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Neuropsychological Assessment > TBI > Flashcards

TBI Flashcards

(57 cards)

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1
Q

Traumatic Brain Injury

A

Any external mechanical force acting on the brain in which a temporary or permanent dysfunction is the result

Can be open/closed, focal/diffuse

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2
Q

3 initial phases of TBI

A

1) LOC/coma
2) Cognitive/bx abnormalities
3) Memory, sequencing time, inability to learn new info
4) Permanent cognitive sequelae

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3
Q

Timing of phases of TBI

A

LOC or cognitive/bx abnormalities can last a few days to one month post injury

6-12 month period following marked by rapid recovery of cognitive functions and subsequent plateau

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4
Q

Severe TBI

A

Altered/prolonged (>24 hours) loss of consciousness (coma), usually diffuse
Post-traumatic amnesia >7 days

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5
Q

Moderate TBI

A

Positive neuro imaging, skull fracture, intracerebral hemorrhage
Loss of consciousness: 30 min-24 hours
Altered consciousness: >24 hours
Post Traumatic Amnesia: >1 day, >7 days

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6
Q

Mild TBI

A

Negative neuro imaging, concussion, symptoms typically resolve
No loss of consciousness or LOC < 30 minutes
Altered consciousness for a few sec-24 hours
Post-traumatic amnesia 0-1 day
Common features: memory problems, photosensitivity, headache, irritability, cognitive inefficiency

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7
Q

Most common site of brain contusion in TBI

A

Due to bony prominences butting brain tissue in the cranial vaults are anterior temporal lobes and orbitofrontal regions

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8
Q

High rate of false negative errors in TBI may be caused by

A

Use of highly specific sign/symptom (contra lateral neglect)

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9
Q

How does Moderate-Severe TBI differ from anoxic brain injury?

A

Anoxic injury would be marked by slower recovery, poorer outcomes, and visual deficits complicating care/treatment

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10
Q

What might patients played on an SSRI or benzo post-TBI experience?

A
  • Worsened gait/balance
  • Cognitive sedating effects
  • Increased disinhibition
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11
Q

What can single photon emission computed tomography (SPECT) provide?

A

May be used in diagnosis of head injury with no LOC/GSC/other imaging studies are normal

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12
Q

Glascow Coma Scale

A

Used to objectively describe the extent of impaired consciousness in all types of acute medical and trauma patients

Score from 3-15 (3 is worst, 15 is highest)

Ages 5+ (pediatric scale for youngers)

Correlated with mortality

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13
Q

Severe GSC

A

3-8

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14
Q

Moderate GSC

A

9-12

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15
Q

Mild GSC

A

13-15

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16
Q

Barriers with the GSC

A
  • Langauge
  • Hearing/speech
  • intellectual/neurological deficits
  • intubation
  • pharmacological/paralysis
  • orbital/cranial fracture
  • spinal cord damage
  • hypoxia-ischemic encephalopathy after cold exposure
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17
Q

What is a potential problem of the GSC in diagnosis mTBI?

A

Ceiling effect (questions are not difficult enough)

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18
Q

Coma

A

Complete unconsciousness, unable to be awakened, may not respond to sound, touch, pain, unable to communicate/see, unable to follow commands, show emotion, engage in purposeful bx

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19
Q

Vegetative State

A

Still unconscious but may awaken at times
Unresponsive wakefulness syndrome
Brief reaction to sounds, sights, touch
Cry, smile, and facial expressions (reflexes)
Automatically fx still controlled by brain

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20
Q

Minimally conscious state (MCS)

A

Regaining consciousness, some self-awareness
Engage in purposeful bx (inconsistent)
Follow simple commands
Makes intelligible verbalizations
Visually follows people in the room
Functional object use inconsistent

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21
Q

Emerged from MCS

A

Communication consistent
Use of 2 objects in purposeful manner
Yes/no responses
Follow instructions
Perform simple tasks

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22
Q

TBI factors in recommending that a patient not return to work

A

Age (over 50)
Education (less than HS)
Prior work hx (unable pre-injury)
TBI severity (severe)

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23
Q

Severe TBI in pediatrics

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A

Children have poorer prognosis (worse with younger ages)
Continued neurobehavioral issues in children depend on age, severity, family resources, and support system

24
Q

In the acute rehabilitation phase (discharge from inpatient to rehab unit), prognosis for functional outcome would depend on

