Long Term Consequences of TBI

Question 1

We all know that young men are idiots. But why do older men have more TBI?

Answer 1

They drink more. Falls -> TBI.

Question 2

Leading cause of TBI overall?

Answer 2

Guns.

Question 2

are tbi more common in men or women?

Answer 2

men 2:1

Question 3

What are the 3 parts of the Glasgow coma scale?

Answer 3

Eyes, Best Motor Response, Best Verbal Response

Question 4

Which of the 3 parts of the Glasgow coma scale is most important?

Answer 4

The Best Motor Response. Eyes can have problems, people can be intubated and not speaking.

Question 4

what is leading cause of tbi-related death?

Answer 4

firearms

Question 5

What is the “eyes” part of the Glasgow coma scale?

Answer 5

Do they open spontaneously or in response to verbal command, pain? Or not at all?

Question 6

how common are tbi? (traumatic brain injury)

Answer 6

230,000 annual hospitalizations
50,000 deaths/year (30% of all trauma)
80,000 long term disability
5.3 million people - prevelence

Question 6

what are three parts to GCS? And how many points does each contribute?

Answer 6

motor - 6
verbal - 5
eye - 4

Question 6

how is score for eyes in gcs determined?

Answer 6

open spontaneously - 4
to verbal command - 3
to pain - 2
no response - 1

Question 7

where are two peaks in tbi-related deaths for men?

Answer 7

late teens/early 20’s

>70 - alcohol related falls

Question 8

what is glascow coma scale?

Answer 8

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

Question 8

how is score for verbal determined?

Answer 8

oriented and converses - 5
disoriented and converses - 4
inappropriate words - 3
incomprehensible sounds - 2
no response - 1

Question 9

how do total scores for gcs detemine severity?

Answer 9

severe < 9
moderate 9 - 12
minor 13 - 15

Question 11

how is score for motor determined?

Answer 11

obeys verbal command - 6
to painful stimuli  - localizes pain - 5
flexion withdrawal - 4
flexison abnormal - 3
extension - 2
no response - 1

Question 11

how are CTs graded in severe tbi?

Answer 11

_ Diffuse Injury
_ I: no swelling
_ II: minimal swelling
_ III: cisterns absent
_ IV: swelling + shift
_ Evacuated mass lesion
_ Non-evacuated mass lesion

Question 12

what is CT grading important?

Answer 12

good predictor of outcome

Question 14

what is glascow outcome scale?

Answer 14

_ good recovery: 5
_ moderate disability: 4
_ severe disability: 3
_ vegetative: 2
_ death: 1

Question 14

what are goals of TBI management in ER?

Answer 14

_ 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)

Question 15

what causes diffuse injury?

Answer 15

inertial loading

Question 17

what should be done in the field for tbi?

Answer 17

resucitate & intubate –> want to minimize hypoxia, hypotension and anemia

Question 17

what animal model is used for focal injury?

Answer 17

experimental lateral fluid percussion brain injury in the rat

Question 18

how is diffuse axonal injury currently diagnosed?

Answer 18

diagnosis of exclusion

Question 20

what causes focal injury?

Answer 20

contact loading

Question 20

what are the molecule events after TBI? (3)

Answer 20

_ necrosis/apoptosis
_ inflammation
_ atrophy

Question 21

what part of the hippocampus is most affected by tBI?

Answer 21

CA1

Question 23

what in the future will be used to dx diffuse axonal injury?

Answer 23

diffusion tensor imaging - measued water flow - if flow of water is disrupted - axons are damaged

Question 23

describe plasticity in the hippocampus?

Answer 23

hippocampus undergoes structural re-organization in response to a number of experimental manipulations, as well as following pathological processes.

Question 24

how do young v. old people compare with plasticity?

Answer 24

young people’s brains are more plastic

Question 26

what are the processes involved in recovery after TBI?

Answer 26

_ plasticity
_ neurogenesis
_ physiological recovery
_ behavioral response

Question 26

what happens after damage to entorhinal cortex?

Answer 26

septal fibers “sprout_ on the unocccupied dendrites of the molecular layer of the dentate gyrus and can be detected by cholinesterase stains

Question 28

has new neuronl integration been demonstrated in humans?

Answer 28

no, demonstration of their integration into the synaptic connections has not been established in humans, though it has in rodents

Question 29

is plasticity of the brain always good?

Answer 29

no - abherrant connections can result in epilepsy

Question 29

what is the neurophysiological response to severe TBI?

Answer 29

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.

Question 31

describe neurogenesis in recovery after TBI

Answer 31

neurogenesis occurs in the adult mammalian hippocampus and olfactory region

Question 34

what is behavioral response to TBI?

Answer 34

Learning and memory are clearly adversely affected in human TBI

Question 35

how was behavioral response demonstated in rats?

Answer 35

Morris water maze –> performance declined after tbi