Long Term Consequences of TBI Flashcards
We all know that young men are idiots. But why do older men have more TBI?
They drink more. Falls -> TBI.
Leading cause of TBI overall?
Guns.
are tbi more common in men or women?
men 2:1
What are the 3 parts of the Glasgow coma scale?
Eyes, Best Motor Response, Best Verbal Response
Which of the 3 parts of the Glasgow coma scale is most important?
The Best Motor Response. Eyes can have problems, people can be intubated and not speaking.
what is leading cause of tbi-related death?
firearms
What is the “eyes” part of the Glasgow coma scale?
Do they open spontaneously or in response to verbal command, pain? Or not at all?
how common are tbi? (traumatic brain injury)
230,000 annual hospitalizations
50,000 deaths/year (30% of all trauma)
80,000 long term disability
5.3 million people - prevelence
what are three parts to GCS? And how many points does each contribute?
motor - 6
verbal - 5
eye - 4
how is score for eyes in gcs determined?
open spontaneously - 4
to verbal command - 3
to pain - 2
no response - 1
where are two peaks in tbi-related deaths for men?
late teens/early 20’s
>70 - alcohol related falls
what is glascow coma scale?
a neurological scale that aims to give a reliable, objective way of recording the conscious state of a person for initial as well as subsequent assessment
how is score for verbal determined?
oriented and converses - 5
disoriented and converses - 4
inappropriate words - 3
incomprehensible sounds - 2
no response - 1
how do total scores for gcs detemine severity?
severe < 9
moderate 9 - 12
minor 13 - 15
how is score for motor determined?
obeys verbal command - 6 to painful stimuli - localizes pain - 5 flexion withdrawal - 4 flexison abnormal - 3 extension - 2 no response - 1
how are CTs graded in severe tbi?
_ Diffuse Injury _ I: no swelling _ II: minimal swelling _ III: cisterns absent _ IV: swelling + shift _ Evacuated mass lesion _ Non-evacuated mass lesion
what is CT grading important?
good predictor of outcome
what is glascow outcome scale?
_ good recovery: 5 _ moderate disability: 4 _ severe disability: 3 _ vegetative: 2 _ death: 1
what are goals of TBI management in ER?
_ Continue/initiate resuscitation (ABC_s)
_ Prevent secondary injury by maintaining
adequate perfusion.
_ Decreased perfusion
_ Increased cerebral vascular resistance
_ Decreased oxygenation or glucose
_ Increased metabolism
_ Obtain diagnosis of type of TBI (CT scan)
what causes diffuse injury?
inertial loading
what should be done in the field for tbi?
resucitate & intubate –> want to minimize hypoxia, hypotension and anemia
what animal model is used for focal injury?
experimental lateral fluid percussion brain injury in the rat
how is diffuse axonal injury currently diagnosed?
diagnosis of exclusion
what causes focal injury?
contact loading
what are the molecule events after TBI? (3)
_ necrosis/apoptosis
_ inflammation
_ atrophy
what part of the hippocampus is most affected by tBI?
CA1
what in the future will be used to dx diffuse axonal injury?
diffusion tensor imaging - measued water flow - if flow of water is disrupted - axons are damaged
describe plasticity in the hippocampus?
hippocampus undergoes structural re-organization in response to a number of experimental manipulations, as well as following pathological processes.
how do young v. old people compare with plasticity?
young people’s brains are more plastic
what are the processes involved in recovery after TBI?
_ plasticity
_ neurogenesis
_ physiological recovery
_ behavioral response
what happens after damage to entorhinal cortex?
septal fibers “sprout_ on the unocccupied dendrites of the molecular layer of the dentate gyrus and can be detected by cholinesterase stains
has new neuronl integration been demonstrated in humans?
no, demonstration of their integration into the synaptic connections has not been established in humans, though it has in rodents
is plasticity of the brain always good?
no - abherrant connections can result in epilepsy
what is the neurophysiological response to severe TBI?
dentate gyrus becomes hyperexcitable and CA1 region becomes hypoexcitable
from notes:
Using animal models of TBI, specific features of the electrical activity within the hippocampus have been identified. Experiments have been conducted both in vivo, as well as in hippocampal slices. Single cell and whole field recording has shown that the dentate gyrus, which normally filters out aberrant or excessive input to the hippocampus becomes hyperexcitable (a potential cause for post
traumatic epilepsy).
The CA 1 region, recognized to play a role in learning and memory
through LTP, becomes hypo-excitable, suggesting that new memories may be more
difficult to establish.
describe neurogenesis in recovery after TBI
neurogenesis occurs in the adult mammalian hippocampus and olfactory region
what is behavioral response to TBI?
Learning and memory are clearly adversely affected in human TBI
how was behavioral response demonstated in rats?
Morris water maze –> performance declined after tbi
