TBI Flashcards
1
Q
TBI
A
- Rapid injury to brain: stroke, external inflicted trauma, infection, parasite etc.
- Typical cause: MVA, falls, sports, violence, knife wounds, blunt force trauma
2
Q
Types of TBI (2)
A
- Force inflicted wounds
- Closed head wound (most common)
- Open Head wound: penetrating/ crushing (least common)
- Encephalopathey
- Anoxic
- Metabolic
3
Q
Concussion
A
- Closed head wound
- Mild TBI
- Causes: blunt force, deceleration, angular rotation
4
Q
Pathophysiology of Concussion
(what happens)
A
- Brain bounces inside cranium rubbing dura mater and bone, causing hematoma (blood collection like bruise) and swelling.
- Brain stretches from base,cause tissue to rub together. Axons become distended (mild DAI)
- Brain presses down or streches brainstem, temp shutting it down.
5
Q
Symptoms of Concussion
A
- Headache
- Nausea
- Sleepiness
- Vomitting
- Loss of orientation (more disoriented the worse)
- Glas Coma Scale of 12 and up
- LoC for less than 30
- Amnesia for less than 24 hr
- normal pupillary response less than 5 mm more than 3 mm
6
Q
Tx for Concussion
A
- Usually no treat as long as no focal injury non CT
- ice on contusions
- monitor vital signs for 24 hr
7
Q
Prognosis for Concussion
A
- Excellent prog
- multiple concussions can lead to lasting impairment
- one concussion cause permanent impairment in short term mem, attention, encoding, recall, concentration.
8
Q
Closed head Wounds
Epidural
A
- Blunt force: smack to skull, on sides, cause epidural or subdural hematoma
- Epidural: blood collects btwn skull & dura mater. Convex blood collection on CT
9
Q
Closed Head Wounds
Subdural Hematoma
A
- blood collects btwn skull & arachnoid mater
- often venous bleed
- crescent shape on CT
- more common
10
Q
Deceleration Injury
A
- Head moving in 1 direction, quickly stopped, sent in other direction
- Causes: MVA, falls, blunt force
- Coup-contre coup=Brain travelling in direction of inertia, bounces back against skull to hit opposite side
- common in frontal/occipital, temporal/temporal
11
Q
Rotational Injury
A
- Head twisted by impact, parts of brain/skull rub against each other
- Brain rubs against skull/meninges: veins in arachnoid mater rupture, causing subdural/subarachnoid hemorrhage
- Shearing injury: Brain rub against itself: Axons get stretched/torn (DAI), causing petechial/intraparenchymal hemorrhage
12
Q
Diffuse Axonal Injury
A
- Neurons stretched by deceleration/ abraded by shearing
- Damage from DAI can occur after initial injury when broken axons release apoptic factors (cell suicide)
- very difficult to see in brain scan bc microscopic
- POOR prognosis
- predictive of coma
- more evident DAI on brain scan=higher mortality
13
Q
Open Head Wounds
A
-
Penetrating
* cranium penetrated-by skull, blunt or piercing object (bullet) - Crushing
- Skull crushed btwn objects causing widespread fracture/ brain visibility
- symptoms same as closed w/ higher risk of infectoin & pneumocephalus (air entering brain cavity disrupting pressure)
14
Q
Extra Axial Bleed
A
Bleed occuring inside skull but outside brain tissue
15
Q
Herniation
A
- Occurs during Extra axial bleeds
- ICP inc, brain swell, blood/meninges push brain in places it souldn’t go.
- Tentorium=area of dura mater seperating cerebellum/cerebrum
- Uncus=inferior medial temporal lobe
- Cingulate gyrus=medialportion of cerebrum (around corpus cal)
- Foramen magnum=big hole at bottom of cranium where spinal cord/brainstem meet
16
Q
Supratentorial Herniation
A
- Herniation above tentorium
- Subfalcine=most common. Cingulate gyrus pushed under falx cerebri
- Central=midbrain pushed down tentorium
- Transcalvarial=brain matter pushed through defect in cranium
- Uncal=medial temporal lobe pushed through tentorium
17
Q
Infratentorial Herniation
A
- Herniation below tentorium
- Upward Cerbellar=cerebellar pushed up tentorium
- Tonsillar=downward cerebellar, pushed through for mag
18
Q
Symptoms of TBI
A
- Skull fracturing, skull depression
- worsening headache, then slip in2 coma/unconsciousness=bad prognosis
- confusion
- nausea/vomiting
- altered mental stat/loss of orientation
- ICP inc–>symptoms intensify–>herniation, midline shift, mass effect, pupillary irregularity=prognosis worsens
- potential seizure & AMS
19
Q
Fencing Posture
A
- Arm flies out as a tonic response to disruption of neurochemistry, with vestibular function involved
- often in contusion leading to unconsciousness
20
Q
Opisthotonus Posture
A
- severe muscle spasms caused by compression of corticoreticular tracts in midbrain
- Back and head arch back
- not common in TBI
21
Q
Decorticate Posture
A
- arms fold into “prayer” position, legs extended and feet turned inwards
- muscles rigid
- Indicative of pressure or damage to brainstem, especially motor tracts going through medulla
- Bad
22
Q
Decerebrate Posture
A
- arms straighten, hands curl downward and outward. Legs extend, feet turn inwards
- very rigid, teeth clenched
- If unconscious and continous, indicates brainstem herniation
- VERY bad
- seen frequently for short periods of time in comatose patients with brainstem damage
23
Q
Acute Dx and Prognostic Ind of TBI
A
- CT: differential Dx for extr vs. intra axial hemorrhage, skull frac, vertebral frac
- Acute Prog Indicator: age, pupillary response, consciousness, Glas Coma Scale, temp (lower=better), hypoxia (amount of oxygen in blood/brain)
- Goals: evacuation of blood for decompression, remove dead/dying tissue to prevent infection
24
Q
Primary Tx options for TBI (5)
A
- Burr-hole: drill hole in cranium, suck out blood for extra axial bleed.
