TBI Flashcards
What is the most common cause of TBI in children?
falls and abuse
What is the most common cause of TBI in adolescents and young adults?
Falls, assault, and MVA
What is the most common cause of TBI in older adults?
FALLS
What is the difference between opened and closed injuries? Is one more serious than another?
open - penetrating type of wound (knife, gunshot, sharp object)
- skull fractured or displaced
closed - impact to head but skull is not fractured
- only cortical neuronal tissue is damaged
Open is worse b/c of infection risk plus debris
What happens to the meninges during open TBI? Closed TBI?
open - meninges are compromised and at risk for infection, bleeding, impaired CSF circulation
closed - meninges remain intact
What is meant by primary brain damage? What types of primary brain damage exist?
direct injury that results from mechanical issue at the time of trauma
focal and diffuse injury
Focal injury
localized to area under site of impact or site opposite of impact
- coup-contracoup injury
Diffuse injury
more widespread injury
hematoma
pool of clotted or partial clotted blood that congregates and settles in whatever space it is confined in
- due to rupture or damage to meningeal structures when in skull
Epidural hematomas
- location
- characteristics
- intervention
location - between the dura mater and skull
characteristics - involve brief loss of consciousness followed by period of awareness and then crash
- unconsciousness (bad) - alert (better) - deteriorate (way worse)
intervention - craniotomies and hematoma evacuation
subdural hematomas
- location
- characteristics
- intervention
location - rupture to the cortical bridging veins between dura and arachnoid
characteristics - blood slowly leaks over several hours or weeks and symptoms similar to CVA
intervention - small clots reabsorbed and larger ones require surgical removal
Which type of focal injury is seen in elderly after falls w/ blow to the head?
subdural hematomas
- they think they are fine and family member will start to notice something is off and then go to ER to find bleed
subarachnoid hemorrhage
- location
- sequela
location - between arachnoid and brain tissue
sequela - vasospasm
intracerebral hemorrhage
- location and cause
- sequela
location and cause - within the brain itself from significant brain injury
sequela - seizures, stroke-like presentation
What type of hemorrhage is the most life-threatening?
subarachnoid hemorrhage
What is a brain contusion? How does it present?
bruising on the surface of the brain is sustained at time of impact
presents on side of impact or opposite side of impact
coup lesion
contusion on the same side of the brian as the impact
contrecoup lesion
surface hemorrhages on the opposite side of the brain trauma as a result of deceleration
- whiplash of the brain
Which is typically worse in damage, coup or contrecoup injuries? Why?
contrecoup injuries are worse because of momentum of brian towards the impact side is little than picks up speed (there is more room) and slams into opposite sides
- PHYSICS!
What areas are most commonly involved in coup contrecoup injuries?
anterior poles and underside of temporal and frontal lobes
What is a diffuse axonal injury (DAI)? What typically causes it?
widespread shearing and retraction of damaged axons that results in traumatic “micro bleeds”
- significant neurological involvement and poor prognosis
caused from HUGE acceleration, deceleration, and rotational forces (MVA most common)
What areas are most suspectable to damage from a DAI?
corpus callosum
basal ganglia
brainstem
cerebellum
What occurs with secondary brain damage?
global reduction of O2 in the body so brain starts to die
- can further lead to reduction in CO and/or ischemic event
What occurs with secondary brain damage caused from a TBI?
electrolyte imbalance and mass release of damaging neurotransmitters
- causes apoptosis