Traumatic Brain Injury Flashcards
Alteration of brain function secondary to an external force
TBI
5 sources of TBI
Falls, MVA, Sport-related, Violence, Blast Injury
Two classifications of TBI
Open head and Close head
Classifications of TBI: Mild TBI
Close head
Classifications of TBI: Skull is open and damaged dura mater
Open head
Classifications of TBI: Most common
Close head
Classifications of TBI: Penetrating
Open head
Classifications of TBI: Skull remains intact
Close head
Classifications of TBI: Severe TBI
Open head
3 types of Primary Brain Injury
Diffuse Axonal Injury, Concussion, Contusion
Primary Brain Injury secondary to high-velocity forces
Diffuse Axonal Injury
Primary Brain Injury secondary to shaking of the brain
Concussion
Primary Brain Injury secondary to low-velocity forces
Contusion
DAI MOI
Acceleration-deceleration angular forces (MVA)
Three sites of DAI
Corpus Callosum, Parasagittal white matter, Pons & midbrain
DAI is responsible for _______?
Initial LOC and Coma
Concussion is responsible for ________>
Alterations of consciousness
It is a distinguishing feature of TBI
DAI
The most common site of DAI
Corpus Callosum
Two other names of Concussion
Mild TBI/Mild DAI
Level of Consciousness: (+) visual tracking
Minimally Conscious State
Level of Consciousness: (+) Ventilator support
Coma state
Level of Consciousness: (+) Sleep-wake cycle
Vegetative state
Level of Consciousness: Mildly depressed
Lethargy
Level of Consciousness: (+) Unresponsiveness
Stuporous
Level of Consciousness: (-) Sleep-wake cycle
Coma State
Level of Consciousness: (+) Reflex crying/smiling
Vegetative State
Level of Consciousness: Cannot be aroused but can be aroused briefly via vigorous repetitive sensory stimulus
Stuporous
Level of Consciousness: More depressed
Obtunded
Level of Consciousness: (+) Minimal evidence of self and environment awareness
Minimally Conscious State
Level of Consciousness: GCS 3-8
Coma State
Level of Consciousness: Can be fully aroused with little difficulty
Lethargy
Level of Consciousness: Cannot be fully aroused
Obtunded
What is the indicator to say that the patient is out of the coma?
If the patient resume following commands
How can you say that the patient is in a persistent vegetative state?
If they are in a vegetative state for >30 days and >1 year
Level of Consciousness: Decrease interest/drowsy
Obtunded
Two types of contusion
Coup injury and Countercoup injury
Contusion on opposite site of impact
Countercoup injury
Contusion at the site of impact
Coup injury
Two sites of Contusion
Inferior frontal lobe and anterior temporal lobe
What site of contusion will result in memory loss?
Anterior temporal lobe
What site of contusion will result in behavioral changes?
Inferior frontal lobe
Behavioral Change: Excited
Agitated
Behavioral Change: Quick
Impulsive
Behavioral Change: Moody
Irritable
Behavioral Change: Violent
Aggressive
Behavioral Change: Decrease interest
Apathy
The length of time from the injury up until the time in which the patient remembers a going event.
Post-traumatic amnesia
2 forms to assess Post-traumatic amnesia
Galveston Orientation Test (GOAT) and Orientation Lag Test
What form is used to assess severe TBI?
Orientation Lag Test (10)
What form is used to assess mild TBI?
Galveston Orientation Test (GOAT)
What is the normal score of the Galveston Orientation Test (GOAT)?
76-100
Three types of secondary brain injury
Hydrocephalus, Herniation, ICP & CPP
What is the adult communicating form of hydrocephalus?
Normal Pressure Hydrocephalus
What is the problem in Normal Pressure Hydrocephalus?
There is no absorption
Triad of Hydrocephalus
DIG: Dementia, Incontinence (urinary), Gait Ataxia
Intervention for Hydrocephalus
Shunting
What is the first to improve after shunting?
Gait Ataxia
Three types of herniation
Uncal, central, Tonsilar
Most common CN affected in Herniations?
CN 3
4 areas affected in the Uncal Herniation
Cerebral Peduncle, RAS, Oculomotor, PCA
2 areas affected in the Central Herniation
Midbrain & Pons, RAS
3 areas affected in the Tonsilar Herniation
Cerebellar Tonsil, RAS, Medulla Oblongata
If RAS is affected, what manifestation will come out?
Coma
If PCA is affected, what manifestation will come out?
Hemianopsia
If Midbrain & Pons is affected, what manifestation will come out?
Decerebrate Rigidity
If Cerebellar Tonsil is affected, what manifestation will come out?
Neck Pain
If Cerebral Peduncle is affected, what manifestation will come out?
Paresis
If Medulla Oblongata is affected, what manifestation will come out?
Alteration of HR, RR, BP
If the Oculomotor nerve is affected, what manifestation will come out?
Gaze palsy
If the Above midbrain is affected, what manifestation will come out?
Decorticate rigidity
What fracture affects CN 9-12?
Basilar skull fracture
What fracture affects CN 3, 4, 6?
Orbital fissure fracture
What fracture affects CN 5, 7, 8?
Temporal fracture
What fracture affects CN 2?
Optic canal fracture
What fracture affects CN 1?
Cribriform plate of ethmoid fracture
If CN 1 is affected, what manifestation will come out?
