NeuroPathology - TBI Objectives (EXAM ONLY)

Question 1

What is a primary injury for a TBI?

Answer 1

Result of forces exerted on the brain at impact

Question 2

What is a secondary injury for a TBI?

Answer 2

Compromise of brain function from brain’s reaction to trauma, brain swelling, impaired cerebreal perfusion

Question 3

What is a strong predictor of a poor outcome in TBI?

Answer 3

Low BP

Question 4

What is the respiratory rate with damage to the bilateral hemispheric area or diencephalon?

Answer 4

Cheyne-Stokes breathing // Rhythmic pattern of alternating rapid breathing and momentary stopping of breathing

Question 5

What is the respiratory rate with damage caused by lesions in the pontines or midbrain?

Answer 5

hyperventilation

Question 6

What is the respiratory rate with damage caused by lesions of the mid- and caudal- portions of the pons?

Answer 6

apneustic breathing // prolonged pause at the end of inspiration

Question 7

What is the respiratory rate with damage caused by lesions in the medulla

Answer 7

Ataxic breathing // irregular in both rate and tidal volume

Question 8

What is Retrograde Amnesia?

Answer 8

partial or total loss of ability to recall events that have occurred during the period immediately preceding TBI

Question 9

What is Post-Traumatic Amnesia (PTA)?

Answer 9

Time lapse between injury and when functional memory returns // automatic activities may improve // no carryover // ***indication of injury severity

Question 10

What does loss of Anterograde amnesia look like?

Answer 10

The ability to form new memories, decreased attention or inaccurate perception, last function to return

Question 11

______ damage results in ataxia, either on one side of the body or global

Answer 11

cerebellar

Question 12

______ dysfunction results in tremor or bradykinesia

Answer 12

basal ganglia dysfunction

Question 13

What is Decorticate Posturing caused by?

Answer 13

Loss of cortical control

Question 14

What is Decerebrate Posturing caused by?

Answer 14

Injury at superior border of the pons

Question 15

What are signs of Decorticate Posturing?

Answer 15

Hyperactive flexor reflexes in UEs + Hyperactive extensor response in LEs

Question 16

What are signs of Decerebrate Posturing?

Answer 16

Hyperactive extensor reflexes in UEs & LEs + loss of inhibitory control of cortex and basal ganglia

Question 17

What is the “cut off” for the Glasgow Coma Scale?

Answer 17

≤8

Question 18

What range indicates a moderate severity on the GCS?

Answer 18

9-11

Question 19

What range indicates a minor injury on the GCS?

Answer 19

> 12

Question 20

What range indicates a severe rating on the GCS?

Answer 20

3-8

Question 21

What are the 8 stages on the Rancho Los Amigos Scale?

Answer 21

I: No response // II: Generalized Response // III: Localized Response // IV: confused and agitated // V: confused and inappropriate // VI: confused and appropriate // VII: automatic and appropriate // VIII: purposeful and appropriate

Question 22

What are negative prognostic indicators for TBI?

Answer 22

Loss of consciousness for >1min, significant cognitive symptoms, younger age, female gender, depression, high levels of activity

Question 23

What are symptoms of a concussion?

Answer 23

headache, disorientation, dizziness, nausea, irritability, fatigue, etc

Question 24

what do Diffuse Axonal Injuries cause impairments to?

Answer 24

cognitive, sensory function, and autonomic motor impairments

Question 25

What is Level I of the RLA scale?

Answer 25

No response
- no response to sounds, sights, touch, or movements

Question 26

What is Level II of the RLA Scale?

Answer 26

Generalized Response

• begins to respond slowly and inconsistently to sounds, sights, touch/movement

-*Same response for everything

Question 27

What is Level III on the RLA scale?

Answer 27

Localized Response

• Reacts more specifically to tactical, auditory, and visual stimuli. Begins to recognize friends/family
• may follow SIMPLE commands

Question 28

What is Level IV on the RLA Scale?

Answer 28

Confused and Agitated

• very confused/frightened and unaware that people are trying to help

highly focused on their basic needs!

Question 29

What is Level V on the RLA scale?

Answer 29

Confused and Inappropriate

• pays attention for only a few min
• disoriented
• makes things up to fill in gaps in memory
• perseveration
• focused on basic needs

Question 30

What is Level VI on the RLA Scale?

Answer 30

Confused and Appropriate

• remembers main conversation points but forgets/confuses details
• confused in routine changes
• pays attention for ~30min (except when noisy)
• impulsive

Question 31

What is Level VII on the RLA scale?

Answer 31

Automatic and Appropriate

• able to do routine self care without help
• has problems in new situations
• continue to need supervision

Question 32

What is Level VIII on the RLA scale?

Answer 32

Purposeful and Appropriate

ALMOSTTTT back to normal

• ready for driving/back to job training
• poor judgement in new situations
• needs some help in decision making
• becomes overloaded quickly
• learns new things Slowly