TBI Quiz 1 Flashcards
SAH
Subarachnoid hematoma
DAI
Diffuse axonal injury
CHI
Closed head injury
SBS
Shaken baby syndrome
ABI
Acquired brain injury
ICH
Intracerebral hemmorage
TME
Toxic metabolic encephalopathy
Interdisciplinary team consists of..
Who is the center of the team
Neurologist PT OT SLP social worker psychologist Neuropsychologist Respiratory therapy Rehab therapy Center- patient
How many people sustain a TBI during the calendar year?
1.7 billion
Why are some TBIs not reported?
May be an abuse situation, don’t want to report and get in trouble. People may not realize they have a TBI
How many deaths are recorded from TBI each year?
52,000
Do we focus on incidence or prevalence?
Incidence
Prevalence is too hard to measure
Incidence
Amount/frequency it happens within a time period
What gender has the highest incidence of TBI?
Males- more risk takers, more hands on/dangerous jobs
Infant TBIs
Shaken baby syndrome, falls
Adolescent TBIs
Motor vehicle accidents, falls during sports
15-24 have greatest incidence of TBI
Elderly TBI
Falls, can be more medically compromised which can lead to death
SDH
Subdural hematoma
Highest incidence of falls is
Among youngest and oldest people
Highest incidence of TBI in youths is cause by
Sports injuries- 80% have no change in academic ability after their TBI
TBI occurs in how many motor vehicle accidents
Over half
Intentional TBI
street violence, violent crimes, child abuse, domestic abuse, suicide attempts, military actions (harder to prevent these)
Unintentional TBI
MVAs, sports, job, falls
Risk factors of TBI
Substance abuse
Per existing medical conditions
Previous brain injury
After 2 brain injuries the risk is __ x greater
8
When is TBI season? Why?
May through October
More people playing outside, outdoor activities, riding motorcycles
Golden hour
An hour after injury happens prognosis is better and recovery is quicker
Acquired brain injury (ABI)
Any injury that occurs after birth
Non traumatic ABI are
- tumors
- toxic metabolic encephalopathy (TME)
- anoxia
- hypoxia
Toxic metabolic encephalopathy (TME)
brought on by endocrine and metabolic disturbances, toxins, infection and cause changes to cognition and consciousness
Anoxia
reduced oxygen supply to the brain
Hypoxia
reduced blood supply to the brain (heart attack, clot – wind up with cognitive changes and can end up with TBI)
Services for those with TBI
IDEA
New Jersey state department of human services - has a TBI fund for support for families and those with TBI
Translational acceleration
-force travels through the heads center of gravity – linear
Coup contra coup injury
Can have it side to side or back to back
Rotational acceleration
- force passes at any point other than the center
- you have no idea what’s going to be injured
- can force the head in any direction
Diffuse axonal injury (DAI)
- one of the more common CHIs also can be potentially most severe
- cause by movement of the brain within the skull – disrupting nerve cell messages
Shearing
Tearing too much to the point that the nerve severs
More susceptible to shearing where the gray and white matter meet
Primary injuries
Occur at the time of impact Shearing Hemorrhage Subarachnoid hemorrhage Intracerebral hemorrhage Contusion
Hemorrhage
- typically within brain tissue itself
- ruptured vessels and bleeding into the spaces between the skulls and brain tissue
Intracerebral hemorrhage
Means inside the brain
Can also be a stroke
Contusion
bruising of brain tissue, pooling and swelling of the tissue
Secondary brain injuries
Hematoma Subdural hemorrhage Epidural Subarachnoid Intracranial Cerebral swelling Cerebral edema
Hematoma
localized pools of blood found outside the circulatory system
Epidural
outside dura mater
-often involves skull fracture
-less dangerous when found quickly does not invade neural tissue
Subdural
– between dura mater and arachnoid mater (30% of severe TBIs)
-can compress and shift brain tissue
Subarachnoid
-form in the space from a tear of a cerebral artery
-can be found with a spinal tap- will be blood in spinal fluid
Intracranial
-most dangerous – occur in 60% of severe injuries
-not always diagnosed at first because of brain swelling
Cerebral swelling
blood traveling to the injured site
Can be more problematic for pediatric TBI
Cerebral edema
Increase in water content within the brain
-vasogenic – capillaries allow fluid from blood vessels to travel through
Cytotoxic neurons become gorged with liquid content
If there is intracranial pressure -pressure has to be removed slowly.. How?
Elevate the head
Draw fluids out with diuretic medications
Increased oxygen (hyperventilation)
High doses of barbiturates (phenobarbital)
Craniectomy
Blast injuries (war)
- increase because of active war time
- primary blast injury - atmospheric pressure changes responsible for brain damage (don’t actually have to be right next to the bomb or materials that explode)
- additional research needed on multiple blast injuries
Secondary blast injury
shrapnel or debris from blast can strike a soldiers head CHI through blunt force trauma or penetrating head injury that damages brain tissue
Tertiary blast injury
energy released by an explosion can accelerate a soldiers body though the air into ground
(ex coup contrecoup)
Fourth blast injury
Swelling of the brain
CT Scan
- a series of x-ray images that provide cross sectional slices of brain tissue
- can be with or without contrast
- number one way they assess an injury
- does not show contrast as much and it isn’t as clear – things can be missed
MRI
- uses large magnets, radiofrequencies, computer
- can pinpoint differences between soft tissue and abnormal tissue
- more contraindications
- if you have metal in your body you CANNOT have an MRI
Skull/cranium
- outside is smooth – we can feel that
- inside is bumpy and jagged – can cause your tearing and shearing
More susceptible to skull fractures
- orbital plates of frontal lobe
- sphenoid and temporal bones around the sinuses and middle ear cavities
Meninges
Three layers of membrane that surround the brain
-dura mater-cranial nerves pass through: encases sinuses
-arachnoid mater – delicate and fibrous
-subarachnoid space that contains cerebrospinal fluid
-pia mater-inner most
-thin and tightly around the brain tissue itself
-saran wrap around brain tissue itself
Ventricular system
Contains 4 ventricles
- produces CSF
- CSF is another buffer for the brain tissue
Cerebral cortex
4 lobes: frontal
temporal
parietal
occipital
Frontal lobe
executive function
Temporal lobe
Comprehension
Language on the left
Parietal lobe
Sensation
Depth perception
Processing
Occipital lobe
Vision
Cerebellum
- motor movements, balance
- very hard to have a TBI that affects this, location is hard to get to
Limbic system
- memories, emotion, physical desires
- deepest part
Diencephalon
-nerve damage (maybe DAI injury)
Hypothalamus
Memory
Brainstem
- midbrain
- pons –swallowing
- medulla
- heartrate, breathing, organs affected
How do we predict recovery
Extent and location of injury Length of impaired consciousness Post traumatic amnesia Neurological testing scores Genetics
