Major/Mild Neurocog D/O Due to TBI Flashcards
criterion A for M/M NCD due to TBI
criteria are met for M/M NCD
criterion B for M/M NCD due to TBI
there is evidence of a traumatic brain injury
define traumatic brain injury
“brain trauma”–>an impact to the head or other mechanisms of rapid movement or displacement of the brain within the skull, with one or more of the following:
loss of consciousness
posttraumatic amnesia
disorientation and confusion
neurological signs (i.e neuroimaging demonstrates injury; a new onset of seizures; a marked worsening of preexisting seizure disorders; visual field cuts; anosmia; hemiparesis)
criterion C for M/M NCD due to TBI
the NCD presents immediately after the occurrence of the TBI or immediately after recovery of consciousness and persists past the acute post injury period
what specifiers are there for M/M NCD due to TBI
severity specifier
rate the severity of the NCD, NOT the underlying TBI
what is the cognitive presentation of M/M NCD due to TBI
variable
commonly see difficulties in the domains of:
- -complex attention
- -executive ability
- -learning
- -memory
- -slowing speed of info processing
- -disturbances in social cognition
*in more severe TBI, there may be additional neurocognitive deficits like aphasia, neglect, or constructional dyspraxia
what are some other categories of symptoms that may be associated with M/M NCD due to TBI
disturbances in emotional function
personality changes
physical disturbances
neurological symptoms and signs
orthopedic injuries
what deficits in emotional function may be present in those with M/M NCD due to TBI
irritability
easy frustration
tension
anxiety
affective lability
what personality changes may accompany M/M NCD due to TBI
disinhibition
apathy
suspiciousness
aggression
what physical disturbances may accompany M/M NCD due to TBI
headache
fatigue
sleep disorders
vertigo, dizziness
tinnitus or hyperacuity
photosensitivity
anosmia
reduced tolerance to psychotropic medications
what % of the population lives with a TBI associated disability
2%
what % of TBIs are in males
59% (in the USA)
what are the most common etiologies of TBI in the USA
falls
vehicular accidents
being struck on the head
*collisions and blows to the head that occur in the course of contact sports are increasingly recognized as sources of mild TBI with a concern that repeated mild TBI may have a cumulatively persisting sequelae
what are the severity levels of TBI and when are they rated
rated AT TIME OF INJURY
mild–> moderate–> severe
what are the three injury characteristics taken into consideration when judging the severity of a TBI
loss of consciousness (length of time)
posttraumatic amnesia (length of time)
disorientation and confusion at initial assessment (GCS)
list the characteristics of a mild TBI
loss of consciousness less than 30 min
posttraumatic amnesia less than 24 hours
GCS 13-15 at initial assessment (not below 13 at 30 min)
list the characteristics of moderate TBI
loss of consciousness 30 min-24 hours
posttraumatic amnesia 24 hours - 7 days
GCS 9-12 at initial assessment
list the characteristics of severe TBI
loss of consciousness over 24 hours
posttraumatic amnesia more than 7 days
GCS 3-8 at initial assessment
does the severity rating of the TBI correspond to the severity of the resulting NCD?
no not necessarily
what are factors that affect course of recovery from TBI
course of recovery is variable
depends on:
- -specifics of injury
- -age
- -prior history of brain damage
- -hx of substance use
when are neurobehavioural symptoms most severe after TBI
in immediate aftermath
what is the usual recovery course in the case of mild or moderate TBI
typical course is that of complete or substantial improvement in associated neurocognitive, neurological and psychiatric symptoms and signs
how quickly do neurocognitive symptoms associated with mild TBI tend to resolve
within days to weeks after the injury
complete resolution typical by 3 months
*other symptoms that co occur with the neuro symptoms, like photosensitivity, headache, irritability, fatigue, sleep disturbance) tend to also resolve in the WEEKS following mild TBI
what may happen in the case of repeated mild TBI
may have persisting neurocognitive disturbance
list some of the symptoms that can persist in the cases of moderate and severe TBI
seizures (particularly in the first year)
photosensitivity
hyperacusis
irritability
aggression
depression
sleep disturbance
fatigue
apathy
inability to resume occupational and social functioning at pre-morbid level
deterioration in interpersonal relationships
moderate and severe TBI increases risk for which disorders
depression
aggression
possible NCDs like alzheimers
how might persisting-TBI related impairment present in a child
delays in reaching milestones
worse academic performance
impaired social development
how might persisting-TBI related impairments present in a teen or adult
various neurocognitive deficits
irritability
hypersensitivity to light and sound
easy fatigability
mood changes (including depression, anxiety, hostility or apathy)
which populations are at highest risk for TBI
kids younger than age 4
older adolescents
adults older than 65 years
what is the most common cause of TBI
falls (then MVAs)
sports concussions are frequent cause of TBI in older kids, teens and young adults
what are some risk factors for neurocognitive disorder after TBI
repeated concussions –> can lead to clinical NCD and neuropathological evidence of traumatic encephalopathy
co-occuring intoxication with substance may increase severity of TBI from MVA but not sure if it affect cognitive outcome
list factors associated with worse outcome from moderate to severe TBI
older age (above 40)
initial clinical parameters (low GCS, worse motor function, pupillary nonreactivity, CT evidence of brain injury)
what might you see on CT scan in the setting of TBI
petechial hemorrhages
SAH
contusion
what might people notice functionally in the case of MILD NCD due to TBI
reduced cognitive efficiency
difficulty concentrating
lessened ability to perform usual activities
what might people notice functionally in the case of MAJOR NCD due to TBI
may have difficulty with independent living and self care
may have prominent neuromotor features like:
- -severe incoordination
- -ataxia
- -motor slowing
what psychiatric disorder can often co occur with TBI, and also have overlapping symptoms
PTSD (especially in military populations)
