spinal cord injury and brain injury Flashcards
What is an acquired brain injury?
an injury caused to the brain since birth
What is a traumatic brain injury?
a brain injury caused by trauma to the head
How long does someone with a minor brain injury lose consciousness for?
less than 15 minutes
How longs does someone with a minor brain injury have post traumatic amnesia for?
less than an hour
How long does someone with a moderate brain injury lose consciousness for?
15 mins - 6 hours
How long does someone with a moderate brain injury have post traumatic amnesia for?
1 hour -24 hours
How long does someone with a severe brain injury lose consciousness for?
6 hours to 48 hours
How long does someone with a severe brain injury have post traumatic amnesia for?
24 hours to 7 days
How long does someone with a very severe brain injury lose consciousness for?
more than 48 hours
How log does someone with a very severe brain injury have post traumatic amnesia for?
more than 7 days
Name some causes of a traumatic brain injury
road traffic collisions
slipping and falling
something falling or being thrown that strikes the head
being shaken violently
sports-related events or activities
acts of violence
What are the three types of traumatic brain injury?
open (or penetrating) wounds
crushing injuries
closed head injury
Name some immediate signs and symptoms of a TBI
difficulty concentrating or confusion
changes in consciousness
headaches or dizziness
vomiting and nausea
changes in mood, behaviour, or personality
changes in the eyes/dilated pupils
hallucinations
swelling at the site of the suspected brain injury
inability to remeber
difficulty breathing
any fluid leaking from the nose, eyes, or ears
difficulties with language or speech
changes in vision, especially blurred vision
Name some causes of a non-traumatic brain injury
tumour
stroke
brain haemorrhage
encephalitis
carbon monoxide poising
hydrocephalus
meningitis
What is a cerebral anoxia?
a complete interruption of the supply of oxygen to the brain
What is a cerebral hypoxia?
When there is still a partial supply of oxygen, but at a level which is inadequate to maintain normal brain function
Name some causes of anoxic brain injury
cardiac or respiratory arrest
irregular heart rhythm or poor function of the heart muscle after a heart attack, resulting in inefficient supply of blood to the brain
very low blood pressure following massive trauma
suffocation
choking
strangulation
very severe asthma attack
near drowning
exposure to high altitudes
smoke inhalation
carbon monoxide inhalation
poisoning
drug overdose
electric shock
attempted suicide
In all cases what medical treatment will there be for an anoxic brain injury?
efforts will be directed at restoring a normal heartbeat, blood pressure and a good supply of oxygen to the brain
What are the immediate signs and symptoms of anoxic brain injury?
confusion
loss of consciousness
feeling woozy or dizzy
intense headache
vomiting
changes in behaviour or sensation
What are some hidden long term effects of acquired brain injuries?
changes in behaviour or personality
difficulty with previously unchallenging tasks
changes in relationships
difficulty with short or long-term memory
trouble recognising familiar people or animals
new fears or phobias
psychological symptoms such as unexplained depression or anxiety
frequent headaches
unexplained pain in the limbs
What is a vegetative state?
severe, have sleep-wake cycles but no conscious awareness of themselves or their surrounding
What is a minimally conscious state?
shows distinct but limited signs awareness and response to stimulation. very difficult to remain aware or responsive for any length of time or in a predictable way
What is locked-in syndrome?
this is a rare condition in which a person is aware of themselves and their surroundings but is unable to move or speak. Often people can move their eyes or eyelids and may be able to communicate by blinking
What does prognosis of a brain injury depend on?
age - recovery prognosis declines with age
location of contusion on the brain
length of time spent in coma - paired with post-traumatic amnesia, this can dictate how long the recovery period will take
How do physios manage brain injury patients?
respiratory care
rehabilitation - starting early and ongoing
sensory assessment
asses and treat symptoms
What are the 3 different mechanisms for a traumatic SCI?
destruction from direct trauma
compression by bone fragment, hematoma or disc material
ischemia from damage or impingement on the spinal arteries
What are some non traumatic causes of SCI?
degenerative disc diseases and spinal canal stenosis
spinal infarct
tumour
inflammation of spinal cord
viral infection
development/congenital abnormalities
What is a complete SCI?
complete loss of function below the point of injury
What is an incomplete SCI?
some sparing of neural activity below the level of the lesion
What is tetraplegia or quadriplegia SCI?
impairment at cervical segments of the cord
affects all four limbs: upper and lower limbs
What is paraplegia SCI?
impairment at thoracic, lumbar or sacral segments of the cord
involving lower limbs
depending on level of injury, trunk, legs and pelvis may be involved
What are areas of the vertebral columns have a higher risk of SCI?
cervical spine, typically C5-7
thoracolumbar, typically T12
mid thoracic T4-&
What immediate management is required for a SCI?
