Cognitive and Psychological Consequences of Brain Injury

Question 1

What is acquired brain injury?

Answer 1

Umbrella term

Injury to brain after birth

Question 2

What are some types of acquired brain injury?

Answer 2

Stroke
Infections
Traumatic brain injury
Hypoxic injuries because of myocardial infarcts
Neurodegenerative

Question 3

Which areas of the brain are most sensitive to hypoxic injury?

Answer 3

Hippocampus

Areas of shared vascular territories

Question 4

What are some types of congenital brain injury?

Answer 4

Encephalopathy
Some epilepsies
Developmental defects

Question 5

What are some factors that contribute to having a congenital brain injury?

Answer 5

Genetic factors
Environmental factors
- Vitamin deficiencies
- Foetal alcohol syndrome
- Prenatal infection

Question 6

What are traumatic brain injuries?

Answer 6

Sudden trauma causing injury to brain

Question 7

What are some examples of neurodegenerative injuries?

Answer 7

Parkinson's disease
Alzheimer's disease
Dementia
Alcohol syndrome
Motor neuron disease

Question 8

How do you classify a mild traumatic brain injury?

Answer 8

Glasgow coma scale at scene: 13-15

Time of unconsciousness:

Question 9

How do you classify a moderate traumatic brain injury?

Answer 9

Glasgow coma scale at scene: 9-12
Time of unconsciousness: 30 min-6 hrs
Length of post-traumatic amnesia: 1-7 days

Question 10

How do you classify a severe traumatic brain injury?

Answer 10

Glasgow coma scale at scene: 3-8
Time of unconsciousness: >6 hrs
Length of post-traumatic amnesia: >7 days

Question 11

What is the most important factor in classifying traumatic brain injury?

Answer 11

Length of post-traumatic amnesia

Question 12

What is the biggest cause of traumatic brain injury?

Answer 12

Car accidents

Question 13

What are some causes of traumatic brain injury?

Answer 13

Car accidents
Falls
Fights
Blast injuries
Domestic violence
Child abuse

Question 14

What are the risk factors of having a traumatic brain injury?

Answer 14

Male (2:1) - until elderly when it evens out
Substance use
- Especially alcohol
Age
- 0-4 yrs
- 15-24 yrs
- Over 75 yrs
Psychosocial factors
- Risk taking behaviour
- History of psychiatric disorder
- Limited educational attainment
- Unstable work history

Question 15

What are predictors of a good outcome after a traumatic brain injury?

Answer 15

Normal function beforehand
Length of post-traumatic amnesia
Number of previous traumatic brain injuries
Age
Location
Function
Motivation
Pre-morbid psychiatric history
Cognitive reserve
- Higher education
- Higher intelligence

Question 16

What is congenital brain injury?

Answer 16

Present at birth because of developmental defects/damage

Question 17

What is neurodegenerative injury?

Answer 17

Because of ongoing neurodegenerative disease

Question 18

What is post-traumatic amnesia?

Answer 18

Period of dense confusion after traumatic event

Question 19

What can acceleration and deceleration forces cause to the head?

Answer 19

Laceration of scalp
Skull fracture
Shifting of intracranial contents
Focal and diffuse changes in brain matter

Question 20

What are some focal changes that can occur?

Answer 20

Haematoma
Contusion
- Commonly at basal/polar areas of frontal and temporal lobes

Question 21

What are some diffuse changes that can occur?

Answer 21

Axonal injury
Microvascular damage
Widespread neural excitation
Metabolic changes

Question 22

What are some secondary complications that can occur?

Answer 22

Brain swelling
Infection
Raised intracranial pressure
Respiratory arrest

Question 23

Which areas of the brain are frequently damaged, and why?

Answer 23

Because of proximity to bony structures in skull
- Frontal and temporal lobes
Because of vulnerability of white matter tearing
- Corpus callosum
- Basal ganglia
- Hypothalamus
- Superior cerebellar peduncles
- Fornices
Because of hypoxia
- Hippocampus

Question 24

What are the common and prominent cognitive and psychological difficulties associated with traumatic brain injury?

Answer 24

Processing speed
Attention
Working memory
Executive functioning
Regulating emotions
Managing frustration

Question 25

How long do post-concussion symptoms take to subside in mild traumatic brain injury?

Answer 25

Days-weeks

Question 26

What are common physical symptoms after a mild traumatic brain injury?

Answer 26

``` Headache Dizziness Fatigue Blurred/double vision Sensitivity to noise and/or bright lights Tinnitus ```

Question 27

What are common psychological symptoms after a mild traumatic brain injury?

Answer 27

``` Restlessness Insomnia Irritability Anxiety Depression ```

Question 28

What are common cognitive symptoms after a mild traumatic brain injury?

Answer 28

Reduced - Processing speed - Attention - Memory

Question 29

What is persistent post-concussive syndrome?

Answer 29

Symptoms persisting after mild TBI and can result in ongoing disability and adjustment difficulties

Question 30

What is persistent post-concussive syndrome associated with?

Answer 30

``` Pre-injury physical and psychiatric problems Adjustment issues Coping style Presence of additional stressors Previous TBIs ```

Question 31

What are the physical symptoms after a moderate to severe traumatic brain injury?

Answer 31

Fatigue Balance and coordination difficulties More specific effects dependent on specific location and severity of injury

Question 32

What are the cognitive symptoms after a moderate to severe traumatic brain injury?

Answer 32

``` Attention Information processing speed New learning and memory Word-finding problems Executive difficulties - Planning - Problem solving - Goal directed behaviour - Abstract thinking - Mental flexibility Impulsivity Emotional regulation difficulties Reduced insight ```

Question 33

What are the psychological and behavioural symptoms after a moderate to severe traumatic brain injury?

Answer 33

``` Increased irritability Aggression Lowered frustration tolerance Reduced initiative/apathy Flattened affect Verbosity Egocentricity Mood swings Excessive emotion Reduced emotion perception Reduced behavioural insight ```