Neurotrauma

Question 1

Df. of TBI

Answer 1

Non-degenerative
Non-congenital
Caused by external mechanical force to the body whereby transitional forces acts on the brain leading to temporary/permanent neurulogical impairments and altered state of consciousness

Question 2

Inx of TBI in UK/worldwide/rate

Answer 2

1.4M/yr in UK ad. to ED
10M serious HI worldwide
rate ~200-800/mil (but likely to be under-reported)

Question 3

> 95% of TBI cases are of which class?

Answer 3

mild, GCS 13-15

Question 4

70% of mTBI < 34 yrs; HI acc. for 34% of all trauma

Answer 4

Y

Question 5

TBI is the leading cause of D&D in those

Answer 5

Leading cause of D&D <45yrs
15% of death in 1-15 yrs
25% in 15-25 yrs

Question 6

Projected to become the __ largest cause of global disease burden by 202

Answer 6

3rd

Question 7

Epidemiology of HI in UK

Answer 7

70-90% male (~2/3)
10-20%>65yrs - increasing
40-50% children

Question 8

Main cause of TBI

Answer 8

‘Remember RAF’ + booze

• RTA (25%)
• Assault (30-50%)
• Falls (22-43%)**
• Alcohol - involved up to 65% of adult head injuries (also why grey trauma increasing)

Question 9

Prevalence of HI and primary mechanism of injury

Answer 9

Two peaks - Young (15) and old (85)

MOI usually fall most common

Question 10

Classification of TBI based on 3 factors

Answer 10

Severity – GCS, LOC, PTA*
Focal lesion - abnormalities on scan
Diffuse lesion - can be absent on CT but show on MRI

Question 11

Classifying mild, moderate and severe TBI

Answer 11

Mild = GCS 13-15 (post-resus); LOC <30min; PTA < 24hrs; usually LOS in hospital <48hrs; scan can be abnormal or not (aka. complicated/uncomplicated)

Mod = GCS 12-9; LOC >30 min <6hrs; PTA >24hrs < 7days; LOS >48hrs

Severe = GCS <=8-(3); LOC >6hrs; PTA >7 days; LOS >48hrs

Question 12

Consequence of head injuries

Answer 12

Catastrophic injuries leading to LT-disability (cognitive, behavioural, emotional, movement, complications) and death

Question 13

LT-disability post-head injury is related to initial severity of HI

Answer 13

Y

Question 14

Causes of death following HI (preventative mortality)

Answer 14

‘SECs count’

• Suicide
• Epilepsy
• CVDs

Question 15

Identify at least 3 sequelae of HI in the physical, cognitive and psychological aspects

Answer 15

• Physical - Fractures,Paralysis,Hemiparesis,Pain
  Fatigue,Sleep disturbance, Movement disorders (gaiting, ataxia, spasticity, tremors)
• Cognitive - reduced sense of reasoning, attention, perception, problem solving
• Psychological - decreased sense of well-being including - anxiety, depression, psychosis, inappropriate sexual behaviour, substance abuse etc…

Question 16

Depression inx in post-HI patients

Answer 16

30-50%; normal rate ~6%

Question 17

PTSD inx in post-HI patients is X times higher than the normal population due to

Answer 17

8x higher; decrease ability to cope with stress and altered biological mechanisms - maybe prophylactic anti-depressants

Question 18

The faster, deeper the force upon impact the more central the damage is to the brain. These incl.?

Answer 18

thalamus
brainstem
corpus callosum

Question 19

High speed HI is often asso. w/ what type of haematoma in the brain?

Answer 19

SDH, but can be a mixture of patterns

Question 20

Drawback of GCS in predicting prognosis of head injury outcome

Answer 20

Diverse patterns of head injuries of scans can all have the same GCS, GCS therefore is NOT predictive of outcome

Question 21

DAI consist of X% of severe head injury. These are particularly asso. w/ patients w/ what symptoms/state

Answer 21

50-60%

asso. w/ patients not emerging from coma, vegetative state and disability/poor outcome

Question 22

causes of DAI

Answer 22

usually accleration, deceleration type injuries leading to shearing, tearing and stretching of the neuronal axons

Question 23

Presentation of DAI

Answer 23

IMMEDIATE LOC
NO evident focal injury
Pts not emerging from coma for a long period of time

Question 24

Classification of DAI

Answer 24

mild, mod, severe; indicated by LENGTH OF COMA AND BRAINSTEM SIGNS

Question 25

Inx of SAH

Answer 25

30-40% of TBI pts, particularly asso. w/ high risk of hydrocephalus due to blocked arachnoid villi. Sometimesleads to IVH

Question 26

ICH usually found w/i which matter of the frontal and temporal lobes

Answer 26

white matter.
Inx ~4-15% of brain injured patients.
Space occupying lesions
*clincal presenation can be normal