Ch 6: Medical Complications

Question 1

How many people in the US are living with a long term disability as the result of brain injury?

Answer 1

3. 2 to 5.3 million

1. 1 to 1.7% of the US population

Question 2

What is DVT and what is the incidence in TBI? How is it treated?

Answer 2

Deep vein thrombosis- blood clot forms in vein
54%
Treatment- prophylaxis, compression stockings, vena cava filters (metal device that traps blood clots), intermittent pneumatic compression (device to prevent blood clot)

Question 3

What are some musculoskeletal complications of TBI? What are common treatments?

Answer 3

Spasticity
Hyperreflexia- involuntary increase in muscle tone and deep tendon reflexes
Contractures- a condition of joints, reduced range of motion
Heterotopic ossification- abnormal bone formation after injury

Tx include:
Exercise, casting/orthotic techniques, ultrasounds/estim, meds, surgery/radiation

Question 4

Dysphagia level 1 (National Dysphagia Diet Level)

Answer 4

Puréed diet
Mod-severe
Foods requiring bolus formation, manipulation and chewing are not allowed

Question 5

Dysphagia level 2 (National Dysphagia Diet Level)

Answer 5

Mechanically altered
Mild to moderate and/or pharyngeal dysphagia

Moist, soft and easily form bolus

Question 6

Dysphagia level 3 (National Dysphagia Diet Level)

Answer 6

Dysphagia advanced
Mild
Includes most textures except hard, sticky, or crunchy foods
Requires chewing ability

Question 7

In comparison to pre injury, how many calories should a person consume during the acute phase of TBI healing? Why?

Answer 7

40% more calories

Metabolic needs increase significantly following a moderate to severe injury as the body works to heal the brain

Question 8

What is diabetes insipidus and how is it treated?

Answer 8

Occurs when too little vasopressin is produced and the person produces significantly more urine leading to increased thirst.
Treated with increased fluid and desmopressin

Question 9

Syndrome of inappropriate anti diuretic hormone (SIADH)

Answer 9

Caused by changes to the hypothalamus or certain medications

Blood sodium level is low and urine is not concentrated

Symptoms: nausea, vomiting, irritability, confusion, seizures, coma

**fluid restriction

Question 10

Metabolic syndrome

Answer 10

Combination of medical disorders that increase the risk for both cardiovascular disease and diabetes.

Marked by abdominal obesity, insulin resistance, HTN, and dyslipidemia

Affects 40% of adults over 60

Question 11

What is the frequency of UTI after brain injury?

Answer 11

60% experience UTI within the first 6 weeks after TBI

Question 12

What percent of brain injury patients report sleep disorders?

Answer 12

30-70% of TBI patients

Question 13

Post traumatic hypersomnia

Answer 13

Excessive sleepiness that occurs as a result of traumatic event involving CNS; daytime sleepiness; cognitive and physical fatigue

Question 14

What is the treatment for insomnia?

Answer 14

Treatment includes:

Lifestyle changes, exercise, reg sleep schedule, avoiding naps, limiting fluid before bed, and decreasing caffeine

Question 15

What is the reported occurrence of post traumatic seizures and what are the three categories?

Answer 15

4-53%

3 different categories of seizures
Immediate post traumatic convulsions (IPTC)
Early post traumatic seizures (EPTS)
Late post traumatic seizures (LPTS)

Question 16

Immediate post traumatic convulsions (IPTC)

Answer 16

+LOC and involuntary movement within seconds of impact

Non epileptic events that are more likely passing out

Brief period of tonic positioning followed by clonic or myoclonic jerks of less than 2-3 min

Altered state of consciousness with associated retrograde and anterograde amnesia

Brief traumatic functional decerebration- loss of cerebral brain function

Question 17

Early post traumatic seizures (EPTS)

Answer 17

Occur within 1st week (up to 7 days) following brain injury

Result from primary direct effects of trauma

Incidence report: 2-10% and can occur in mTBI

50% occur within 24hrs of impact; 25% 1st hr

Strong risk factor for LPTS

Question 18

Status epilepticus

Answer 18

Seizure that lasts longer than 5 minutes or seizures that occur close together without recovery between seizures; common in children

Question 19

Late post traumatic seizures (LPTS)

Answer 19

Occur later than 1 week post injury , but usually within the first 18-24 months (has been reported later)

Interchangeable with post traumatic epilepsy as the occurrence of one seizure likely leads to more
Common in 65+

Question 20

Post traumatic headache (PTH)- when does it start and how prevalent is it?