- Craniotomy: remove part of skull, suck out blood. Extra and some intra axial bleeds. Followed by cranioplasty (reinserting skull/plastic)
- Craniectomy: remove part of skull. Hemorrhage and decompress of brain tissue & ICP due to swell & herniation.
- marsupialization=keeping piece of skull in abdomen for cranioplasty
- Lobectomy: remove part of brain after Wada test to make sure it isnt vital. Cases of severe focal injury
- Shunt/EVD for drainage of CSF or blood
25
Q
Encephalopathy
A
Anoxic=oxygen not reaching brain
- Asphyxiation
- cardiac arrest
- drowning
- CO poisoning
- Acute drug OD
Metabolic=caused by external factor
- cytotoxic drug use (huffing)
- lead poisoning
Symptoms/Prog vary widely bc damage to entire brain, hard to spot.
26
Q
Long Term Care/Prog
A
- Prognosis=extremely variable
- Long term prog indicators: age, sverity of injury, length/depth of coma, amount of recovery=6mos, level of amnesia.
- Temporally graded amnesia: amnesia for amount of time before injury. Should give GOAT Test.
- 10% seizure disorder
- 50% personality change/mood disorder
27
Q
Long Term Sequelae
A
- Encephalomalacia: softening of brain tissue by necrosis
- Heterotrophic Ossification: very rare
- Periods of dizziness and nausea
- Photosensitivity/headaches
- Cranial nerve/visual damage
- Memory deficits
- Aphasia
- anosognosia: Insight and judgment deficits
- Seizures
- Personality change
- Executive functioning deficits in planning, organization, problem-solving
28
Q
TBI Rehab
4 therapies
A
- Typically four therapies:
Speech
Physical
Occupational
Cognitive - Counseling, Job Placement, Community Re-entry
- Physical and occupational therapies maintain gains after rehab
- Cognitive therapy has shown to remit somewhat after termination of therapy, indicating ongoing therapy is required
29
Q
Hemineglect
A
- disorder that tends to appear after damage to the R Parietal Lobe
- causes: CVA, TBI, or disease
- often occurs w/ Left Homonymous Hemianopsia (only seeing out of the Right side of both eyes)
- common types of neglect are Spatial, Motor, Sensory, maybe Auditory involvement
30
Q
Symptoms of Hemineglect
A
- Hemianopsia Inattention – can’t see out of the L side, like left side of the world does not exist
- Anosognosia – doesn’t believe half body belongs to them, not bothered by it
- Extinction to Double Simultaneous Stimulation – can raise their arms separately, but when asked to raise both, will only raise the R.
31
Q
Hemineglect Personality Change
& Tx
A
- tempero-parietal junction controls mood/personality function
- will become nonchalant about neglect
OR
- become argumentative, angry, non-compliant w/ Tx
- Tx=Behavioral plans based on contingency management (reinforcement for compliance with therapy)
32
Q
Tx of Hemineglect
A
- Lighthouse Therapy – teach pt to use head and eyes like a lighthouse, “scanning” left to right. Maintain continuous tactile stimulation on the neglected side, and force to use neglected limbs.
- Cancellation Tests – used to teach pts to overcome inattention
33
Q
Prognosis of Hemineglect
A
- not good for recovery
(BUT age=good predictor for recovery – I.e., younger people are-more likely to recover than older)
- Tx=compensatory (focus on insight and awareness of inattention).
- remind ind. to groom neglected half
- Highlight neglected side of important documents
- Place arrows pointing to neglected side
- worse the motor and personality components (vs. visual/spatial components)=worse prognosis for recovery and compensation for deficits.
