TBI Sequelae Flashcards
Define traumatic brain injury.
“Force” acting on the brain:
- Caused by impact to the head, or other events that cause rapid movement or displacement of the brain within the skull, for example, blast injuries
What are the results of TBI?
- Disturbance in level of consciousness
- Loss of consciousness not required
Name 3 mechanism sof TBI?
1) Impact Forces: (contact with object)
2) Inertial Forces: (acceleration or deceleration of the brain)
3) Blast Forces
*Coup/contre coup site is common
What are the neurovascular/neuro disturbances that can occur post TBI?
- Subdural Hematoma
- Shear hemmorage
- DAI
- Contusion
What are the areas that are more commonly affected by Diffuse axonal injury?
1) Sub-cortical white matter
2) Corpus callosum
Describe the injury sequence of DAI (Diffuse Axonal Injury).
Injury Sequence:
- Axon is stretched
- Increased permeability
- Calcium influx
- Damage to cytoskeleton
- Impaired axoplasmic transport
- Axonal swelling
- Detachment and axonal death
What secondary injuries are associated with TBI?
- Massive release of neurotransmitters
- Cerebral edema/ischemia/hypoxia
- Increased intracranial pressure
- Subsequent triggering of excitotoxic injury cascades
What neurochemical disturbances can occur post TBI?
Cholinergic
Catecholaminergic
Glutamatergic
Serotonergic
What are the measures of severity for TBI?
- Loss of consciousness
- Duration of post traumatic amnesia
- Glasgow Coma Scale score
How severe are most TBI?
70-80% are “mild”
- Mild with major sequelae
What is the Glasgow Outcome Scale Score?
The ‘Glasgow Outcome Score’ (GOS) is a scale so that patients with brain injuries, such as cerebral traumas can be divided into groups that allow standardised descriptions of the objective degree of recovery.
*It is NOT a marker of severity for TBI
What are the major causes of TBI (4)?
1) Falls (most common) => Elderly (and very young)
2) Motor vehicle accidents => Teens and young adults
3) Sports Injuries => Youth-Adult
4) Assaults => Urban populations
Describe the prevalence of TBI.
Gender: TBI occurs twice as often in men as in women.
Age:
- Children below age 4
- Individuals between the ages of 15 and 24 years
- Individuals age 75 and older
What is implicated in nearly HALF of TBI cases?
Alcohol
What (childhood) disorder is associated with TBI?
ADHD
What are the physical symptoms of TBI?
Seizures Headaches Dizziness Balance and coordination problems Visual disturbances Hearing impairments Weakness or paralysis Sensory impairments
What are the cognitive impairments of TBI?
Impaired attention
Memory
Language skills
Complex cognition (judgment, insight, problem solving)
What are the emotional/behavior symptoms of TBI?
Depression Anxiety Mania Irritability Affective lability Rage/aggression Psychosis (rare) Diminished motivation (apathy) Impulsivity Perseveration
What type (broadly) of disorder do nearly half of TBI patients incur?
Almost half of individuals who sustain a TBI will develop a neuropsychiatric disorder
What cognitive domains are MOST impacted by mild TBI?
[ Dysexecutive syndrome]
- Social Cognition (Social comportment)
- Lateral orbitofrontal
- Complex Attention (Motivation)
- Anterior cingulate
- Learning/memory (Executive)
- Dorsolateral prefrontal
What are the symptoms associated with Lateral Orbitofrontal Circuit dysfunction?
[Social Comportment]
Impulsivity
Irritability
Affective Instability
Awareness deficits
What are the symptoms associated with Anterior Cingulate and Medial Frontal Circuit dysfunction?
[Motivation]
Apathy:
- Loss of interest
- Loss of initiative
- Loss of drive
What is the prevalence of developing an axis I disorder post TBI?
48% developed Axis I Disorder after TBI [ - 28% depression - 12% alcohol abuse/dependence - 8% panic disorder - 8% phobic disorder - 7% psychotic disorder]
What are the cognitive/executive deficits after TBI?
Executive Function Attention Memory Speed of Information Processing Speech and language
