Lecture 6 - Traumatic Brain Injury

Question 1

What is the difference between a closed head injury (CHI) and a penetrating head injury (PHI)

Answer 1

Closed = an external force caused injury within the brain without penetrating the skull and penetrating = something penetrated the skull or caused bone splinters to do so

Question 2

Which age group(s) is the most at risk for acquiring TBI?

Answer 2

Children and young adults (15-24)

Question 3

What are the most common risk factors for TBI?

Answer 3

Age, gender (male), substance abuse, lower socioeconomic status, unemployment and lower education

Question 4

What are the main causes for TBI?

Answer 4

Falls and transportation related injuries (car accidents, etc.)

Question 5

What are some long-term implications of TBI?

Answer 5

mortality, dementia (late-life)

Question 6

TBI has different severities, what does the severity of the TBI correlate with the most?

Answer 6

long-term social and cognitive effects

Question 7

There are different ways to assess severity within TBIs, name two and which is more reliable in predicting long-term cognitive status, neuroimaging status and severity?

Answer 7

GCS (Glasgow coma scale) which gives scores based on different facets of consciousness and PTA (post-traumatic amnesia) which is the more reliable way of assessment

Question 8

What is the leading cause of PHI?

Answer 8

gunshot wounds

Question 9

There are three types of PHI, which are they?

Answer 9

Objects embedded in the head, “through and through” aka entry and exit, bone fragments driving into the brain (tangential injury)

Question 10

Which quality of PHI is most determining for the outcome?

Answer 10

Physical qualities like speed, wobble and malleability (high speed = more dmg)

Question 11

What are some delayed effects of PHI?

Answer 11

post-traumatic epilepsy and an increased risk of cancer (both because of scar tissue)

Question 12

What are the most prominent neuropsychological effects of PHI?

Answer 12

Attention and memory, especially short-term memory

Question 13

What does the general progression of PHI look like?

Answer 13

Rapid gains in first 1-2 years, after which it slows down > cognitive impairments usually improve, but sensory deficits (like visual blind spots) tend to persist. Unlikely to return to pre-trauma functioning

Question 14

What are some main determining factors in the outcome after CHI?

Answer 14

severity of injury

Question 15

What are some biomechanical features in the context of CHI

Answer 15

Diffuse axonal injury, which is caused by frontal or lateral impact and causes the axons to twist and break off from their cell bodies

Corpus callosum shearing is the tearing of the axons of the corpus callosum > atrophy (dies away/diminishes use) and slower processing

Shearing (tearing) of vasculature are concerning because of heamatoma and contusions causing pressure

Question 16

CHI can also cause cause a coup contrecoup injury, explain

Answer 16

Initial blow (coup) where head hit a surface causes brain to eject itself to the other side of the brain, hitting the skull and causing opposite damage (contrecoup)

Question 17

There are primary and secondary injuries in TBI, what is a secondary injury and what are some examples?

Answer 17

Physiological processes that occur in the aftermath like inflammation, brain swelling (edema), elevated intracranial pressure (ETA), insufficient oxygen (hypoxia), insufficient blood supply (ischemia) and fever (pyrexia)

Question 18

What are the main cognitive impacts of CHI?

Answer 18

Reduced mental speed, attention, cognitive efficiency, high-level executive, impaired memory (new shit), confusion, irritability and fatigue

Question 19

The ACRM has a definition of Mild TBI>

Answer 19

loss of consciousness < 30min

PTA does not exceed 24 hours

an alteration in mental state has to be present (dazed, confusion, etc.)

Question 20

What does general progression consist of for mild TBI?

Answer 20

Cognitive issues sometimes don’t come up until days/weeks later, most individuals recover within hours to weeks, but certain symptoms like headaches, fatigue and dizziness can persist

Question 21

What’s a post-concussion syndrome

Answer 21

immediate symptoms persist >3 months (not consistent with expected diagnosis)

Question 22

Cognitive deficits in mild TBI?

Answer 22

communication, perceptual and conceptual disturbances, attention (most common), sensory and perceptual issues

Question 23

Cognitive deficits in moderate TBI?

Answer 23

> 6 months especially processing speed, short-term memory deficits, behaviour if frontal/temporal dmg, learning disorders/affective changes if temporal

Question 24

Progression of moderate TBI?

Answer 24

generally independent functioning, many differ from former self, reduced initiative in non-routine actions and impaired emotional processing

Question 25

Definition of severe TBI?

Answer 25

GCS <8, loss of consciousness >30min, PTA >24h

Question 26

Cognitive deficits severe TBI?

Answer 26

Executive dysfunction, memory deficits, communication (behaviour, long-term and short, aphasia)

Question 27

There are two progression phases of severe TBI, explain both

Answer 27

gradual improvement in physical status and cognition, long-term pervasive deficits, improvement in learning/cognitive shit, but rarely to pre-injury levels

> 1 year slower pace of improvement, emotional and psychosocial usually stays static

Question 28

Outcomes of severe TBI?

Answer 28

Reduced independence, persistent physical complaints, and social repercussions

Question 29

Chronic Traumatic
Encephalopathy (CTE) what is it and why is it?

Answer 29

Repeated concussions cause stacking damage over time > cognitive and motor symptoms

Question 30

Polytrauma?

Answer 30

Head injuries + body injuries > hinders rehabilitation and often risk of worse outcomes