Brain Injury Flashcards
What are the causes of anoxic brain injury
- Stroke or transient ischemic attack (TIA)
- Anaphylactic shock
- Electrocution
- Extremely low blood pressure
- Severe pneumothorax or a collapsed lung
- Oxygen deprivation at birth
- A physical attack or assault, such as being choked or struck in the windpipe
- Asphyxiation (choking or suffocation)
- A drug overdose
The severity of a brain injury is defined by what two main criteria:
1) Loss of Consciousness
2) Post traumatic amnesia
What are the causes of TBI
- Road traffic accidents (RTAs)
- Slipping and falling
- Something falling or being thrown that strikes the head
- Being shaken violently
- Sports-related events or activities
- Acts of violence
Name the two types of Acquired Brain Injury
1) Non-traumatic brain injury: stroke, infections, tumours, surgical complications, seizures, endocrine disorders, drug reactions, environmental toxins and anoxia (lack of O2)
2) Traumatic Brain Injury (More devastating than stroke - potentially both sides of body affected)
What are the S&S of a TBI that can be more disturbing than the motor S&S?
Cognitive and Emotional symptoms: personality changes and increased aggression
A very severe traumatic brain injury is classified by —— hours of loss of consciousness and ——- post traumatic amnesia
Loss of consciousness >48 hours
Post traumatic amnesia > 7 days
Define intracranial haematoma
ruptured blood vessel results in a pool of blood either around the brain or in between the brain and skull
What are the immediate S&S of anoxic brain injury
- Confusion
- Loss of consciousness
- Feeling woozy or dizzy
- Intense headache
- Vomiting
- Changes in behaviour or sensation; your arms or legs may feel tingly or numb.
What are the three main types of TBI?
Closed Head Injuries - These account for the majority of brain injuries and occur when the brain is rattled or traumatized inside the skull
Open Wound - These injuries are often life-threatening and occur when a blow to the head occurs that is forceful enough to penetrate the skull
Crushing Injuries - these types of injuries occur when the brain is compressed between two objects. Although rare, these are the most damaging and life-threatening of the TBIs.
A minor traumatic brain injury is classified by —— hours of loss of consciousness and ——- post traumatic amnesia
Loss of consciousness <15 mins
Post traumatic amnesia <1 hour
Name some immediate signs and symptoms following a brain injury
Confusion, changes to consciousness level, vomiting, nausea, dizziness, headaches, swelling, difficulty remembering, difficulties breathing, vision changes, hallucinations, changes to pupil sizes, changes to mood, behaviour, personality
Define diffuse cerebral hypoxia
This is a mild to moderate injury that causes minimal brain impairment due to low blood oxygen levels.
Define and explain what a diffuse atonal injury is
coup-contracoup mvt = head shakes violently in both directions in acceleration/deceleration; commonly affects frontal and occipital lobes
a. Occurs at axons at gray-white matter interface causing primary axon shearing injury
b. Biomechanical changes at cellular level cause secondary injury - axonal bulbs or neuronal disruption (axonal varicosities)
c. Axonal bulbs - hours-days after primary injury, swelling and rupture of axons results in immediate loss of nerve impulse transmission
d. Axonal varicosities - after shear injury these form along length of axons, may result in partial loss of nerve impulse transmission; demyelination may also occur up to 24 months after shearing injury, eventually resulting in complete loss of nerve impulse transmission
Define Concussion
Temporary disruption of brain function
Name two common symptoms following an anoxic brain injury.
Low tone & ataxia
What is the difference between Traumatic Brain Injury and Anoxic Brain Injury?
A TBI is an injury to the brain caused by a trauma to the head (head injury).
An ABI is due to the brain becoming deprived of oxygen (anoxia). Left without oxygen for too long, neural cells begin to die through a process called apoptosis. When a large number of brain cells simultaneously die, patients can be left with diminished brain function.
Define cerebral contusion
Bleeding in brain
Define global cerebral ischemia
This is a complete cessation of blood flow and oxygen to the brain, and typically causes catastrophic harm.
Define a cerebral infarction
This is a brain injury due to a stroke that completely deprives multiple brain regions of oxygen, leading to serious side effects.
What is the immediate medical management of ABI
- Oxygen and breathing assistance – this incudes being intubated for mechanical ventilation on arrival at hospital, depending on the severity of the injury.
- Controlling the heart rate and rhythm - medications given via infusion as initially after someone has been put on to ventilation they will also be sedated – given sedative medication to reduce their consciousness level. This will also help to give more specific regulation to blood pressure, heart rate amongst other symptoms.
- Fluids, blood transfusions, or medicines to raise blood pressure if it is low
- Anti-seizure medications or general anaesthetics to calm seizures - Seizures often occur due to a build-up of pressure or fluid around the brain tissue as a result of swelling or inflammation leading increased fluid production
How can PTs be involved in treatment of ABIs
As the cognitive and emotional symptoms are the most difficult to manage for patients and families we can use techniques to help:
Relaxation techniques
1.Breathing techniques
2.Laura Mitchell technique ( specific relaxation technique)
3.Visualisation method
•Mindfulness
•SMART goals
•Other Cognitive Behavioural Therapy techniques
What are the types of anoxic brain injury
Diffuse cerebral hypoxia
Focal cerebral ischemia
Global cerebral ischemia
Cerebral infarction
Define focal cerebral ischemia
This is oxygen deprivation, usually due to a stroke, that occurs in a single area of the brain. This brain region may be affected, while other areas of the brain are left unharmed.
A moderate traumatic brain injury is classified by —— hours of loss of consciousness and ——- post traumatic amnesia
Loss of consciousness15 mins - 6 hours
Post traumatic amnesia 1 hour - 24 hours
What are the types of open-wound injuries
Linear skull fracture, Diastatic skull fracture, Depressed skull fracture, Basilar skull fracture
What are the types of closed head injuries
Diffuse axonal injury
Concussion
Intracranial haemotoma
Cerebral contusion
How long can the brain survive without oxygen?
4 minutes
A severe traumatic brain injury is classified by —— hours of loss of consciousness and ——- post traumatic amnesia
6-48 hours loss of consciousness
24 hours - 7 days post traumatic consciousness
Describe the Glasgow coma scale in relation to prognosis
3 65% mortality 4 = 45% mortality 5 = 35% mortality 6 = 24% mortality 7-13 = 10-15% mortality
