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Clinical Neuropsych > Traumatic Brain Injury > Flashcards

Traumatic Brain Injury Flashcards

1
Q

TBI FACTS

A
  • approx 1 every 20 seconds in US
  • 22% overall mortality
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2
Q

What are the 2 types of TBI

A
  • Force-Inflicted Wound
  • Encephalophathy
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3
Q

2 Types of force-inflicted wounds

A
  • Closed head
  • Open head
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4
Q

Types of closed head wounds

A
  1. Concussion
  2. Blunt Force
  3. Epidural
  4. Deceleration
  5. Rotational
  6. Diffuse Axonal
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5
Q

Concussion

A
  • .6-1% annual prevalence
  • 1/100 people per year
  1. Brain bounces inside crainium, potentially causing hematoma and swelling
  2. Brain stretches from base, cause tissue to rub together and axons to become distended
  3. Brain preesses down or stretches the brainstem, cause it to temporarily shut down
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6
Q

Symptoms of concussion

A
  • headache
  • nausea
  • sleepiness
  • ocassional vomiting
  • loss of orientation
  • loss of conciousness for less than 30 mins
  • amnesia for less than 24 hours
  • normal pupillary response
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7
Q

Treatment of Concussion

A
  • no treatment unless there are focal injuries seen on CT scan
  • ice on contustions
  • monitor vital signs for 24 hours
  • prognosis is excellent
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8
Q

Blunt Force Wound

A
  • a smack to the skull on the sides
  • can cause epidural or subdural hematoma (outer layer of meniges)
  • venous bleed, not artieries or capillaries
  • likely to bleed into brain
  • crescent shape on CT scan
  • 40-60% mortality
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9
Q

Epidural

A
  • blood collects between skull and dura mater
  • appears as convex blood collection on CT scan
  • problems with pressure in the brain
  • 10% mortality
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10
Q

Deceleration Injury

A
  • head is moving in one direction and is very quickly stopped or sent in the other direction
    • car accidents
    • falls
  • brain bounces from one side to the opposite side which is called coup-contrecoup injury.
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11
Q

Rotational Injury

A
  • when head is twisted by impact, parts of the brain/skull can rub against each other, instead of direct impact
  • beause brain is split into two hemispheres, its easy for it to rub against itself
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12
Q

In a rotational injury, what happens if the brain rubs against the meniges/skull?

A
  • veins in arachnoid mater can rupture
  • causing subdural/subarachnoid hemorrhage
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13
Q

In a rotational injury, what happens if the brain rubs against itself?

A
  • axon get stretched and torn, and petechial/intreparenchymal hemorrhage can result
  • this is known as SHEARING injury
  • which causes Diffuse Axonal Injury..
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14
Q

Diffuse Axonal Injury

A
  • neurons get stretched by deceleration or abraded by shearing
  • diffuse because shearing injuries can occur everywhere
  • hard to see in brain scans cause they are microscoptic and all over the place
  • poor prognosis
  • predicts coma
  • the more evident on the brain scan, the higher mortality rate
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15
Q

In a DAI, why can deterioration occur weeks after injury?

A
  • broken axons release apoptotic factors that cause surrounding tissue to kill itself
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16
Q

Open Head Wounds

A
  1. Penetrating
  2. Crushing
17
Q

Penetrating

A
  • cranium is penetrated either by the skull being hit really hard by a blunt object or by a piercing object such as a bullet
  • if gunshot victim survives, prognosis for recovery is very good because the gunshot is in and out.
    • the focal area of the brain add to survival
18
Q

Crushing

A
  • skull is crushed between two objects cause widespread fracture and brain visibility
  • much higher risk of infection than closed head wounds
  • air can enter brain cavity and disrupt skull pressure (pneumocephalus)
19
Q

Herniation

A
  • pressure pushes the brain where its not supposed to go
  • caused in extra-axial bleeds because ICP increases, brain swells, and blood in meniges pushes the brain in places it should not go
20
Q

Types of Herniation

A
  1. Supratentorial
  2. Infratentorial
21
Q

Supratentorial

A
  • when the brain herniates above tentorium
  • subfalcine
    • cingulate gyrus pushed under falx cerebri- MOST COMMON
  • central
    • parts of midbrain pushed down tentorium)
  • transcalvarial
    • brain pushed outside of cranium)
  • uncal
    • medial temporal lobe pushed through tentorium
22
Q

Infratentorial

A
  • herniation below tentorium
  • upward cerebellar
    • cerebellum pushed up through tentorium
  • downward cerebellar (tonsillar)
    • cerebellum pushed through foramen magnum
23
Q

Symptoms of TBI

A
  • if concious: Ps start out lucid and complain of worsening headache
  • slip into unconciousness/coma
  • confusion
  • nausea/vomiting
  • loss of balance
  • altered mental status
  • loss of orientation
  • altered pupillary response
24
Q

Fencing Posture

A
  • arm flies straight out as a tonic response to disruption of neurochemistry
  • seen often in contusion heading to unconciousness
25
Q

Opisthotonus

A
  • severe muscle spasms cause by compression of corticoreticular tracts in midbrain
  • back and head arch back
  • not super common in TBI
26
Q

Decorticate Posture

A
  • arms fold into prayer position
  • legs extended
  • feet turned inwards
  • mucles rigid
  • indicative of pressure or damage to brainstem
  • BAD
  • can also be seen in coma Ps
27
Q

Decerebrate Position

A
  • arms straighten
  • hands curl downward and outward
  • legs extend, feet turn inwards
  • teeth clenched
  • very rigid
  • if unconcious and continuous, indiates brainstem herniation
  • VERY BAD

Clinical Neuropsych (5 decks)

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