Traumatic Brain Injuries Flashcards
What is the chief mechanism of traumatic brain injury?
– Axonal Stretching, apart from the brain contusions. The stretching is what causes the longer term symptoms.
What are the mechanisms of axonal injury to the neurons by severity of stretch?
- Nodes of Ravier ionic fluxes (5%)
- Reversible Cytoskeletal Damage (disruption of axoplasmic transport) [10%]
- Compromised mechanisms that disrupt restorative properties of homeostasis [15-20%]
What are the primary mechanism of neuron damage in traumatic brain injuries?
- Calcium Influx
- Potassium Efflux
- *Begins Excitotoxicity cascade of damage
- Receptors dysfunction
- Free Radicals
- Inflammation
What metabolites and electrolytes increase immediately with traumatic brain injury?
- Elevated Ca+2
- Elevated Glutamate
- Elevated Potassium
- Elevated Lactate
Diminished Cerebral Blood Flow – further worsens damage to neurons
What areas of the brain are most likely to get contusions during a traumatic closed head injury?
- Frontal Lobe
- Temporal Lobes
What might you see in an injury that consisted of rapid acceleration and deacceleration of a MCV?
Petechial Hemorrhage
A lower Glasgow coma score predicts what of the patient long term?
- Mortality (not a good predictor of morbidity)
Number of days with Post-Traumatic Amnesia is an indicator of what?
- Morbidity
The more days of amnesia after a CHI the higher risk of longer term disability and symptoms.
What are common residual effects of traumatic brain injury?
- Difficulty sustaining attention
- Decreased speed of processing information
- Less mental flexibility
- Impaired Memory and Learning
- Diminished impulse control
- Irritability and Depression
If a patient got hit in the head with a baseball during a game and immediately became confused at the time of accident without any focal neurologic deficit. The patient did not have any LOC, but does not remember any part of the baseball game. What is the injury classified as?
- Mild Traumatic Brain Injury Criteria: - Any LOC (less than 30 minutes) - Loss of memory of event before and after (no longer than 24 hours) - GCS 13-15 30 minutes after event - Transient focal neurologic deficits
How long does it take for apparent complete recovery of symptoms after CHI?
7-10 days seems to be when 80-90% of people fully recover
When do the most repeat concussions happen?
75-92% of repeat concussions happen within first 7-10 days of recovery
Athletes who resume playing the sport
What is the current evidence regarding the current time point of the patient returning to play?
7-10 days to return to play – they are physiologically improved and back to normal without symptoms, but functional studies of the neural connections indicate that the brain is still recovering and not back to normal yet.
What kind of patients are slower to recover from a traumatic brain injury or have higher risk of persisting symptoms?
- History of traumatic brain injury
- History of psychiatric illness
- Other systemic injury, vertigo, visual migraines, seizures
- Upper limits of Mild Traumatic Injury
- Severe Acute or 3-month symptoms
- Older patients
What is the best treatment of Mild Traumatic brain injuries?
- Education – reassure them they will return to normal
- Early Monitoring / Intervention
- Medications for symptoms
- Gradual return to play and work
- Follow up to ensure proper recovery
