Traumatic brain injury

Question 1

2 age groups that have the most TBI-related ED visits

Answer 1

adolescence (15-19) and older adults (85+)

Question 2

Most common cause of TBI-related ED visits in adolescents and older adults

Answer 2

sports and recreational activities; falls

Question 3

4 mechanisms of TBI

Answer 3

blunt impact, acceleration/deceleration, blast force, penetrating

Question 4

2 forces in a blunt impact

Answer 4

linear acceleration forces (shifting back and forth inside the cranium); rotational forces

Question 5

Time span of LoC in mild, moderate, severe TBI

Answer 5

0-30 mins; >30 mins and <24 hours; >24 hours

Question 6

Time span of post-traumatic amnesia in mild, moderate, severe TBI

Answer 6

<1 day; >1 to <7 days; >7 days

Question 7

Glasgow coma scale scores in mild, moderate, severe TBI

Answer 7

13-15; 9-12; 3-8

Question 8

Mild TBI compared to moderate-severe

Answer 8

at least 8x more common; challenging diagnosis with brief or no hospital care; macrostructural brain injury in <15%

Question 9

Most likely prognosis of mild TBI

Answer 9

full recovery within 4-12 weeks

Question 10

5 mechanisms in the pathophysiology of concussion (mins-hours)

Answer 10

neurometabolic cascade (disturbance in brain’s function); nonspecific depolarization (action potentials); release in excitatory NTsl; potassium spilling out; increased activity in ionic pumps to restore homeostasis

Question 11

3 primary neuropathologies in moderate-severe TBI

Answer 11

diffuse axonal injury, bleeds (intracerebral hemorrhage, epidural or subdural hematoma), focal contusions

Question 12

Examples of secondary neuropathologies in moderate-severe TBI

Answer 12

edema (brain swelling), ischemic-hypoxic injury (similar to anoxia)

Question 13

Which kind of neuropathology causes long-term deficits in moderate-severe TBIs?

Answer 13

primary

Question 14

Diffuse axonal injury

Answer 14

shearing or tearing of axons (near junction of gray and white matter) as brain shifts and rotates around the skull

Question 15

2 common sites of DAI

Answer 15

corpus callosum and brain stem

Question 16

DAI 12 days vs 6 months post-TBI

Answer 16

axons partially damaged; axons either repair themselves or fully degenerate, and degradation in white matter injury

Question 17

Subdural hematoma

Answer 17

blood build-up on the surface of the brain; requires surgery and can be fatal due to intracranial pressure

Question 18

Contusions

Answer 18

bruising on the brain due to it bumping up against the skull; commonly occurs in frontal-temporal lobes

Question 19

2 reasons for frontal-temporal contusions

Answer 19

contracoup; body and rigid inner skull

Question 20

Contracoup

Answer 20

brain swishes to the opposite direction, hitting against the skull due to a person falling backward

Question 21

Physiological vs symptom recovery after concussion/mild TBI

Answer 21

physiological recovery lags behind symptom recovery (i.e. person is functioning properly but the brain is still healing)

Question 22

2 ways to monitor physiological recovery of the brain

Answer 22

metabolism (magnetic resonance spectroscopy) and cerebral blood flow (arterial spin labelling)

Question 23

Examples of persistent post-concussion symptoms

Answer 23

physical, emotional, cognitive (e.g. headaches, sleep problems, appetite changes, fatigue, trouble concentrating, memory problems, depression/anxiety, sensitivity to light/noise, dizziness)

Question 24

Strong preinjury factor for TBI symptom persistence

Answer 24

mental health (e.g. struggling with depression/anxiety, psychological trauma)

Question 25

Phases of recovery from moderate-severe TBI

Answer 25

coma (no response, generalized response, localized response); post-traumatic confusion

Question 26

When is most recovery from moderate-severe TBI occurring?

Answer 26

within the first year; 25-30% chance of full recovery

Question 27

Which age group has a greater chance of recovery from moderate-severe TBI?

Answer 27

younger people (16-29)

Question 28

Sensory post-acute clinical presentation

Answer 28

unable to smell or taste due to injured olfactory bulbs and fibers in brain sensitive to rupture

Question 29

Motor post-acute clinical presentation

Answer 29

balance issues due to diffuse axonal injury (left/right side unable to communicate); focal motor deficits due to bleeds

Question 30

Neurobehavioral post-acute clinical presentation

Answer 30

mainly cognitive (problems with memory, executive function, processing speed) due to DAI and contusions

Question 31

Management of concussion/mild TBI

Answer 31

relative rest for 24-48 hours; gradual return to usual activities as tolerated; aerobic exercise; symptom-based management (e.g. migraine medications, vestibular rehabilitation for dizziness)

Question 32

5 phases in the treatment pathway for mod-sev TBI

Answer 32

dispatch center; emergency medical service; hospital presentation and admission; post-acute care; community reintegration

Question 33

3 treatments for TBI

Answer 33

acute mitigation of secondary injury (e.g. sedation, monitoring intracranial pressure, craniotomy, surgical evacuation of hematoma); inpatient interdisciplinary rehabilitation focused on functional independence (3 hrs/day for weeks); outpatient rehabilitation based on needs

Question 34

Chronic traumatic encephalopathy (CTE)

Answer 34

years of contact sport participation (repetitive head trauma) necessary but not sufficient for developing CTE; variable and non-specific clinical presentation with diagnosis only possible post-mortem

Question 35

Controversies and unknowns in CTE

Answer 35

selection bias in brain bank studies; extent of repetitive head trauma; latent period after retirement from sport prior to development; minimum threshold for diagnosis with multiple neuropathologies on autopsy; prognosis for disease progression