CSF Rhinorrhea
The normal amount of ICP
<20 mmHg
Four clinical manifestations associated with Increased ICP
Headache, vomiting, nausea, papilledema
Swelling of opting disc
Papilledema
What cranial nerve lesion that results in Papilledema?
CN 2
The medication used to decrease ICP
Diuretics (Mannitol)
According to Sullivan, what intervention can you do to the patient experiencing increasing ICP?
Elevate the head up to 30 degrees from supine
The formula for Cerebral Perfusion Pressure
CPP = MAP - ICP
The normal amount of CPP
> 50 mmHg
The normal amount of MAP
60-110 mmHg
The formula for Mean Arterial Pressure
MAP = DBP + 1/3 PP
The formula for Pulse Pressure
PP = SBP - DBP
Mild TBI: LOC
0-30 min
Severe TBI: PTA
> 7 days
Mild TBI: GCS
13-15
Moderate TBI: LOC
30 min - 1 day
Severe TBI: GCS
3-8
Moderate TBI: PTA
1-7 days
Severe TBI: LOC
> 1 day
Moderate TBI: GCS
9-12
Mild TBI: PTA
0-1 day
GCS: EO to sound
3
GCS: EO to pressure
2
GCS: Verbal words
3
GCS: Verbal sound
2
GCS: Withdraws to pain
4
GCS: Localizes pain
5
GCS: Verbally confused
4
GCS: Decorticates
3
GCS: Decerebrates
2
Scale that assesses the reflex
Glasgow Liege Scale
Glasgow Liege Scale: 5
(+) Fronto-orbicular reflex
Glasgow Liege Scale: 1
(+) Oculocardiac Reflex
Glasgow Liege Scale: 4
(+) Vertical oculocephalic
Glasgow Liege Scale: 2
(+) Horizontal oculocephalic
Glasgow Liege Scale: 3
(+) Pupillary light reflex
Glasgow Liege Scale: 0
No reflex activity
Ommaya Scale: Patient not obeying the command
3
Ommaya Scale: Patient is not recording ongoing events
2
Ommaya Scale: Patient is in decerebrate rigidity
4
Ommaya Scale: Patient is oriented
1
Ommaya Scale: Patient is still talking and obeying commands
2
Ommaya Scale: Patient is not responding to stimulus correctly
4
Ommaya Scale: Patient is totally unresponsive
5
Ommaya Scale: Patient is recording ongoing events
1
Ommaya Scale: Patient is responding to stimulus correctly
3
Ommaya Scale: Patient is disoriented
2
Ommaya Scale: Patient is fully conscious
1
Glasgow outcome scale extended: Good Recovery
8-7
Glasgow outcome scale extended: Vegetative State
2
Glasgow outcome scale extended: Moderate Disability
6-5
Glasgow outcome scale extended: Death
1
Glasgow outcome scale extended: Severe Disability
4-3
Glasgow outcome scale extended: Assistance 24 hours per day
3
Glasgow outcome scale extended: Returned to the previous lifestyle completely
8
Glasgow outcome scale extended: Indep ADL but has not returned to the previous lifestyle
5
Glasgow outcome scale extended: Returned to the previous lifestyle with some problem
7
Glasgow outcome scale extended: Assistance 8 hours per day
4
Glasgow outcome scale extended: Returned to the previous lifestyle with modification
6
Criteria used to assess cognitive functions of TBI
Ranchos Los Amigos
RLA: 1
No Response
RLA: 3
Localized Response
RLA: 7
Automatic Appropriate
RLA: 9
Purposeful Appropriate with standby assistance upon request
RLA: 4
Confused-Agitated
RLA: 5
Confused-Inappropriate
RLA: 2
Generalized Response
RLA: 8
Purposeful Appropriate
RLA: 6
Confused-Appropriate
RLA: 10
Purposeful Appropriate with modified independence
RLA: Responses are related to stimulus
RLA 3: Localized Response
RLA: Responses are not related to stimulus
RLA 2: Generalized Response
RLA: Follow simple commands inconsistently
RLA 3: Localized Response
RLA: Follow simple commands fairly consistently
RLA 5: Confused-Inappropriate
RLA: Follow simple commands consistently
RLA 6: Confused Appropriate
RLA: (+) Bizzare Behavior
RLA 4: Confused-Agitated
RLA: (+) Goal-directed behavior
RLA 6: Confused-Appropriate
RLA: (+) Robot-like behavior
RLA 7: Automatic Appropriate
RLA: No learning is possible
RLA 5: Confused-Inappropriate
RLA: Carry-over of relearned task
RLA 6: Confused Appropriate
RLA: New learning at a decrease rate
RLA 7: Automatic Appropriate
RLA: New learning without supervision
RLA 8: Purposeful Appropriate
RLA: Response is physiologic body changes, limited, same, stereotypic
RLA 2: Generalized Response
RLA: (-) STM/LTM
RLA 4: Confused-Agitated
RLA: Impaired Judgement
RLA 7: Automatic Appropriate
RLA: Has environmental awareness
RLA 8: Purposeful Appropriate
RLA: Patient is in a heightened state of activity
RLA 4: Confused-Agitated
RLA: Non-agitated
RLA 5: Confused-Inappropriate
RLA: (+) Abstract Reasoning
RLA 8: Purposeful Appropriate
RLA: Patient is in deep sleep
RLA 1: No Response
