TBI

Question 1

Peak Ages for TBI

Answer 1

1-2 years: most often related to child abuse
15-24 years: risk-taking behaviors, sports-related
>65 years: falls

Question 2

T/F: diffuse axonal injury is detectable on MRI

Answer 2

FALSE - not always!

Question 3

Majority of TBI occur from __?

Answer 3

MVA (50%)
Falls (25%)
Assault/Violence (15%)
Sports (10%)

Question 4

Normal ICP

Answer 4

4-15mmHg

Question 5

T/F: Cognitive deficits are MORE indicative of recovery than physical/motor function?

Answer 5

TRUE

Question 6

Concussion typically resolves within ___?

Answer 6

7 days

Question 7

Cheyne Stokes breathing

Answer 7

rhythmic, alternating rapid breathing and momentary stopping

*indicative of bilateral hemispheric lesions OR diencephalon involvement

Question 8

Apneustic breathing

Answer 8

prolonged pause at inspiration

*indicative of lesion at mid-caudal portion of pons

Question 9

Stupor

Answer 9

difficult to arouse, but will eventually interact

Question 10

3 predictors of disability post-TBI

Answer 10

1. Severity of injury - Glasgow Coma Scale
2. Length of Coma
3. Length of Post-Traumatic Amnesia

Question 11

Length of Coma

Answer 11

> 2 weeks: MOD-SEVERE disability 1 year post-injury

<1 week: MILD-MOD disability

Question 12

Length of PTA

Answer 12

> 12 weeks: MOD-SEVERE disability

<=4 weeks: MOD disability or good recovery at 1 year

Question 13

GCS Eye Opening

Answer 13

4-spontaneous
3-to speech
2-to pain
1-no response

Question 14

GCS Best Motor Response

Answer 14

6-follows motor commands
5-localizes
4-withdraws
3-abnormal flexion
2-extensor response
1-no response

Question 15

GCS Verbal Response

Answer 15

5-oriented
4-confused conversation
3-inappropriate words
2-incomprehensible sounds
1-no response

Question 16

GCS Severity Scoring

Answer 16

13-15: Mild
9-12: Moderate
<=8: Severe

Question 17

Ranchos Level I

Answer 17

No Response - deep coma, completely unresponsive

Question 18

Ranchos Level II

Answer 18

Generalized Response - non-purposeful, non-specific, inconsistent

Question 19

Ranchos Level III

Answer 19

Localized Response - light coma, reacts specifically but inconsistently
-may follow simple commands in inconsistent, delayed manner (ex: close eyes, squeeze hand)

Question 20

Ranchos Level IV

Answer 20

Confused - Agitated:

• heightened state of activity
• bizarre, non-purposeful behavior
• cannot cooperate
• verbalizations frequently incoherent/inappropriate
• selective attention often non-existent

Question 21

Ranchos Level V

Answer 21

Confused - Inappropriate:

• can respond to simple commands fairly consistently
• highly distractible
• unable to learn new information

Question 22

Ranchos Level VI

Answer 22

Confused - Appropriate:

• shows goal-directed behavior, but dependent upon external input for direction
• follow simple directions consistently
• carryover with re-learned tasks
• little/no carryover with new task

Question 23

Ranchos VII

Answer 23

Automatic - Appropriate:

• oriented, automatic daily routine
• carryover for new learning, but at decreased rate
• judgment remains impaired
• can initiate social activities with structure

Question 24

Ranchos VIII

Answer 24

Purposeful - Appropriate:

• carryover for new learning
• aware & responsive to environment
• requires NO supervision
• may show decreased ability to PLOF and w/abstract reasoning

Question 25

Signs of Increased ICP: (7)

Answer 25

1. Decreased responsiveness 2. Impaired consciousness 3. Severe HA 4. Vomiting 5. Irritability 6. Papilledema - optic nn edema, visual changes 7. Change in vitals: inc BP, dec HR

Question 26

Activities that can increase ICP: (4)

Answer 26

1. Cervical flexion 2. Coughing 3. Percussion 4. Vibration

Question 27

imaging modality for TBI

Answer 27

CT Scan

Question 28

What % of clinically-severe TBI have normal CT scan?

Answer 28

10-15%

Question 29

Which is more sensitive to DAI? CT Scan or MRI?

Answer 29

MRI

Question 30

Cushing's Phenomenon

Answer 30

increase in BP in presence of acute rise in ICP

Question 31

Concussion: Grade I

Answer 31

Transient confusion No LOC Resolution <15 minutes *can return to play same day with normal sideline neuro exam

Question 32

Concussion: Grade II

Answer 32

``` Transient confusion No LOC >15 minutes of symptoms to resolve *1 week until return to play *multiple Grade II concussions: 2 weeks ```

Question 33

Concussion: Grade III

Answer 33

LOC! * brief (seconds) - return to play in 1 week * prolonged (minutes) - 2 weeks * multiple Grade III concussions - 1 month or longer