TBI Flashcards
Peak Ages for TBI
1-2 years: most often related to child abuse
15-24 years: risk-taking behaviors, sports-related
>65 years: falls
T/F: diffuse axonal injury is detectable on MRI
FALSE - not always!
Majority of TBI occur from __?
MVA (50%)
Falls (25%)
Assault/Violence (15%)
Sports (10%)
Normal ICP
4-15mmHg
T/F: Cognitive deficits are MORE indicative of recovery than physical/motor function?
TRUE
Concussion typically resolves within ___?
7 days
Cheyne Stokes breathing
rhythmic, alternating rapid breathing and momentary stopping
*indicative of bilateral hemispheric lesions OR diencephalon involvement
Apneustic breathing
prolonged pause at inspiration
*indicative of lesion at mid-caudal portion of pons
Stupor
difficult to arouse, but will eventually interact
3 predictors of disability post-TBI
- Severity of injury - Glasgow Coma Scale
- Length of Coma
- Length of Post-Traumatic Amnesia
Length of Coma
> 2 weeks: MOD-SEVERE disability 1 year post-injury
<1 week: MILD-MOD disability
Length of PTA
> 12 weeks: MOD-SEVERE disability
<=4 weeks: MOD disability or good recovery at 1 year
GCS Eye Opening
4-spontaneous
3-to speech
2-to pain
1-no response
GCS Best Motor Response
6-follows motor commands 5-localizes 4-withdraws 3-abnormal flexion 2-extensor response 1-no response
GCS Verbal Response
5-oriented 4-confused conversation 3-inappropriate words 2-incomprehensible sounds 1-no response
GCS Severity Scoring
13-15: Mild
9-12: Moderate
<=8: Severe
Ranchos Level I
No Response - deep coma, completely unresponsive
Ranchos Level II
Generalized Response - non-purposeful, non-specific, inconsistent
Ranchos Level III
Localized Response - light coma, reacts specifically but inconsistently
-may follow simple commands in inconsistent, delayed manner (ex: close eyes, squeeze hand)
Ranchos Level IV
Confused - Agitated:
- heightened state of activity
- bizarre, non-purposeful behavior
- cannot cooperate
- verbalizations frequently incoherent/inappropriate
- selective attention often non-existent
Ranchos Level V
Confused - Inappropriate:
- can respond to simple commands fairly consistently
- highly distractible
- unable to learn new information
Ranchos Level VI
Confused - Appropriate:
- shows goal-directed behavior, but dependent upon external input for direction
- follow simple directions consistently
- carryover with re-learned tasks
- little/no carryover with new task
Ranchos VII
Automatic - Appropriate:
- oriented, automatic daily routine
- carryover for new learning, but at decreased rate
- judgment remains impaired
- can initiate social activities with structure
Ranchos VIII
Purposeful - Appropriate:
- carryover for new learning
- aware & responsive to environment
- requires NO supervision
- may show decreased ability to PLOF and w/abstract reasoning
Signs of Increased ICP: (7)
- Decreased responsiveness
- Impaired consciousness
- Severe HA
- Vomiting
- Irritability
- Papilledema - optic nn edema, visual changes
- Change in vitals: inc BP, dec HR
Activities that can increase ICP: (4)
- Cervical flexion
- Coughing
- Percussion
- Vibration
imaging modality for TBI
CT Scan
What % of clinically-severe TBI have normal CT scan?
10-15%
Which is more sensitive to DAI? CT Scan or MRI?
MRI
Cushing’s Phenomenon
increase in BP in presence of acute rise in ICP
Concussion: Grade I
Transient confusion
No LOC
Resolution <15 minutes
*can return to play same day with normal sideline neuro exam
Concussion: Grade II
Transient confusion No LOC >15 minutes of symptoms to resolve *1 week until return to play *multiple Grade II concussions: 2 weeks
Concussion: Grade III
LOC!
- brief (seconds) - return to play in 1 week
- prolonged (minutes) - 2 weeks
- multiple Grade III concussions - 1 month or longer
