TBI (Doms lecture)

Question 1

traumatic brain injury (TBI)

Answer 1

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

Question 2

most common causes of TBI

Answer 2

adolescence and young adults: motor vehicle collisions
adults/older: falls

Question 3

2 primary types of TBI

Answer 3

closed BI
penetrating BI

Question 4

closed BI

Answer 4

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

Question 5

coup contrecoup

Answer 5

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

Question 6

diffuse axonal injury

Answer 6

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

Question 7

penetrating BI

Answer 7

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

Question 8

chronic traumatic encephalopathy (CTE)

Answer 8

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

Question 9

confirmation of CTE postmortem

Answer 9

abnormal tau protein accumulation (similar to alzheimer’s)
reduced brain volume (corpus callosum and limbic system)
ventricular enlargement

Question 10

characteristic deficits in CTE

Answer 10

mood and cognitive impairment can appear years after injury occurred
dysexecutive functioning and mood lability

Question 11

other mechanisms of injury (primary injury and secondary injury)

Answer 11

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

Question 12

recovery process

Answer 12

one will lose a period of time from before injury

Question 13

post-traumatic amnesia

Answer 13

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

Question 14

classification system for TBI

Answer 14

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

Question 15

Glasgow Coma Scale

Answer 15

done on site by EMT or in ED; used to get severity of injury; looks at eye opening, best motor response, and verbal response

Question 16

Limitation os Glasgow Coma scale

Answer 16

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)

Question 17

behavioral presentation of PTA

Answer 17

confused and disoriented
agitation and aggression
inability to recognize loved ones
childlike clingy behavior
confabulation

Question 18

for PTA you should never…

Answer 18

ask them to recall the injury.. they cannot do it

Question 19

Rancho Los Amigos Scale -Revised (RLAS-R)

Answer 19

a scale used to describe behavioral and cognitive patterns found post TBI

Question 20

Dose response relationship

Answer 20

for mild TBI cognitive changes resolve within weeks-~3 months at most

changes tend to persist >2 years following moderate-severe TBI

Question 21

non-injury risk factors that influence TBI outcomes

Answer 21

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)

Question 22

FBS

Answer 22

symptom validity scale; non-credible somatic and cognitive complaints

Question 23

RBS

Answer 23

response bias scale; exaggerated memory complaints

Question 24

post concussion syndrome: conscious attempt

Answer 24

2 types:
Primary gain (goal is internal; for medical attention or sympathy)
secondary gain (goal is external; day off at work or extra compensation)

Question 25

primary gain: fictitious disorder

Answer 25

Munchausen syndrome (imposed on self)
Munchausen by Proxy (imposed on another usually child or elderly patient)

Question 26

Post concussion syndrome vs somatization: unconscious attempt

Answer 26

somatic symptoms and related disorders;
somatic symptom disorder
conversion disorder
illness anxiety disorder