Traumatic Brain Injury Flashcards
1
Q
What is a traumatic brain injury? What are the 4 ways it can manifest?
A
- An alteration in brain function caused by any external force rotating the brain to unphysiologically high rates of angular acceleration (> 2 x 10^5 degrees / second^2)
- Any alteration in mental state at the time of injury
- Any loss of memories for events before or after the injury
- Any decreased level of consciousness
- Any neurological deficits (transient or permanent)
2
Q
What are the most common causes of TBI?
A
- Transportation related collisions are most common cause (motorcycle accidents account for 40-60%)
- Others include slips and falls, assaults, sports, and explosions
3
Q
How is TBI diagnosed?
A
- Acute clinical criteria at time of event (neurological tests and observations)
- Ancillary tests: neuroradiology, lab tests, EEG, etc.
- Neuropsychological tests after acute phase, such as tests on choice reaction time, selective attention, task switching, etc.
4
Q
What are 10 symptoms of TBI?
A
- Amnesia
- Personality changes
- Confabulation
- Loss of consciousness
- Slurred / incoherent speech
- Blurry / double vision
- Confusion
- Dizziness
- Headache
- Photo / phonophobia
5
Q
What is mild traumatic brain injury? What are the grades of severity?
A
- Concussion: Most common type of closed head TBI
- Multiple concussions associated with increased risk of CTE, PD, and depression
- Grade 1: Confusion lasts less than 15 minutes and no LOC
- Grade 2: Confusion lasts over 15 minutes and no LOC
- Grade 3: LOC for seconds (IIIa) or minutes (IIIb)
6
Q
What are the 10 common symptoms of mTBI?
A
- Memory loss
- Fatigue
- Headaches
- Visual disturbances
- Poor attention / concentration
- Sleep disturbances
- Dizziness
- Irritability
- Depression
- Seizures
7
Q
Explain the Glasgow Coma Scale. What 3 aspects does it measure?
A
- A subjective behavioural assessment scale
- Serial assessment of presence, duration, and depth of impaired consciousness and coma
- Used to describe altered consciousness from mild confusional state to deep coma
- Highly reliable when used by trained persons but not valid
Eye opening (4 points)
- 4: Spontaneous
- 3: Opens to speech
- 2: Opens to pain
- 1: Does not open eyes
Best motor response (6 points)
- 6: Follows simple commands
- 5: Pulls hand away with pain
- 4: Pulls body part away with pain
- 3: Arms contract / abnormal flexion with pain
- 2: Body becomes rigid in an extended position with pain
- 1: Flaccid motor response to pressure
Best verbal response (5 points)
- 5: Tells examiner who he is, where he is and why, and the month and year
- 4: Response seems confused and disoriented
- 3: Random, incoherent speech
- 2: Makes sounds that can’t be understood
- 1: No noise
- Score of 13-15 = mild
- Score of 9-12: moderate
- score of 3-8: severe (coma)
- Injury severity is predictive of long term disability
8
Q
What are some issues with the Glasgow Coma Scale?
A
- Scalar number system: Numbers that contributed to it are lost
- Alcohol / drugs can mimic symptoms of brain damage
- Other injuries may prevent accurate assessment
9
Q
Explain the period following coma / impaired consciousness.
A
- Patient is confused and disoriented
- Post-traumatic amnesia is characterized by intellectual and behavioural disturbances (violence, emotional disturbance). Loss of episodic memories.
- Hallmark of PTA is amnesia where patient is unable to record events in a continuous or connected manner.
- Duration of PTA defined as from the time of injury until return of continuous memory and includes period of coma / impaired consciousness
- PTA is one of the best predictors of outcome following TBI and is more accurate than GCS
10
Q
How do the LOC and PTA scales grade TBI severity?
A
LOC:
Mild: less than 30 mins
Moderate: 30 min - 24 hours
Severe: More than 24 hours
PTA:
Mild: Less than 24 hours
Moderate: 1-7 days
Severe: More than 7 days
11
Q
How may CT scans be useful for detecting TBI?
A
- Can detect blood
- Has nearly perfect sensitivity (99-100%)
- Specificity of 48-77% for injury requiring neurosurgical intervention
12
Q
What are 4 reasons that TBI in athletics are underreported?
A
- Potential lost opportunity for sports career advancement
- Scholarship and other educational advancements potentially lost
- Coaches attempt to keep key players on playing field
- Parents who place pressure on their children to do well
13
Q
How is choice reaction time impaired after a concussion?
A
- Choice RT: Timed choice responses
- Concussed subjects found to be significantly slower than normal controls, especially after 1st month of injury
- At 3 months, concussed subjects still do not obtain skin of controls
- No correlation between severity of concussion and RT: Even mild concussions can cause significant attentional and information processing impairments in the absence of any neurological problems
- Assessed with neuropsychological tests
14
Q
Discuss problems associated with sports-related TBI.
A
- Precise guidelines for which evaluation methods should be used to determine full recovery do not exist yet: Players determine when they feel better but often return too soon
- Symptom recovery occurs in nearly 50% of athletes following returning to play or returning to learn
15
Q
What is focal brain injury? Name and describe the different types.
A
- Closed head injuries focused on one region of the brain that often produce bleeding without symptoms
- Contusions: Bruise of brain tissue. Preferentially affects frontal pole, inferior frontal lobes, temporal poles, lateral and inferior frontal lobes, and cortex above and below operculum of sylvan fissures
- Intracranial hematoma: Bleeding in brain. Most frequent cause of deterioration and death in patients initially lucid after TBI.
- Neuropsychologists not involved
