Traumatic Brain Injury

Question 1

Pt fell and experienced at least one of the following:

Loss of consciousness for

Answer 1

mTBI aka concussion

Question 2

Pt fell and experienced at least one of the following:
Loss of consciousness for > 30 mins but 24 hrs.
Amnesia lasting >24 hrs but

Answer 2

Moderate TBI

Question 3

Pt fell and experienced at least one of the following:
Loss of consciousness for > 24 hrs.
Some alteration of consciousness lasting > 24 hrs.
Amnesia lasting > 7 days.
GCS 3-8

They experienced:

Answer 3

Severe TBI

Question 4

What is Coup-contrecoup?

Answer 4

Blow to front of head causes damage there.

Blow causes fall resulting in secondary impact to back of head, causing damage there.

Question 5

What causes diffuse axonal injury?

Why does this cause global neurological deficits beyond the immediate site of injury?

Answer 5

The brain moving about in the skull after a blow causes stretching, shearing, and torsion of axons.

Death of axons at primary site of injury causes swelling of brain, reducing blood flow to other parts of the brain—> global ischemia. Shearing of axons also releases intracellular components that cause more direct damage to parenchyma.

Question 6

How do you medically treat HA resulting from concussive injury?

Answer 6

0-2 days post injury: Acetaminophen (to avoid blood thinning of NSAIDs in case of bleed)
2-7 days: NSAIDs
Triptans if migrainous features present
AVOID NARCOTICS, supplement w/ IM Ketolorac

Beyond a week, consider TCAs, AEDs, antihypertensives for prevention.

Non-pharm: rest (physical/mental), relaxation training