A brain lesion (damage to the brain tissue) that has a clear location of damage (more prescribed damage) would be describe as ______, whilst brain lesions that were spread out affecting many areas of the brain would be described as _____.
Focal - site, determines nature of injury; size, determines severity.
Brain disorders that involve gradual deterioration are considered _____, whilst brain disorders that occur from a single-event (static) are considered _____.
What are the most common causes of traumatic head injuries?
Motor vehicle accidents
Sports (gymnastics, diving, skiing, football, HR)
What are the peak ages for the occurance of traumatic brain injuries? and what are the most likely causes for these ages?
are men or women more likely to have a traumatic brain injury?
15-24 years, car accidents
less than 5 years old, falls
Men are more likely than women to have a traumatic brain injury.
What are the two types of traumatic head injury?
Penetrating head injury
Closed head injury
Describe the neuropathology (usual features) of a penetrating head injury.
An object penetrates the skull and exposes the brain.
- Focal lesions
- Severe brain damage
- high potential for infection when brain is exposed
Describe the neuropathology (usual features) of a closed head injury.
Skull remains intact. Injury occurs when object hits head, head hits object or from whiplash (rapid acceleration/deceleration).
Can result in diffuse or focal lession (or both)
- Diffuse lessions - e.g., damage to bloodvessels and cells
- Focal lessions - coup ("impact injury") and countercoup (opposite side to imapct resulting from pressure) injury.
What is a coup and what is a countercoup injury?
Coup injury describe brain lesions at the site of the impact.
A countercoup injury describes lesions at the exact opposite side of the head to the impact site, it occurs because the pressure from the impact site causes compression on the other side of the brain.
Give some examples of where rapid acceleration and decceleration can result in brain damage.
Acceleration - propelled into motion e.g., hit with a baseball
Decceleration - movement is suddenly stopped e.g., the landing from a fall.
How is the severity of traumatic head injury assessed?
The patient is assessed using the Glasgow Coma Scale, this assesses the depth and duration of their coma
Describe how the Glasgow Coma Scale is used to assess the depth of a patients coma. (describe how and what it measures)
The glasgow coma scale is a brief test of simple visual, verbal and motor abilities.
Visual - does the patient open their eyes? ranked from 1 (not at all) ->2 (to pain) ->3 (to speech)-> 4 (spontaneous)
Verbal - do they respond verbally? ranked from 1-5: none, incomprehensible, inappropriate, confused, orientated.
Motor - Do they respond to a motor command (e.g., can you move X) ranked from 1-6: none, extension, abnormal flexion, withdrawal, localises pain, obeys command
What GCS rating combined with Coma durations suggest Mild, Moderate and Severe traumatic brain injuries, respectively?
What level of disability are each of these categories predictive of?
- GCS: greater than 13
- Duration: less than 30 minutes
- Predicts: good recovary
- GCS: 9-12
- Duration: less than 6 hours
- Predicts: moderate disability
- GCS: less than 8
- Duration: greater than 6 hours after admission
- Predicts: severe disability
What rating on the Glasgow Coma Scale is predictive of greater mortality?
A GCS score of less than 7.
At what score on the Glasgow Coma Scale is the unconsciousness considered to be a "Coma"?
less than or equal to 8.
however it is important to recognise that "coma" is a continuum from no coma -> shallow coma -> deep coma ...and that people come out of coma gradual in stages.
Damage to what structure of the brain results in coma?
What is reterograde amnesia?
Inability to recall events that occured BEFORE the injury (e.g., driving before accident)
What is Anterograde amnesia?
Inability to recall events that occured AFTER injury (e.g., ambulence ride to hospital)
How is reterograde amnesia and anterograde amnesia tested?
It is part of the Galveston Orientation Amnesia Test (GOAT).
asks two questions to assess amnesia
Reterograde: "what is the last thing you remember after the injury?"
Anterograde: "what is the first thing you remember after the injury?
participants must give details
Post-traumatic amnesia severity can be categorised based on it's duration.
at what duration would PTA be considered:
- very mild
- very severe
- extremely severe
very mild < 5 mins
mild 5-60 mins
moderate 1-24 hours
severe 1-7 days
very severe 1-4 weeks
extremely severe > 4 weeks
What are the four main complications of a closed head injury?
Oedema (accumulation of fluid, not enough space for brain to swell into)
Haemorrhage (bleeding) and resulting hematoma (accumulation of blood)
Skull fractures (protrude into the brain and can result in infection)
Post-traumatic epilepsy (due to scar tissue)
What extreneous factors can affect the severity of a traumatic brain injury?
History of head injury
History of alcohol abuse
What are (or can be) the cognitive symptoms of traumatic head injury? (its neuropsychological profile)
What personality changes can result from traumatic brain injury?
Lack of initiative & loss of spontaneity
Temper outbursts & mood alterations
poor self-awarenss (of deficits)
deppression (usually after 6 months post-injury)
What is another name for a mild closed head injury?
Describe the duration of loss of consciousness(LOC) post-traumatic amnesia (PTA) and 'complaints' consistent with a mild traumatic head injury (i.e., concussion)
LOC: less than or equal to 30 mins
PTA: less than or equal to 24 hours
Complaints: less than or equal to 3 months (changes in the brain are microscopic)
What are the common complaints of a mild traumatic head injury (i.e., a concussion)?
How long does it usually take complaints to emerge?
How long does recovary usually take?
- Dizziness, headaches, noise sensitivity, vision (e.g., blurred)
- Orientation (initial person/time/place), Attention (concentrating) and Memory
- Patience/temper, anxiety and deppression.
Symptoms/complaints emerge a few days after injury (When people attempt to resume regular activity)
Recovary can take 3 months and symptoms tend to disappear gradually.
What is the neuropsychologists role in the case of a traumatic brain injury?
Initial brief evaluation at hospital - orientation, attention & memory.
This proves a baseline, information about the patients tolerance for further tests and is usefull for outcome prediction
- Subsequent comprehensive formal evaulation
- Aids in detection of brain injury
- outlines deficits & residual stengths
- Documents individual features of disabilities
- Predict outcome and prognosis
- Monitor recovery
- Evalutate effectiveness of rehabilitation
What is the timeline of recovery for traumatic brain injuries?
During what time period are the most recovery gains made?
Max level of recovery reached around 2 years post-THI
Most gains made during the first 6 months.
What are the 3 types of Cerebro Vascular Disorders (CVAs)?
Transient Ischemic Attack (TIA)
Obstructive Ischemic Stroke
Why are CerebroVascular accidents so devastating?