Brain Injury

Question 1

What are the causes of anoxic brain injury

Answer 1

1. Stroke or transient ischemic attack (TIA)
2. Anaphylactic shock
3. Electrocution
4. Extremely low blood pressure
5. Severe pneumothorax or a collapsed lung
6. Oxygen deprivation at birth
7. A physical attack or assault, such as being choked or struck in the windpipe
8. Asphyxiation (choking or suffocation)
9. A drug overdose

Question 2

The severity of a brain injury is defined by what two main criteria:

Answer 2

1) Loss of Consciousness

2) Post traumatic amnesia

Question 3

What are the causes of TBI

Answer 3

1. Road traffic accidents (RTAs)
2. Slipping and falling
3. Something falling or being thrown that strikes the head
4. Being shaken violently
5. Sports-related events or activities
6. Acts of violence

Question 4

Name the two types of Acquired Brain Injury

Answer 4

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)

Question 5

What are the S&S of a TBI that can be more disturbing than the motor S&S?

Answer 5

Cognitive and Emotional symptoms: personality changes and increased aggression

Question 6

A very severe traumatic brain injury is classified by —— hours of loss of consciousness and ——- post traumatic amnesia

Answer 6

Loss of consciousness >48 hours

Post traumatic amnesia > 7 days

Question 7

Define intracranial haematoma

Answer 7

ruptured blood vessel results in a pool of blood either around the brain or in between the brain and skull

Question 8

What are the immediate S&S of anoxic brain injury

Answer 8

1. Confusion
2. Loss of consciousness
3. Feeling woozy or dizzy
4. Intense headache
5. Vomiting
6. Changes in behaviour or sensation; your arms or legs may feel tingly or numb.

Question 9

What are the three main types of TBI?

Answer 9

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.

Question 10

A minor traumatic brain injury is classified by —— hours of loss of consciousness and ——- post traumatic amnesia

Answer 10

Loss of consciousness <15 mins

Post traumatic amnesia <1 hour

Question 11

Name some immediate signs and symptoms following a brain injury

Answer 11

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

Question 12

Define diffuse cerebral hypoxia

Answer 12

This is a mild to moderate injury that causes minimal brain impairment due to low blood oxygen levels.

Question 13

Define and explain what a diffuse atonal injury is

Answer 13

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

Question 14

Define Concussion

Answer 14

Temporary disruption of brain function

Question 15

Name two common symptoms following an anoxic brain injury.

Answer 15

Low tone & ataxia

Question 16

What is the difference between Traumatic Brain Injury and Anoxic Brain Injury?

Answer 16

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.

Question 17

Define cerebral contusion

Answer 17

Bleeding in brain

Question 18

Define global cerebral ischemia

Answer 18

This is a complete cessation of blood flow and oxygen to the brain, and typically causes catastrophic harm.

Question 19

Define a cerebral infarction

Answer 19

This is a brain injury due to a stroke that completely deprives multiple brain regions of oxygen, leading to serious side effects.

Question 20

What is the immediate medical management of ABI

Answer 20

1. Oxygen and breathing assistance – this incudes being intubated for mechanical ventilation on arrival at hospital, depending on the severity of the injury.
2. 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.
3. Fluids, blood transfusions, or medicines to raise blood pressure if it is low
4. 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

Question 21

How can PTs be involved in treatment of ABIs

Answer 21

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

Question 22

What are the types of anoxic brain injury

Answer 22

Diffuse cerebral hypoxia
Focal cerebral ischemia
Global cerebral ischemia
Cerebral infarction

Question 23

Define focal cerebral ischemia

Answer 23

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.

Question 24

A moderate traumatic brain injury is classified by —— hours of loss of consciousness and ——- post traumatic amnesia

Answer 24

Loss of consciousness15 mins - 6 hours

Post traumatic amnesia 1 hour - 24 hours

Question 25

What are the types of open-wound injuries

Answer 25

Linear skull fracture, Diastatic skull fracture, Depressed skull fracture, Basilar skull fracture

Question 26

What are the types of closed head injuries

Answer 26

Diffuse axonal injury
Concussion
Intracranial haemotoma
Cerebral contusion

Question 27

How long can the brain survive without oxygen?

Answer 27

4 minutes

Question 28

A severe traumatic brain injury is classified by —— hours of loss of consciousness and ——- post traumatic amnesia

Answer 28

6-48 hours loss of consciousness

24 hours - 7 days post traumatic consciousness

Question 29

Describe the Glasgow coma scale in relation to prognosis

Answer 29

3  65% mortality
4 = 45% mortality
5 = 35% mortality
6 = 24% mortality
7-13 = 10-15% mortality