Answer 20

Starts within 14 days of LOC

More prevalent in mTBI (95%) in comparison to 22% of mod-severe reporting pain

Question 21

Most common type of headache reported by all TBI pts?

Answer 21

Migraine

Question 22

Peripheral nocioception

Answer 22

Peripheral receptors in the head and neck which are very sensitive to pain

Located on the ends of nerves that initiate near the spinal cord and communicate back to pain centers in the brain
Those involved with post traumatic headache:
CN 5 trigeminal, CN 9 glossopharyngeal, CN 10 vagus nerve, greater occipital nerve, lesser occipital nerve

Question 23

Primary headache

Answer 23

No specific cause

Question 24

Secondary headache

Answer 24

Identifiable cause that can be determined

Question 25

Chronic headache

Answer 25

Occurs at least 15 days per month for at least 3 months, not linked to overuse or withdrawal of medication

Question 26

What is a tension type headache?

How is it treated?

Answer 26

Most common form of primary headache

Presents with bilateral pressing head pain

Do not worsen with activity and patients do not present with other symptoms

Treatment- Non-steroidal anti-inflammatory drugs or aspirin or acetaminophen
Long term- low load craniocervical mobilization, botulinum toxin, antidepressants, anticonvulsants

Question 27

Migraine headache

Answer 27

usually affects one side of the head, are throbbing, and worsen with physical activity, associated nausea or vomiting

Question 28

Cervicogenic headache

Answer 28

Pain generated from the cervical spine; treatment- nerve injections, severing nerves

Question 29

Craniomandibular headache

Answer 29

Subtype of tension headache that causes pain in jaw with eating and talking
Treatment- bite blocks, diet changes, surgery

Question 30

Which cranial nerve plays a role in the pathophysiology of headaches?

Answer 30

CN5 trigeminal

Question 31

What are the 4 phases of migraine?

Answer 31

Prodrome- early symptoms
Aura
Headache
Postdrome- other symptoms following the headache

Question 32

Having low sodium levels is a risk for _______.

Answer 32

Seizures

Question 33

Neuralgia

Answer 33

Type of pain that is caused by damage or change to a nerve

Question 34

Neuroma

Answer 34

Nerve becomes entrapped in scar tissue

Question 35

C-O-L-D-E-R Acronym- Headache review of systems

Answer 35

Character: throbbing, sharp, dull etc & severity

Onset: does anything set off the headache? Prior hx of headaches, migraines, neck pain, or other related pain involving the head

Location: one side of the head, or both? Front or back? Start in neck? Shooting or radiating?

Duration/freq: when did it start and how often?

Exacerbation: anything that makes it worse?

Relief: does anything help to relieve/resolve the headache?

Question 36

What are complications with functions of elimination after TBI? How treated?

Answer 36

Urinary or fecal incontinence, urinary tract infections

Treatment- suprapubic or foley catheter, timed voiding, anti-cholinergics

Question 37

Dysphagia Level 4 (National Dysphagia Diet Level)

Answer 37

Regular diet, all foods as tolerated

Question 38

Why are tube feedings important?

Answer 38

provide hydration and calories to promote their metabolism and overall health

Question 39

What is the treatment for pressure sores?

Answer 39

keep skin clean and change positions every two hours, use of pressure relieving devices;
Oral antibiotics, antifungal creams

Question 40

Periodic limb movement disorder

Answer 40

periodic episodes of repetitive and highly stereotyped limb movements during sleep

Question 41

What is the preferred initial medication for aborting a migraine?

Answer 41

AAC- aspirin, acetaminophen and caffeine