Brain Injuries Flashcards
Types
> Traumatic > Non - Traumatic - Stroke - infection - surgical complication - anoxia
Facts
> ~ 350,000 in UK
more common in males (females numbers are on the rise)
TBI increased by 6% in last 15 years
Peak risk is 16-25yr olds or over 65’s
Traumatic Brain Injury
- Definition
- Causes
> Injury to the brain via trauma to the head
> Causes
- Automobile accident
- slipping/falling
- something striking the head
- being shaken violently
- sports
- violence
Traumatic brain injury - closed head injuries
> Brain is traumatized inside the skull (majority)
Diffuse axonal injury = accel + deccel of brain on skull
(‘coup-contracoup’ injury or rattling of brain)
- white + grey matter are different densities so travel at different speeds = shearing force at boundary
- Primary = shear
- Secondary = chemical/swelling damage to axon + demyelination
Concussion = temporary disruption of brain function
Intracranial haematoma = ruptured vessel causes pool of blood around brain or between brain + skull
Cerebral Contusion = bleeding in brain
Traumatic Brain Injuries
- Open wound injuries
- Crushing injuries
> Open wound injuries
- blow to head is forceful enough to penetrate the skull
- often life-threatening
- potential for infection
> Crushing injuries
- brain is compressed between two objects
- very life threatening (rarest of brain injuries)
Traumatic Brain Injury - Signs + Symptoms
> Difficulty concentrating or confusion > Changes in consciousness > Headaches + dizziness > Vomiting + Nausea > Changes in mood/personality/behaviour > Changes in eyes/dilated pupils > Changes in vision - blurred vision/hallucinations > Swelling at site of brain injury > Inability to remember > Difficulty breathing > fluid leaking from nose/ears/eyes = CSF > Difficulty with speech
Traumatic Brain Injuries - Severity
> dictated by: a) loss of consciousness b) post traumatic amnesia > Minor a) <15mins b) < 1 hour > Moderate a) 15mins - 6hrs b) 1-24hrs > Severe a) 6-48 hours b) 24hrs - 7 days > V. severe a) 48 hours + b) 7 days +
Coma + Reduced Awareness states
> Vegetative
- brainstem = functioning
- sleep - wake cycles
- no conscious awareness of themselves or their surroundings
> Minimally Conscious
- Distinct but limited signs of awareness - will respond to stimuli
- v. difficult to remain aware or responsive for a predictable amount of time
> Locked in Syndrome
- Aware of themselves + surroundings
- unable to move/speak (can communicate via blinking)
Anoxic Brain Injuries - Definition
> Non- traumatic
Brain is deprived of oxygen (neural cells begin to die = apoptosis)
If enough cells die (large amount) then there is diminished brain function
Anoxic Brain Injuries - Causes
> Stroke or TIA > Anaphylactic shock > Electrocution > Extremely low blood pressure > severe pneumothorax/collapsed lung > O2 deprivation at birth > Choking or strike to windpipe > Drug Overdose
- Brain damage = possible after 30 secs without O2
- almost inevitable after 2 mins
- brain death can occur after 4 mins without O2
Anoxic brain injuries - Types
> Diffuse Cerebral Hypoxia
- mild to moderate injury
- minimal brain impairment due to low blood O2
Focal Cerebral Ischaemia
- O2 deprivation (usually due to stroke) to a single brain region
- Other regions may be unaffected
Global Cerebral Ischaemia
- Complete cessation of blood to brain = v. damaging
Cerebral Infarction
- Stroke completely deprives multiple brain regions of O2
Anoxic Brain Injuries - Immediate Signs + Symptoms
> Confusion > Loss of consciousness > Feeling woozy/dizzy > Intense headache > Vomiting > Changes in behaviour > Changes in sensation (tingly/numb)
Signs + Symptoms of all brain injuries
> Depend on area affected
> Can affect all four limbs
Damage to Frontal Lobe
- Decision Making + Problem Solving
- Attention
- verbal expression
> Movement - sequencing
- lack of spontaneity
- movement initiation
> Emotional Control + Personality changes
Damage to Temporal Lobe
> Speech - Understanding speech - Inhibition - constantly talking > Identification/Categorization/Location/Recognition of objects, faces etc. > Selective Attention > Sexuality Changes > Aggressive Behaviour
Damage to Parietal Lobe
> Object classification
Tactile sensation processing
Decreased cognitive ability + academic skills
Worse proprioception (hand-eye co-ordination decreases)
Damage to Occipital Lobe
> Vision/Visual field changes - difficulty locating objects - identifying colours - hallucinations - movement perception - visual processing (word blindness) > Issues reading/writing
Damage to Cerebellum
> Control of movement
- co-ordination
- voluntary motor skills
- balance
- posture
- eye movement
Brain Stem
> Autonomic Control
- Body temp
- heart rate
- breathing
- balance
- movement
- swallowing
- Vertigo/dizziness/nausea symptoms
Tests for brain injuries
> Angiogram (X-ray after dye put in system - detect blockages)
blood tests
CT scan
Echocardiogram (ultrasound of heart)
Electrocardiogram - ECG - measures hearts electrical activity
Electroencephalogram - identify seizures + how cells work
evoked potentials - whether certain sensations reach brain
MRI of head
Immediate management
> breathing assistance - mechanical ventilation
Controlling heart rate + rhythm
Raise blood pressure if low
Calm seizures (due to pressure build up/fluid around brain tissue)
Medications
> Anticonvulsants - seizures (gabapentin/carbamazepine)
Antidepressants - anxiety/chronic pain/depression
Antipsychotics- aggression/sleep disorders
Pain management
Anti-spasmodics - baclofen/tizanidine
Memory + attention drugs
Prognosis
> Lower glasgow coma scale = higher mortality risk
prognosis declines with age
location of contusion
length of time in coma + time of post-traumatic amnesia
Treatment for behaviour changes
> Relaxation - breathing techniques - laura mitchell technique - visualisation > Mindulness > SMART goals > Cognitive Behavioural Therapy
