Acquired Brain Injury - Stoke and TBI

Question 1

Cerebral Vascular Accident (Stroke) - Definition

Answer 1

Clinical syndrome consisting of rapidly developing clinical signs of focal disturbance of cerebral function lasting more than 24h or leading to death with no apparent cause other than a vascular origin.

Question 2

How long can a acute state, caused by a cerebrovascular injury, last? and what happens after this period.

Answer 2

Between 6-8 weeks.
After this period, signs of UMN related to spasticity can be seen in the contra-lateral body hemisphere, impairing functionality (ADLs).

Question 3

Transient Ischemic Attack - Definition

Answer 3

Minor stroke. Temporary interruption of blood flow, producing symptoms that usually do not last over 72h. Considered a warning sign, leading to stroke in most cases.
No loss of consciousness. No long lasting damage.

Question 4

Cryptogenic Stroke - Definition and Possible Causes (3)

Answer 4

All strokes that cannot be traced to a specific cause, but interruption of blood flow in a specific cerebral artery causes permanent neural damage, leading to sensorimotor or cognitive symptoms.
- Cardiovascular events
- Anatomical changes (cancer)
- Metabolic changes affecting permeability of vessels or composition of blood.

Question 5

Modifiable Risk Factors (3) - Stroke

Answer 5

Physical inactivity (intensity influences risk for women)
Obesity (abdominal fat and BMI for women, only BMI for males)
Hypertension

Question 6

Nonmodifiable Risk Factors (5) - Stroke

Answer 6

<45-85> years old.
Ethnicity (can be related to poor access to health care)
Arterial fibrillation
Type 1 diabetes
Genetic factor: gene in chromosome 9p21.

Question 7

Which Arteries are most commonly damaged in a stroke (3)?

Answer 7

Anterior cerebral artery
Middle cerebral artery
Internal carotid artery

Question 8

Traumatic Brain Injury - Contusion

Answer 8

Damage due to direct external forces (trauma) on the skull developing a hematoma.

Question 9

Traumatic Brain Injury - Concussion - Cause, Sports, Recovery.

Answer 9

Most common traumatic encephalic diffuse lesion reported in different sports.
Caused by forces of inertia! Can lead to loss of consciousness and pos-traumatic amnesia, resolving spontaneously with time.
2-3 week recovery time.

Question 10

Most Common Types of Hemorrhage (5)

Answer 10

Epidural Hemorrhage (EDH)
Subarachnoid Hemorrhage (SAH)
Subdural Hemorrhage (SDH)
Intraventricular Hemorrhage (IVH)
Intracranial Hemorrhage (ICH)

Question 11

Epidural Hemorrhage (4) vs Subdural Hemorrhage (4)

Answer 11

Epidural: Convex - Convex, arterial blood, a lot of intracranial pressure, smaller area affected.
Subdural: Convex - concave, venous blood, less intracranial pressure, occupies more space.

Question 12

Epidural Hemorrhage - Characteristics (5) Range in severity

Answer 12

Intracranial pressure (non-depressive fracture)
Deviation of the midline (we try to move all processes to the contralateral hemisphere)
Compression of subcortical structures
Compression of brainstem
Loss of consciousness

Question 13

Subdural Hemorrhage - Possible Causes and Time Window

Answer 13

Lesion occurs inside a greater time window (venous bleeding), developing mostly to an acute phase in 3-7 days.
Often seen in patients on anticoagulants. Some genetic, integrity of blood vessels compromised.

Question 14

Subarachnoid Hemorrhage - Most common people affected and most common etiologies

Answer 14

Most common in newborns, elderly or people with disorders affecting thickness, elasticity of arterial or venous walls.
Trauma and rupture of an aneurysm.

Question 15

Intraventricular and Intracerebral Hemorrhage - Death of Neurons and Predictor sites (5)

Answer 15

From Trauma, death of neurons will happen due to pH differences, within 8 hours.
- Basal nuclei: 40-50%
- Cortical areas: 20-50%
- Thalamus/3rd ventricle: 10-15%
- Cerebellum: 5-10%
- Brainstem: 1-5%

Question 16

Emergency Measures (3) - Hemorrhage

Answer 16

Lowering Intracranial pressure - craniotomy or insertion of a shunt.
Monitoring changes - decortication, decerebration patterns. Systolic blood pressure <90mmHg.
Diminishing Brain Damage - Cooling (hypothermia)

Question 17

Can you have both a concussion and a contusion at the same time?

