TBI/DisordersofConsciousness/Concussion

Question 1

Wakefulness

Answer 1

Pt has sleep cycles (can be abnormal), reflexes (to clapping in front of face), arousal (sustained eye opening), and eye opening

Question 2

Awareness

Answer 2

Pt’s actions are voluntary, reproducible, sustained, and purposeful

Question 3

Coma

Answer 3

Pt has no awareness or wakefulness. Appears to be asleep at all times. Brain activity present.

Question 4

Vegetative State

Answer 4

Pt has wakefulness but no awareness. Will have sleep cycles, eye opening, and reflexes but not on command. Pt unaware of what’s happening. Unresponsive to commands.
Persistent VS=4 weeks. Permanent VS=3 months without progression through stages of consciousness

Question 5

Minimally Conscious State

Answer 5

Pt has wakefulness and inconsistent/fluctuating awareness. Pt may be able to squeeze your hand on command, but inconsistently.
Functional communication and functional object use required to emerge from this.

Question 6

Concussion

Answer 6

GCS 15
Brief or no LOC
Focal neuro deficits that resolve in minutes-days
PTA

Question 7

Mild TBI

Answer 7

GCS 13-15

Brief (

Question 8

Moderate TBI

Answer 8

GCS 9-12
LOC 31min-24hr
PTA 1-7 days
Normal or abnormal imaging

Question 9

Severe TBI

Answer 9

GCS 3-8 (or 3-5 in children)
LOC > 24hr
PTA >1 wk
Abnormal imaging
60% mortality--even higher in children

Question 10

Good Prognostic Indicators

Answer 10

GCS at 24 hr (verbal and eye)
Early and rapid improvement
Younger
Cortical lesion
Premorbid status (level of fcn, comorbids)
Higher education level
Social supports

Question 11

Poor Prognostic Indicators

Answer 11

Low GCS (motor)
>65y/o
Abnormal pupil rxn
Single episode SBP 1 wk
PTA >2 wks
midline shift on CT
brainstem involvement
delayed access
presence of petechial hemorrhage
uncontrolled ICP
presence of secondary insults (hypoxia, hypotension, HTN)

Question 12

Predictors of Ambulation

Answer 12

age, duration of PTA, ambulation on admission

Question 13

Secondary complications

Answer 13

ICP elevation
hyperglycemia
fever
fracture
hypotension
seizures
DVT
cerebral hypoxia
heterotopic ossification
sympathetic storm

Question 14

Post Concussion Syndrome

Answer 14

Presence of at least 3 of these sx, 4 weeks after injury:
HA
dizziness
fatigue
irritability
insomnia
concentration difficulty
memory difficulty
increased emotion/stress