Study These Flashcards
A

the time to follow commands following the injury

25
Important in differentiating moderate and mild TBI
PTA and neuro imaging findings to accurately determine the severity of the injury
26
Annual TBI count in the U.S. Number that result in hospitalization Number that suffer chronic disability
2 million 500,000 80,000
27
Men
2x as frequent 4x more likely that TBI will be fatal
28
Bi-modal distribution of TBI
Increases from childhood and peaks at 15-25 Falls afterward Rises again in later states of life
29
Top 4 causes of TBI by percentage
50% MVA 21% falls 12% violence 10% sports
30
TBI Risk factors
Increased age Arteriosclerosis Alcoholism Premorbid personality Marital discord Poor interpersonal relationships Problems at work/school Financial instability
31
Mechanism of TBI
Mechanical forces applied to the skull is then transmitted to the brain Damage can be focal or diffuse
32
Intracerebral hemorrhage
Bleeding into the brain tissue
33
Ischemic infarct
blood supply to part of the brain is interrupted or reduced, preventing brain tissue from getting oxygen and nutrients
34
Motion from brain inside the skull may lead to
Diffuse injury Stretch/shearing of the axons
35
Secondary processing of TBI
Hypoxia (lack of oxygen) Anemia (lack of blood) Metabolic abnormalities Hydrocephalus (build up of CSF in brain ventricles) Intracranial hypertension Fat embolism
36
Free radicals
Result from the release of excitatory amino acids Subsequent release of arachidonic acid metabolites Leads to disruption of neurotransmitters in the synapse
37
Subarachnoid Hemorrhage
Bleeding in the space surrounding the brain Most often occurs when a weaker area in the blood vessel on the surface of the brain bursts and leaks Blood builds up around the brain and inside the skull, increasing pressure on the brain Nuchal rigidity
38
Nuchal rigidity
Neck stiffness, common symptom of subarachnoid hemorrhage
39
Subdural hematoma
Collection of blood forming on the surface of the brain Blood presses against brain and damages tissue Can be life-threatening Can occur in older individuals after minor head injuries Worsening headache pain within 72 hours, decreased GCS, vomiting, trouble following commands, midline shift, hyper dense crescent-shaped abnormalities on CT
40
Diffuse Axonal Injury
Shearing/tearing of the axons Occurs when brain is injured as it shifts/rotates inside the skull May cause coma Often diffuse Commonly marked by decreased mental efficiency, complex reasoning ability, and ability to perform mental arithmetic
41
Intracranial Pressure
Common signs/symptoms: Heached Altered mental status (irritability, depressed alertness/attention) Nausea/vomiting Likely the cause of decompensation of a patient following TBI within 72 hours of injury
42
Hydrocephalus
Abnormal build up of CSF in the ventricles Causes ventricles to widen and put pressure on brain tissue Commonly affects the posterior region Symptoms: headache, nausea, vomiting, cognitive impairment, papilledema (visual), decreased vision
43
Children with early onset hydrocephalus typically perform better on ___ than ____.
VIQ (VCI + WMI) PIQ (PSI + PRI)
44
Normal Pressure Hydrocephalus
Abnormal buildup of CSF in ventricles, occurs if the normal flow of CSF in the brain or spinal cord is blocked Similar to hydrocephalus causing enlargement of the ventricles which put pressure on the brain Occurs slowly and worsens over time, pressure usually isn’t dangerously high Classic indications: dementia, mental decline, gait difficulties, urinary incontienence Primary treatment: shunting
45
Way to distinguish NPH from subcortical dementia
Incontinence
46
Congenital Hydrocephalus
Extensive accumulation of CSF within the ventricles due to an imbalance between synthesis and absorption of CSF One of the most common abnormalities of CNS Most common cause: Lennox-Gastaut Syndrome
47
TBI impact on glutamate pathways
CSF increased glutamate Glutamate antagonists may be beneficial
48
TBI impact on cholinergic neuronal activity
Reduction in cholinergic neuronal activity within hippcampal and neocortical areas Dysfunction of septohippocampal cholinergic pathways, resulting in post-traumatic cognitive and bx deficits
49
TBI impact on ascending biogenic amine pathway
Circulating levels of catecholamine (directly correlates with TBI severity) Increased serotonergic sodium metabolites in CSF Dysregulation of mesolimbic/mesocortical dopaminergic pathways give rise to manic/hypo manic symptoms
50
Related mood disorders
Anxiety, depression, psychoses, apathy ** functioning impairment is related to anxiety/depression, but less so if the imaging is positive
51
Related cognitive problems
Delirium, dementia, amnestic disorder, intellectual impairment Impairment of arousal, attention, concentration, memory, language, exec Fx, memory loss
52
Related behavioral problems
Frontal/temporal lobe syndromes, aggressive disorders, personality change
53
Physiological impacts
Sleep disturbance, headache, dizziness, fatigue
54
General pharmacological TBI treatment
Antiepileptic medications used in inpatient units to manage bx post-severe TBI Side effect: drowsiness/sedation
55
Mood disorders secondary to TBI
Depression/mania most common Persistent dysphoria (feelings of loss, demoralization, discouragement) Fatigue, irritability, SI, anhedonia, disinterest, and insomnia (seen in the majority of pts 6-24 months or longer after TBI) Psychological impairments correlated with severity Risk factors: poor premorbid Fx, psychiatric hx Mechanism: disruption of biogenic amine containing neurons as they pass through the basal ganglia or frontal-subcortical white matter Left dorsolateral frontal and left basal ganglia associated with increased probability of MDD
56
Mood Disorder Treatment Secondary to TBI
Antidepressants, psychostiumlants SSRIs - typically safe, useful for comorbid MDD, mood lability, and impulsivity (no evidence that they treat TBI) Sertraline and citalopram are preferred based on beneficial effects, limited side effects, and short half-life Tricyclics and monoamine oxidase inhibitors are not preferred due to anticholinergic side effects and drug/food interactions Psychostim/some domainergicss can be beneficial Methylphenidate performs similar to sertraline (and improved neuropsychological performance)
57
Mania/Hypomania

Neuropsychological Assessment (9 decks)

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