Moderate/Severe TBI Flashcards
5 acquired TBI
Anoxic: occlusion of O2, 15 sec LOC
Hypoxic: not enough O2 saturation, suffocation
Open/closed head injury
Shaken baby
Non-traumatic (stroke)
A TBI is a results of
Biochem, cellular and molecular events that evolve over time
Primary damage of TBI (6)
-scalp laceration
-skull fx
-cerebral contusion
-cerebral laceration
-intracranial bleeding
-diffuse axonal injury
4 secondary damage of TBI
Ischemia
Hypoxia
Cerebral swelling
Infection
What is DAI? Causes?
Diffuse axonal injury = shearing
-most common type of primary lesion
-from accel/decel or rot injuries
Grade 1 DAI
mild - microscopic change in white matter of cerebral cortex, corpus collosum, brain stem, and cerebellum
Grade 2 DAI
Mod - lesions isolated to corpus collosum
Grade 3 DAI
Severe - multiple and severe focal lesion on brain stem
What is a dural hematoma
Skull fx tear meningeal artery vessels
-tears v superior sagittal sinus (where CSF leaks)
What parts of the brain are involved with motor function (5)
Brain stem, midbrain, cerebellum, cortex, BG
What are 3 functions of the prefrontal cortex
Working mem, self control, decision making
How is amygdala involved with TBI
Increased emotional regulation and fear response
How is hippocampus involved with TBI
Decreased memory and learning
What part of the brain is involved with sleep, wake cycle/arousal
Mid brain
What are 4 majorly motor outcomes of mod-severe TBI
-hemiparesis
-cerebellar ataxia
-synergistic movement
-contractures
What are 3 systems of control regarding the reticular activation system
Waking
Sleeping
Fight or flight
What part of the brain is involved with waking (think reticular activation system)
Thalamus
What is the function of the reticular formation
Integration, relay and coordination
What CN are associated with reticular formation
Trigeminal 5
facial 7
glossopharyngeal 9
vagus 10
Hypoglossal 12
What part of the brain causes sleep dysfxn
Frontal temporal lobe
What is decreased to cause sleep dysfxn
Melatonin
What part of the brain assists with circadian rhythm
Hypothalamus
What are the two main stages of TBI
Initial trauma and cellular response
What is increased with exercise in TBI (4)
-brain derived neurotrophic factor and orexin
-long term potentiation (neuroplasticity)
-neuro genesis
-anti inflam cytokines
What does exercise in TBI help decrease
Inflammatory cytokines
What mem is disrupted in each type of TBI
Short term - mild and mod
Long term - severe
What two parts of the brain does severe TBI involved with memory
Hippocampus and prefrontal cortex
What type of memory does each part of the brain involve:
Prefrontal cortex
Amygdala
Hippocampus
Cerebellum
Prefrontal cortex: working mem
Amygdala: emotional mem
Hippocampus: episode mem
Cerebellum: procedural mem
What assists with mem formation
Rehab physical activities
What 3 types of info can be decreased due to loss of synaptic signaling for mem
Spatial info, non-spatial (ID), actions
What is the norm range for ICP
7-15 mmHg
3 things to look out for regarding ICP
HA, pupillary changes, loss of consciousness**
What is one intervention/equipment that can help decrease ICP
External ventricular drain
What is cerebral perfusion pressure? How much needed to fxn?
Amount of blood perfusion in brain; >60
What is acute hydrocephalus
Blood accumulated in ventricles (requires EVD)
What was the GET up trial? Results?
-study of early mob vs bed rest with burr hole craniotomy
-early mob had less complications, improved recovery
Level 1 Rancho
No response
Level 2 rancho
Person reacts inconsistently, not directly to stimuli
Level 3 rancho
Localized response, reacts inconsistently, directly to stimuli
Level 4 rancho
Confused/agitated, extremely confused
Level 5 rancho
Confused, inappropriate, responds inaccurately to commands
Level 6 rancho
Confused, appropriate, responds accurately to commands
Level 7 rancho
Automatic appropriate; minimal confusion, goes through routine
Level 8 rancho
Purposeful appropriate; functioning mem, responsive to environment
Level 9 rancho
Purposeful appropriate; daily routine, aware of SBA
Level 10 rancho
Purposeful appropriate/mod independent
What are the 3 ranges for Glasgow
Mild: 13-15
Moderate: 9-12
Severe: < 9
What is persistent vegetative state
Decreased responsiveness with no cerebral cortical function
Time ranges for LOC
Mild: 0-30 min
Moderate: > 30 min, < 24 hours
Severe: > 24 hours
What is a decompressive craniectomy
Drill and freeze part of skull; keep brain exposed to decrease edema
What 2 things indicate ICP monitoring
Glasgow equal or less than 8
Abnorm brain CT
