Neurological Disorder

Question 1

Traumatic Brain Injury

TBI

Answer 1

TBI = head injury and cerebral trauma caused by external force and has temporary or permanent impairments in cognitive, emotional, behavioral and/or physcial functioning. TBI result of closed or open-head injury

1. Closed-Head Injury = non-penetrating blow includes injury to the brain at the site of the blow (coup) as well as bruising on the opposite side of the brain due to rebound (contrecoup).
   
   1. May also be afffected by hemorrhage (bleeding) and edema (fluid around the damaged area).
   2. causes an alteration or loss of consciousness and some degree of anterograde and retrograde amnesia.
2. Open-Head Injury = skull is penetrated and does not usually cause a loss of consciousness and produces more localized damage and highly specific symptoms.

Question 2

TBI - Levels of Severity

Answer 2

Severity of TBI is determined by:

1. person’s initial score on the Glasgow Coma Scale (GCS),
2. duration of the post-traumatic amnesia (PTA),
3. duration of the loss of consciousness (LOC).

• Mild: 13-14 gcs under 60min pta under 30 LOC
• Mod: 9-12 1-24 hours pta 30min-24 hours LOC
• Severe: 8– <24hours PTA <24 hours LOC

Question 3

Cognitive Consequences of TBI

Answer 3

Cognitive deficits following TBI are common and include an alteration of consciousness, disorentation, memory impariment, and impaired speed-of-processing, attention and executive functions.

1. Alteration of Consciousness: many with TBI have alteration or loss of consciousness that last for seconds to minutes or persist for hours.
   
   1. Level of consciousness immediately follwoing the injury is a predictor of recovery and assessed with Glasgow Coma Scale: conscious, confused, delirious, obtunded, stuporous, and comatose.
2. Disorientation: common in moderate to severe TBI and usually from diffuse cerebral injury.
   
   1. Recovery is consistent with orientation to person first, then place and time (glen, tarrytown/usa, tuesday/october/2014).
3. Memory Impairment: includes anterograde and retrograde amnesia.
4. PTA= post-injury anterograde amnesia, and it’s duration is good predictor of the persistence of cognitive, motor, personality and other symptoms caused by TBI. 80% with less than 2 weeks PTA duration have good recovery BUT only 46% with PTA of 4-6 weeks.
5. Retrograde amnesia also present = recent memories being affected more than remote memories.
   
   1. “Shrinking retrograde amnesia”=most remote memories return first.

Question 4

Recovery from TBI

Answer 4

Recovery from TBI is moderated by severity of injury and the person’s age, gender, SES and pre-injury physical and mental functioning. Genetic factors as well (poor with allele e4 on the ApoE gene).

greatest amount of recovery occures during the first 3 months, with more still during the first year!

Question 5

Postconcussional Syndrome/Disorder

Answer 5

PCS = pattern of somatic & psychological symptoms that occur in up to 50% or > of people with mild TBI. Common initial symptoms of PCS are headache, dizziness, nausea, blurred vision, and drowsiness. Then insomnia, fatigue, tinnitus, cognitive impairments to memory, attention, concentration, and information processing speed, and irritibility, anxiety and depression.

• Diffuse axonal injury is the primary organic factor
• psychological factors: subjective interpretation of the injury, premorbid personality characteristics, desire for secondary gain, and access to social support.
• majority with PCS fully recover w/in 3 months
• if over one year, symptoms may be permanent

Question 6

DSM =

Postconcussional Disorder

Answer 6

1. history of head trauam that caused significant cerebral concussion as evidenced by LOC, PTA, and post-traumatic seizures.
2. distrubances in attention/memory
3. 3 or more symptoms that have elasted for at least 3 months: fatigue, disordered sleep, headache, vertigo, irritability/anger w/o provocation, anxiety, depression or affective lability, change in personality and apathy or lack of spontaneity.