Need to have normal oxygenation, perfusion and acid/base balance to aid management of the injury
What are the 5 main incomplete spinal cord injuries?
central cord syndrome
anterior cord syndrome
brown-sequard syndrome
posterior cord syndrome
cauda equina syndrome
Describe central cord syndrome
motor dysfunction in upper limbs
bladder dysfunction
corticospinal and spinothalamic tracts
May be due to hyperextension trauma to the neck or could be due to spondylosis
Describe anterior cord syndrome
motor paralysis below lesion
loss of pain and temperature sense
retained proprioception and vibration
caused by disc herniation
Describe Brown-Sequard
motor deficit and numbness to touch and vibration on the same side of lesion
loss of pain and temperature on opposite side of lesion
most common cause is stab or gunshot wound to cervical or thoracic spine
Describe posterior cord syndrome
sensory disturbance and less motor loss
compression to posterior/sensory section of the spinal cord
cause = posterior impact or hyper-extension trauma
Describe cauda equina syndrome
lower motor neurone lesion
motor and sensory loss in lower limbs
saddle anaesthesia, bilateral lower limb sensory changes
causes = lumbar stenosis, spinal trauma, metastatic tumour
What is the difference between traumatic brain injury and anoxic brain injury?
A TBI is as a result of a blow or trauma to the head, an ABI is due to the brain becoming deprived of oxygen
What are the signs and symptoms of a TBI that people with BI report can be more disturbing that the motor signs and symptoms?
cognitive and emotional symptoms: personality changes and increased agression
Define concussion
temporary disruption of brain function
the severity of a brain injury is defined by what two main criteria?
loss of consciousness
post traumatic amnesia
Name two common injuries following an anoxic brain injury
low tone and ataxia
how long can the brain survive without oxygen?
4 minutes
What is EDH?
extradural haemotoma
What is DAI?
diffuse axonal injury
What is SAH/IVH?
subarachnoid haemorrhage/intraventricular haemorrhage
How many main ascending tracts are there and what kind of information do they transmit?
there are three main ascending tracts - they transmit sensory information from peripheral nerves to the cerebral cortex
Name all the major ascending tracts and identify the type of sensory information they transmit
Dorsal column - touch, position, sense and vibration
Spinothalamic - pain and temperature information
Spinocerebellar - proprioceptive information
How many descending pathways are there and what type of information do they transmit?
There are 5 main descending tracts, they transmit motor information from the cerebral cortex to peripheral nerves to innervate muscle movement
What are the main descending pathways?
corticospinal tracts (anterior and lateral) = lateral - motor information to limbs, anterior - motor information to axial muscles
vestibulospinal - integration of head and neck with trunk and extremities
reticulospinal = lateral - facilitates flexion and inhibits extension
rubrospinal - fine motor movements in upper limbs
tectospinal - control muscles in response to visual stimuli
What areas are affected in a person who is tetraplegic?
all 4 limbs and trunk
Name 5 symptoms that occur as a result of autonomic dysfunction
impairment of vasomotor control
postural hypertension
autonomic dysreflexia
problems with bowel and bladder function
problems with sexual function
Name the two sections that the autonomic nervous system is divided into
parasympathetic and sympathetic
What is the ASIA scale?
gold standard for classifying spinal cord injuries
What is the ASIA scale used to determine?
complete or incomplete injury
ASIA impairment scale grade
sensory level on both sides
motor level on both sides
single neurological level
Describe the grades of the ASIA scale
A (complete) = no motor or sensory function is preserves in the sacral segments S4-S5
B (incomplete) = sensory but not motor function is preserves below the neurological level and includes sacral segments S4-5
C (incomplete)= motor function is preserved below the neurological level and more than half of the key muscles below the neurological level have a muscle grade less than 3
D (incomplete) = motor function is preserved below the neurological level and at least half of the key muscles below the neurological level have a muscle grade of more than 3
E (normal) = motor and sensory function are normal
How do you establish whether the motor and sensory functions of sacral segments remain in tact?
rectum examination in order to establish whether any anal sensation and/or tone is present (done by a doctor)
What is autonomic dysreflexia?
an uninhibited sympathetic nervous system response to a variety of noxious stimuli occurring in people with spinal cord injury at T6 level and above
What are the signs and symptoms of autonomic dysreflexia?
raised BP
bradycardia
pounding headache
flushing
sweating or blotching above level of injury
pale, cold, goosebumps below level of injury
