
Age - recovery prognosis declines with age
Location of contusion on the brain
Length of time spent in coma - paired with post-traumatic amnesia, this can dictate how long the recovery period will take
People involved in MDT care -
Physio
OT
Neurologist
Rehab doctor
Clinical neuropsychologist
Speech and language therapist
Nurses
Social workers
Orthotists
Physio management -
Respiratory care
Rehab - starting early and ongoing
Sensory assessments
Assess and treat patient symptoms
What signs and symptoms of brain injury can be more disturbing than the motor symptoms?
Personality changes
Increased aggression
Cognitive and emotional symptoms
What is concussion?
Temporary disruption of brain function
Temporary unconsciousness/confusion caused by a blow/trauma to the head
The severity of a brain injury is defined by what two main criteria?
Loss of consciousness
Amnesia
How long can the brain survive without oxygen?
4 minutes (3-6mins)
4 distinct types of haemorrhages:
Subarachnoid - between arachnoid and Pia
Subdural - between arachnoid and dura
Epidural - between skull and dura
Intracerebral - in the brain
Diagnosis - brain imaging
CT scan -
Quieter and quicker
Computerised tomography scran
Uses x-rays and a computer to create detailed images of the inside of the body
Sometimes referred to as CAT scans
Diagnosis - brain imaging
MRI scan -
Loud!
Magnetic resonance imaging
Uses strong magnetic fields and radios aves to produce detailed images of the inside of the body
MRI’s can be taken in different planes
Normal CT scan - what are you looking for?
CT is always taken as if looking down at the brain
Look for symmetry
White border - skull
