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Advanced Neuro Conditions > Traumatic Brain Injury > Flashcards

Traumatic Brain Injury Flashcards

1
Q

What is a TBI?

A
  • Some sort of external force
  • Alteration in brain function caused by an external force
  • External damage can be:
    o Mechanical
    o Radiation
    o Thermal
    o Chemical
    o Electrical
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2
Q

What are the different types of TBI?

A
  • Coup and contra coup injury
  • Haematomas
  • Diffuse axonal injury
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3
Q

How is TBI caused?

A
  • Direct force. eg. being hit in the head (mechanical) - eg. sports injury or violent attacks
  • Acceleration/deceleration force (eg. not direct contact)
  • Projectiles or similar penetrating injury
  • can be open or closed injury
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4
Q

What are the 2 types of TBI injury (open/closed)

A

Blunt and Penetrating

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5
Q

What is a blunt injury in TBI

A
  • Results from one point of acceleration. Eg. moving object that has impact on the head. Eg. baseball bat hitting head.
  • Deceleration is eg. falling off ladder
  • Acceleration/deceleration when you go from moving to not moving - eg. vehicle accident
  • Rotation = caused by twisting of the brain
  • Compression - causes injury to brain through defamation
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6
Q

What is a penetrating injury in TBI?

A
  • Object penetrates the skull
  • Eg. guns, knives
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7
Q

How is a TBI rated?

A

Mild, moderate, severe through the Glasgow coma scale (length of coma) and Degree of post-traumatic amnesia (PT)

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8
Q

What is the pathology of a TBI?

A

Damage to the brain at time of impact can be focal or diffuse

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9
Q

What is a focal TBI?

A
  • Laceration, haematomas and contusions (small bleed or bruising = results in changing levels of consciousness)
  • Often at temporal and frontal area as brain moves inside the skull across these roughened bony areas
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10
Q

What are the symptoms of a focal TBI?

A
  • Explains why personality, cognition and speech commonly affected
  • Focal are considered symptoms that are related to functions of the brain area that are damaged
  • Issues with personality, cognition and speech
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11
Q

What is a diffuse axonal injury TBI?

A
  • axons snap due to acceleration/deceleration/rotational forces, scattered through brain - corelates with degree of coma
  • Concussion - mildest form of TBI
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12
Q

What is a Coup-contrecoup injury

A
  • Contusion remote from and classically opposite to, the actual site of impact to the head
  • Contrecoup, a French term, means counterblow
  • Brain continues to move inside the skull due to the forces applied even when the skull is stable
  • Leads to focal injuries, commonly frontal and temporal lobes
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13
Q

What are the primary brain injuries?

A
  • Concussion
  • Contusion
  • Epidural haematoma
  • Subdural haematoma
  • Traumatic subarachnoid haemorrhage
  • Intracerebral haemorrhage
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14
Q

What is a primary brain injury?

A

Occurs at the time of the impact and results in focal/diffuse injury

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15
Q

What is a concussion?

A
  • Mildest form
  • Diffuse injury
  • Results in brief loss of consciousness
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16
Q

What is a contusion?

A
  • Small bleed or bruising - can be coup (same side) or contrecoup (opposite side)
  • Changes in patients levels of consicuousness
  • CNS dysfunction
  • Seizures
  • Hemiparesis / hemiplegia
17
Q

What is an epidural haematoma?

A
  • Bleeding between dura mata and skull
  • Common in skull fractures
  • Usually result of arterial bleed and middle meningeal artery under the occipital bone
  • Loss of consciousness, gain in consciousness and then rapid decline which results in change of levels of headache, vomiting, ipsolateral pupil dilation,
  • Focal changes occur because haematoma is putting pressure onto the dura mata
18
Q

What is a subdural haematoma?

A
  • Bleeding between the dura mata and arachnoid mata
  • Result of shearing of cortical veins which are located between dura and arachnoid mata
  • Commonly seen as result of acceleration or deceleration
  • Can sometimes see symptoms progress significantly after 48 hours - slower venous bleed that makes symptoms worse
19
Q

What is a traumatic subarachnoid haemorrhage?

A
  • Different to the below the subarachnoid membrane in the subartachnoid space but outside of the brain tissue
  • Pathologically different to subarachnoid haemorrhage that is the result of an aneurism and often no surgical intervention
  • Poor prognosis
  • Intraventricular haemorrhage
  • Headache, loss of consciousness, seizures
20
Q

What is a intracerebral haemorrhage?

A
  • Bleeding in the parankaimal tissue in the brain
  • Severe
  • Acceleration/declaration injury
  • Changes in consciousness, headaches,
  • Diffuse injury - axonal, diffuse shearing present with coma and abnormal posturing
21
Q

What is secondary pathology of a TBI?

A
  • Subsequent to the insult/injury
  • Brain oedema and intracranial haemorrhage or subdural haematoma
  • Results in intracranial pressure and hypoxia both of which can cause damage to the brain
  • Seizures
  • Medical treatment focuses on reducing these. Eg. reducing brain oedema through medication, ensuring oxygen saturation, surgery to reduce haematomas
22
Q

What motor changes occur in a TBI?

A
  • In addition to weakness, spasticity, ataxia and paresis rigidity is key sign
  • Rigidity is resistance to movement across all ROM
  • Agitation, restlessness frequently also persist
23
Q

What is rigidity?

A
  • Rigidity is resistance to movement across all ROM
  • 2 positional rigid pattern
  • Decorticate: UL flexed IR adducted, LL extended
  • Decerebrate: Both UL and LL and Trunk extended, head retracts, hands fist
  • Can be sever enough to leave only head and feet as contact points
24
Q

What cognitive/behavioural changes occur after a TBI?

A
  • Attention and concentration
  • Memory - anterograde and retrograde amnesia
  • Initiation/termination
  • Insight and judgement
  • Sequencing
  • Learning difficulties
  • Personality changes
25
Q

What are the complications of TBI?

A
  • Seizures
  • Nerve damage
  • Blood clots
  • Narrowing of blood vessels
  • Stroke
  • Coma
  • Infections in the brain

Advanced Neuro Conditions (3 decks)

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