Acquired Brain Injury

Question 1

Contusion vs Concussion

Answer 1

Contusion is an encephalic damage due to direct external forces (trauma) on the skull developing a haematoma.
While concussion is an encephalic damage causing by forces of inertia.

Question 2

EDH

Answer 2

Intracranial pressure (non-depressive fracture)
> Deviation of the midline
> Compression of subcortical structures
> Compression of the brainstem
> LOC

Question 3

SDH

Answer 3

1. Undergoing anticoagulatory therapy
2. Genetic diseases, where the integrity of blood vessels is compromised
3. Elderly falls
4. As an adverse effect of certain drugs and supplements

Question 4

Concussion - Pathophysiology

Answer 4

Question 5

Symptom prevalence in PCS

Answer 5

Physical:
- Headache
- Nausea
- Dizziness
- Fatigue
- Problems with balance and Gait
- Light and Sound sensitivity

Cognitive:
- Cognitive deficits (porblem with concentration, memory, attention)
- Language impairment
- Disorientation and Amnesia

Emotional:
- Emotional lability
- Increased anxiety

Sleep:
- Sleep-wake disturbance

Question 6

Chronic traumatic encephalopathy

Answer 6

Result of multiple traumata to the head (microdamage) lead to:
- Devascularization of areas especially above the sphenoid bone
- And formation of neurofibrillary tangles (NFT)

Symptoms in most cases are similar to subcortical dementia

Question 7

Symptoms of an acute encephalic injury

Answer 7

• Nausea
• Dizziness
• Irritability
• Worsening headache
• Light and sound sensitivity
• Sleep disturbances
• Diplopia
• Fatigue
• LOC
• Poor cognitive performance
• Amnesia
• Convulsion
• Altered pupil reflex

Question 8

How to prevent further complications?

Answer 8

1. Seek medical care
2. Rest your mind
3. Rest your body
4. Sleep
5. avoir driving
6. Avoid anti-inflammatory and strong pain medication
7. Avoid stimulant substance
8. Avoid a heavy diet

• Avoid PA (HR over 10%)
• Expect attention difficulties
• Avoid blood thinners (risk of haemorrhage)

Question 9

Oncotherapy-related neurological issues

Answer 9

• DOC
• Memory and attention deficits
• Perceptual and reasoning deficits
• Aphasia
• Disbalance and involuntary movements

Question 10

MCA and clinical correlates

Answer 10

Question 11

ACA and clinical correlates

Answer 11

Question 12

Upper motor neuron syndrome

Answer 12

Question 13

Shoulder-hand syndrome

Answer 13

Question 14

Perceptual disorders - Aphasia

Answer 14

• Impairment of language, affecting the verbal communication, production and/or understanding of speech
• Sometimes also impairing writing and reading

Question 15

Perceptual disorders - Unilateral spatial neglect

Answer 15

• Behavioural disorder
• Deficit in space orientation, memory, attention, and representation
• After an ischemic stroke of the MCA

Possible resulting issues:

• Pusher syndrome
  > Patient pushes the whole body with the nonaffected side.
  > In all directions.
  > Increasing the strength when stopped.
• Extinction syndrome
  Patient is unable to perceive inputs coming from the former affected side in a situation where both sides are being simultaneously stimulated

Question 16

Precaution considering USN

Answer 16

• Loss of balance in neglect (also related to pusher)
• Loss of mobility on the affected upper limb related to positioning and non-use
• Use of equipment that could lead to harm, like using a sharp knife or a stove for training ADL
• Confronting the patient with a traumatic situation and/or symptomology, that he/she is not aware of, without using a reflexive approach

Question 17

Perceptual disorders - Dyspraxia

Answer 17

• Disconnection syndromes
• Loss of knowledge on motor procedures
• Disregarding a sensorimotor impairment itself

(Main aspects of injuries that connect all patients:
- Diffuse brain damage
- Disruption of inter- and intracortical connectivity
- Low connectivity distributing processing)

Question 18

Disorders of consciousness

Answer 18

Classified as interaction of awareness