Traumatic Brain Injury (TBI)

Question 1

Whate the symptoms of TBIs?

Answer 1

• pain
• loss of consciousness
• post-traumatic seizures
• post-traumatic amnesia

Question 2

what is the Glasgow Coma scale and severity for TBIs?

Answer 2

• 1 (no response) to 4 (spontaneous open, bliking)- eye opening response
• 1 (no response) to 5 (oriented)- verbal response
• 1 (no response) to 6 (obeys commands for movement)- motor response
• Scoring:
• Mild brain injury: 13-15
• Moderate brain injury: 9-12
• Severe brain injury: 3-8

Question 3

What can be used to diagnose TBI?

Answer 3

• CT scan: subarachnoid, intracranial hemorrhage, skull fractures
• MRI: more sensistive in detecting soft tissue injury (inferiror detection of fractures)

Question 4

What are the risk factors/ common causes of TBI?

Answer 4

• falls
• motor vehicles accidents
• struck by object/ unintentional blunt trauma
• assults
• most TBIs are mild
• male- age 15-24 years

Question 5

What is the pathobiology of TBI?

Answer 5

• concussion: aburpt neronal depolarization > release of excitatory neurotransmitters, changes in glucose metabolism, altered cerebral blood flow, impaired axonal function, ionic shift
• injury may be caused when brain decelerated by hitting against inner skull (direct impact injury, acceleration-deceleration injury, blast injury)
• secondary injury processes (long-term morbidity): intracranial pressure elevation, ischemia/ hypoxia, excitotoxicity from radical production

Question 6

long term complications

Answer 6

• seixures
• behavioral and affective symptoms
• sensory (photophobia)
• movement disorders
• increased intracrainial pressure (ICP)
• dementia

Question 7

treatment of TBI?

Answer 7

• may require endotracheal intubation
• mainstay of pharmacologic treatment associated with ICP management
• fluid status
• seizure prevention and treatment
• prevention of fever, hyperglycemia, venous thromboembolism