TBI (Doms lecture) Flashcards
traumatic brain injury (TBI)
when a sudden external, physical assault damages the brain
~ 1.4 million treated in ED each year
27,000 are hospitalized
52,000 die from their injury
most common causes of TBI
adolescence and young adults: motor vehicle collisions
adults/older: falls
2 primary types of TBI
closed BI
penetrating BI
closed BI
non-penetrating injury to the brain with no break in the skull
can result from rapid forward and backwards movement of the brain in skull = tearing and bruising the brain tissues and blood vessels
coup contrecoup
diffuse axonal injury
coup contrecoup
coup = point of impact
contrecoup = injury of opposite side
when the brains goes back and forth in the skull hitting the front and back point of impact
ex) bang head against a walk and the brain goes forward hitting front of skull and then back hitting back of skull
diffuse axonal injury
tearing of the brain’s long connecting nerve fibers (axons) that happen when the brain is injured as it shifts and rotates inside the skull
damage to:
white matter
changes can be microscopic
can lead to disordered consciousness
difficult to see on a CT or MRI
can occur without other visible damage
penetrating BI
open head injuries where there is a break in the skull
results from:
objects penetrating and skull bone fragments damaging brain tissue and blood vessels = deprivation of normal blood supply (ischemia) OR accumulation of blood (hemorrhage)
cognitive impairment tends to be more focal
chronic traumatic encephalopathy (CTE)
produces neurodegeneration due to repeated head trauma
prevalence in athletes who participate in contact sports and experience frequent and repeated head trauma
can only be confirmed postmortem
confirmation of CTE postmortem
abnormal tau protein accumulation (similar to alzheimer’s)
reduced brain volume (corpus callosum and limbic system)
ventricular enlargement
characteristic deficits in CTE
mood and cognitive impairment can appear years after injury occurred
dysexecutive functioning and mood lability
other mechanisms of injury (primary injury and secondary injury)
primary injury happens first: skull lacerations, skull fractures, contusions cerebral lacerations, intracranial hemorrhage, diffuse axonal injury)
time goes on (seconds/minutes/days)
secondary injury due to: increased intracranial pressure, hypoxia, hypotension, hypertension, electrolyte disturbance, toxic amino acid, oxygen radicals
recovery process
one will lose a period of time from before injury
post-traumatic amnesia
state of confusion and disorientation that occurs immediately after TBI; part of the healing process; brain is unable to form continuous day to day memories
can be very difficult for family members = always provide resources and education
goal = support reorientation and sense of safety
classification system for TBI
uses duration of unconsciousness; Glasgow Coma Scale; and PTA; doesnt alway line up perfectly; someone can fall in the mild range for duration of unconsciousness and in the moderate range for Glasgow Coma Scale
Glasgow Coma Scale
done on site by EMT or in ED; used to get severity of injury; looks at eye opening, best motor response, and verbal response
Limitation os Glasgow Coma scale
substance use
administered drugs
intubation (cant talk or respond)
Injury to eye (cant do eye opening test)
Hemiplegia (cant do motor response)
language (verbal response)
behavioral presentation of PTA
confused and disoriented
agitation and aggression
inability to recognize loved ones
childlike clingy behavior
confabulation
for PTA you should never…
ask them to recall the injury.. they cannot do it
Rancho Los Amigos Scale -Revised (RLAS-R)
a scale used to describe behavioral and cognitive patterns found post TBI
Dose response relationship
for mild TBI cognitive changes resolve within weeks-~3 months at most
changes tend to persist >2 years following moderate-severe TBI
non-injury risk factors that influence TBI outcomes
pre-injury psychiatric status and conduct issues/incarceration (hyperfocus on cog issues)
age at injury (older you are the slower you recover)
level of education
stable employment 6 months pre-injury (best predictor of return to employment post-injury)
marital status (perceived social support)
other non-neurological injuries sustained (physical injuries can prevent return to meaningful activities)
FBS
symptom validity scale; non-credible somatic and cognitive complaints
RBS
response bias scale; exaggerated memory complaints
post concussion syndrome: conscious attempt
2 types:
Primary gain (goal is internal; for medical attention or sympathy)
secondary gain (goal is external; day off at work or extra compensation)
primary gain: fictitious disorder
Munchausen syndrome (imposed on self)
Munchausen by Proxy (imposed on another usually child or elderly patient)
Post concussion syndrome vs somatization: unconscious attempt
somatic symptoms and related disorders;
somatic symptom disorder
conversion disorder
illness anxiety disorder
