TBI

Question 1

traumatic brain injury TBI

Answer 1

occurs when an insult to the brain from an external mechanical force causes the brain to move rapidly within the skull, leading to damage

Question 2

TBI can be an impact event

Answer 2

head makes direct contact with an object

Question 3

TBI can be a nonimpact event

Answer 3

head encounters a force such as blast waves or rapid acceleration/deceleration

Question 4

is TBI higher in men or women?

Answer 4

men

Question 5

leading cause of TBI?

Answer 5

falls

Question 6

more than 2/3 of TBI cases are

Answer 6

milk (aka concussions)

Question 7

the brain is naturally protected from injury - the skull

Answer 7

a natural helmet that absorbed impacts & protects

Question 8

Severity of TBI can be divided into 4 categories

Answer 8

subclinical, mild, moderate, severe

Question 9

TBI can lead to - changes in

Answer 9

molecular signaling

Question 10

TBI can lead to - alteration in cellular

Answer 10

structure/function

Question 11

TBI can lead to what type of injury

Answer 11

primary tissue injury

Question 12

TBI can lead to BBB

Answer 12

dysfunction

Question 13

2 phases of TBI

Answer 13

acute primary injury

delayed, secondary injury

Question 14

1st phase - acute primary injury

Answer 14

mechanical forces disrupting the integrity of cels

Question 15

2nd phase - delayed, secondary injury

Answer 15

days to months after trauma, stretching of membrane, unregulated flux of ions, increased glutamate release, cytoskeletal degradation, inflammation, mitochronrial dysfunction, increased oxidative stress, edema, ischemia

Question 16

neuroinflammation based therapies - minocycline

Answer 16

anti-inflammatory properites, crosses BBB. Conflicting effects in animal models

Question 17

neuroinflammation based therapies - melatonin

Answer 17

neuroprotective properties, lipophilic. Varying results in animals

Question 18

neuroinflammation based therapies - statins

Answer 18

neuroprotective and anti-inflammatory properties in mouse model. Suppression of glial activity

Question 19

neuroinflammation based therapies - stem cells

Answer 19

regenerative therapy. Suppression of inflammation

Question 20

neuroinflammation based therapies - granulocyte colony stimulating factor

Answer 20

FDA approved, recruits endogenous stem cells to injury site for neuroprotection

Question 21

changes in excitation and inhibition with TBI are associated with

Answer 21

glutamate and GABA

Question 22

ionic flux modifications - glutamate induces

Answer 22

depolarization

Question 23

metabolic crisis with TBI

Answer 23

energy failure by trying to restore ionic homeostasis through ATP pumps activity

Question 24

Excitoxicity with TBI causes creation of

Answer 24

free radicals and mitochondrial impairments leading to cell death

Question 25

excess glutamaate stimulation activates

Answer 25

NADPH oxidase - generating oxidative stress

Question 26

mitochondrial calcium accumulation causes

Answer 26

membrane potential compromise generating free radicals

Question 27

fluid percussion injury

Answer 27

* Intracranial hemorrhage, brain swelling, grey matter damage, skull fracture * Mixed focal/diffuse injury * Highly reproducible * Requires craniotomy * High mortality rate

Question 28

controlled cortical impact

Answer 28

* Impact is created using a pneumatic/electromagnetic devise to drive an impactor onto the intact dura * Creates focal cortical tissue damage, subdural hemtomas, DAI and disrupts the BBB * High reproducible * Low mortality rate * Requires craniotomy

Question 29

weight drop impact acceleration injury

Answer 29

* Feeney’s model – dropping weight on intact dura, focal cortical injury, requires craniotomy, resembles human focal TBI but has high mortality rate * Shohami’s method – close injury model, weight dropped on skull resulting in a fracture. Creates BBB dysfunction, behavioral deficits and inflammation. Easy to execute but not highly reproducible * Marmarou’s model – skull is surgically exposed and a steel disc is glued to skull and brass weight is dropped. Produces DAI and resembles human injury but as poor reproducibility and high mortality rate * Maryland Model – like that ^^ but with force applied to the anterior portion of the cranium. Prouces DAI but no skull fracture/contusion

Question 30

Blast injury

Answer 30

* Mimics TBI amond military * Animal placed into as shock tube where a compression shock wave is generated * Creates brain edema, DAI and vasospasm

Question 31

behavioral changes with TBI

Answer 31

headaches, attention deficits, cognition impairments, sensory processing deficiency, communication deficits, severe depression, anxiety, sleep disturbances, personality changes, aggression,

Question 32

neuropathology - contusions

Answer 32

areas of cerebral bruising particularly involving gray matter, whereby blood leaks into the extravascular space and it results in cell death and local loss of tissue

Question 33

neuropathology - diffuse axonal injury

Answer 33

affects white matter throughout the cerebrum and brain stem. Followed by generalized atrophy with ventricular enlargement; takes a few weeks/month to develop • Usually responsible for slurred speech

Question 34

assessment of TBI - glasgow coma scale

Answer 34

used soon after injury • Most common scoring system • Used to gauge severity of acute injury • Limitations: drug use, shock or low blood oxygen can lead to inaccurate score

Question 35

chronic traumatic encephalopathy

Answer 35

o Neurodegenerative syndrome that has been linked to serious psychiatric symptoms including depression and suicidal behavior o Found in individual with a history of repeated TBI

Question 36

clinical trials - hypothermia

Answer 36

mild to moderate, decreased mortality and improve rates of neurologic recovery

Question 37

clinical trials - progesterone

Answer 37

no differential effects

Question 38

clinical trials - bone marrow

Answer 38

mononuclear cells used in children and adults with severe TBI

Question 39

clinical trials - deep brain stimulation

Answer 39

central thalamus stimulation for severe TBI, no results yet