Answer 17

yes

Question 18

Which physiological mechanism leads to unconsciousness in Rotational Brain Injury?

Answer 18

Disturbance in the axons of the arachnoid mater → Deregulated ion flux with potassium efflux and calcium influx → Neuronal depolarization → Immense release of GABA, shutting down the brain. → Acute neuronal functional failure.

Question 19

Second Impact Syndrome

Answer 19

Concussion while still recovering from another concussion, leading to instant death.

Question 20

Post Concussion Syndrome (PCS) -
Physical Symptoms

Answer 20

Headache
Nausea
Dizziness
Fatigue
Problems with balance/gait
Light and sound sensitivity

Question 21

Post Concussion Syndrome (PCS) -
Emotional, Cognitive and Sleep Symptoms

Answer 21

Emotional lability
Anxiety, depression

Cognitive deficits (concentration, memory, decision making)
Language Impairment
Disorientation and amnesia

Sleep-wake disturbance

Question 22

Post Concussion Syndrome (PCS) - Metabolic Theory

Answer 22

PCS related to ongoing mismatch between ATP supply and demand, exacerbated by impaired cerebral blood flow and exhausted mitochondrial function.
Most accepted theory

Question 23

Post Concussion Syndrome (PCS) - White Matter Tract Theory

Answer 23

PCS relates to axonal damage.

Question 24

Post Concussion Syndrome (PCS) - Cervicogenic Theory

Answer 24

Concussion symptoms are perpetuated by cervical strain.

Question 25

Post Concussion Syndrome (PCS) - Psychogenic Theory

Answer 25

Concussion symptoms are preserved through maladaptive coping behaviors and psychological co-morbidities.

Question 26

Chronic Traumatic Encephalopathy (CTE)

Answer 26

Result of multiple traumata to the head (microfractures). Leads to non-reversable neuropsychological and hypokinetic physical disabilities over time.
Highly observed in former athletes of contact sports, American football, boxing, ice hokey, basketball and soccer.

Question 27

Chronic Traumatic Encephalopathy - Pathophysiology Pathways

Answer 27

Dopaminergic pathways.
Nigrostriatal: SN-Striatum: movement regulation, attention.
Mesolimbic: VTA-AM: Goal directed behavior
Mesocortical: VTA-PFC,aCC: Attention, working memory.

Question 28

Recognizing a Possible Encephalic Injury (3)

Answer 28

Changes in social behavior such as aggressivity or confusion.
Movement disturbance, like abnormal gait and coordination deficits.
Memory and wakefulness disturbance.

Question 29

Symptoms of a Possible Encephalic Injury (13)

Answer 29

Nausea
Dizziness
Irritability
Worsening headache
Photo- and sound sensitivity
Sleep disturbance
Diplopia (double/multiple vision)
Fatigue
Loss of conscousness
Poor cognitive performance (finding words)
Amnesia
Convulsion (rapid, involuntary contractions, cause shaking like in seizures)
Altered pupil reflex

Question 30

Symptoms of a Severe Encephalic Injury (7)

Answer 30

Worsening headache
Photo and sound sensitivity
Diplopia
Loss of consciousness
Poor cognitive performance
Convulsions
Altered pupil reflex

Question 31

Avoiding Further Complications (8)

Answer 31

Seek medical care
Rest your mind
Rest your body
Sleep (not during day)
Avoid driving
Avoid anti-inflammatory and strong pain meds
Don’t use stimulant substances
Avoid a heavy diet

Question 32

Recovery - Time and Supporting Actions (5)

Answer 32

7-20 days.
Triggers: Avoid experiences that worsen symptoms
Nap if needed (30min)
Avoid any physical activity that increases heart rate over 10% of resting value
Expect difficulties (especially with attention) in complex mental tasks, don’t push it.
Avoid blood thinners, even without an onset bleeding.