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Neuro Clinic > TBI > Flashcards

TBI Flashcards

1
Q

how can TBIs be classified?

A

high vs. low velocity

glascow coma score

  • mild (13-15)
  • moderate (9-12)
  • severe (<8)

focal vs. diffused

open vs. closed

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2
Q

what are 6 types of TBI?

A

concussion

skull fractures

shaking of the brain back and forth with the confines of the skull

hematoma

anoxia

hypoxia

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3
Q

what is a concussion?

A

a short loss of consciousness in response to a head injury

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4
Q

what are the different types of skull fractures?

A

Depressed skull fracture: pieces of the broken skull press into the tissue of the brain

Penetrating the skull fracture: something pierces the skull, such as a bullet

Contusion: a distinct area of swollen brain tissue mixed with blood released from broken blood vessels

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5
Q

what are different types of brain shaking within the confines of the skull?

A

Contrecoup: occurs in car accidents after high speed stops

Diffuse axonal injury (shearing): damage to individual nerve cells (neurons) and loss of connections among neurons

Shaken Baby Syndrome: a baby is shaken forcibly enough to cause the brain to bounce against the skull

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6
Q

what is a hematoma?

what are the types?

A

heavy bleeding into or around the brain

Epidural hematoma: bleeding into the area b/w the skull and the dura

Subdural hematoma: bleeding is confined to the area b/w the dura and the arachnoid membrane

Intracerebral hematoma: bleeding w/in the brain itself

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7
Q

what is anoxia?

A

a condition in which there is an absence of O2 supply to an organ’s tissues, even if there is adequate BF to the tissue

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8
Q

what is hypoxia?

A

a decrease in O2 supply rather than a complete absence of O2

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9
Q

what is the prognosis of a TBI?

A

bc TBI is often multifocal and the effects are cumulative it is very difficult for even the most experienced clinician to predict outcome

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10
Q

what are factors affecting outcome?

A

pre injury
primary damage
secondary damage
post injury support

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11
Q

what is pre injury status?

A

prior health
age
academic records
job history

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12
Q

what is primary damage

A

coup countercoup injury
local injury
diffuse axonal injury

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13
Q

what is secondary damage?

A

increase intracranial pressure –> herniation

hypoxic ischemia

hemorrhage

seizure

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14
Q

what is post injury support?

A

family/friends adjustment and support capabilities

opportunities to re-enter occupation/school

avocational reintegration abilities

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15
Q

what is blast injury?

A

signature injury of the US military conflicts in the Middle East

explosive device detonates and a transient shock wave which causes brain damage

Primary blast injury- blast overpressure on the organs

transfer of kinetic energy from the blast wave through the vasculature (triggers pressure oscillations leading to the brain)

elevations in CSF

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16
Q

what is a coma?

A

complete paralysis of cerebral function

state of unresponsiveness

no response to painful stimuli

eyes closed

ventilator dependent

no auditory or visual function

abnormal motor and postural reflexes may be present

17
Q

what is a persistent vegetative state?

A

disassociation between wakefulness and awareness

brainstem manages basic life functions

Pt. can be weaned off ventilator

eye opening

meaningful cognitive and communication function is absent

a withdraw to noxious stimuli is present

18
Q

what is a minimally conscious state?

A

minimal evidence of self or environmental awareness

cognitively mediated behaviors are repeatable

localize to noxious stimuli and sound

demonstrate sustained visual fixation and pursuit

19
Q

what is stupor?

A

general unresponsiveness

can be temporarily aroused by vigorous and repeated sensory stimulation

20
Q

what is obtunded?

A

sleeps a great deal

when aroused exhibits reduced alertness

disinterested in environment

slow responses to stimuli

21
Q

what is delirium?

A

disoriented

fear

misinterpretation of sensory stimuli

loud, agitated, offensive

22
Q

what is clouding of consciousness?

A

confusion

distractability

faulty memory

slow responses to stimuli

23
Q

what is sensory stimuli? what is it used for?

A

used to increase arousal and elicit movement

theory suggests that by providing stimulation in a controlled, multi-sensory manner, with a balance of stimulation and rest, the reticular activating system may be stimulated

24
Q

what are secondary impairments and complications of TBI?

A

DVT

heterotrophic ossification

pressure ulcer

pneumonia

chronic pain

contractures

decreased endurance

muscle atrophy

fracture

peripheral nerve damage

autonomic dysfunction

respiratory distress

25
Q

what are standardized tools for determine severity of injury?

A

Glasgow coma scale (GCS)

disability rating scale (DRS)

post-traumatic amnesia (PTA)

galveston orientation and amnesia test (GOAT)

orientation log (O-log)

moss attention rating scale (MARS)

26
Q

what are standardized tools to determine person-level indices?

A

functional independence measure (FIM)

functional assessment scale (FAM)

disability rating scale (DRS)

rancho los amigos level of cognitive function scale (RLCFS)

27
Q

what are standardized tools to determine role limitation and community activities?

A

community integration questionnaire (CIQ)

may-portland adaptability inventory (MPAI)

postconcussion symptom inventory

28
Q

what are neurobehavioral deficits of TBI?

A

low frustration tolerance

agitation

disinhibition

apathy

emotional lability

mental inflexibility

aggression

impulsivity

irritability

29
Q

what are cognitive deficits associated with TBI?

A

decrease attention span- decrease concentration

perseverates

decrease problem solving

decrease judgement

decrease abstract thinking

decrease memory

  • post traumatic amnesia (PTA)
  • retrograde amnesia (RA)
  • antegrade amnesia (AA)
30
Q

what are clinical presentations of TBI?

A

behavioral problems

perceptual deficits

visuospatial problems

aphasic

apraxia

dysarthric

dysphagia

abnormal tone/posturing

  • decerebrate
  • decorticate

CN deficits

primitive reflexs

decrease balance and postural adjustments

loss of selective motor control

  • mobility
  • stability
  • mobility superimposed on stability (weight shifting)
  • stability superimposed on movement (skilled movement)

decrease coordination

seizures

  • Partial
  • –simple- consciousness preserved
  • –complex consciousness clouded
  • Generalized- loss of consciousness
  • –absence (petit mal)
  • –tonic clonic or clonic tonic clonic

Neuro Clinic (14 decks)

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