TBI Part 2 Flashcards
common demog for TBI
M > F
0-4 yo - shaking baby
15-24 yo - MVA, sports
> 65 yo - falls
object appears moving even when it is not
oscillopsia
O exam of cerebrum is done if _____
there are S findings of cerebrum deficits
level of consciousness common in TBI
RLA 1-3
sequence of recovery after coma
- eye opening - CN 3
- brainstem function - sleep wake cycle
- hypothalamus function - follow simple
- able to talk and communicate - best indicator
discuss persistent vegetative state
1 mo. unconscious
(+) sleep wake cycle
(+) PLR
(+) oculocephalic
(+) primitive behavior
(+) sponty response
true or false
neurobehavioral deficits are more debilitating
true if long run
classifications of TBI
primary and secondary
primary injury TBI
brain tissue in contact c internal or external if penetrating
head prevented to move after blow
rapid acceleration and deceleration
secondary injury TBI
damage p primary injury - hours to days p
treatable and preventable
type of primary TBI
diffuse axonal injury
cerebral/cortical contusion
concussion
direct laceration
diaschisis
brain hematoma
discuss diffuse axonal injury
disruption of axons and small BV from angular acceleration
d/t MVA - high velocity
LOC —-> coma is common and recovery is gradual
more generalized deficits
common sites and spared in DAI
common: corpus callosum, subcortical WM, brainstem
spared: upper medulla, CN 9 and 11
discuss cerebral/cortical contusion
from translational acceleration - low velocity
elevated risk for seizures and more focal deficits
usually bilat by can be assym
common areas of contusion
undersurface of frontal and ant temporal lobes
frontal: LTA
temporal: STA
discuss the types of contusion
coup: under impact site
countercoup: opposite of impact site
coup-countercoup: combined
discuss concussion
mild TBI
sx should be present 3-12 mo. for persistent deficits
GCS score 13-15 after 30 mins
at least one:
- confusion
- disorientation
- LOC for < 30 mins
- PTA for < 24 hrs
- transient focal neuro deficits
in taking the GCS of a concussion pt what should be considered
absence of alcohol, drugs, sedatives
discuss post concussional syndrome
3 mo. after concussion
loss of concentration
memory deficit
irritability
agitation
fatigue
HA
discuss direct laceration
less common cause of parenchymal injury
caused by metallic or bony fragments
- GWS
- depressed skull fx
- blunt trauma
- penetrating
discuss diaschisis
neurons remote from injury but anatomically connected are functionally depressed
crossed-cerebellar: dec BF in cerebellar hemisphere contra to cortical stroke
discuss brain hematoma
epidural: arteries
- meningeal artery rupture
subdural: veins
- intracerebral hemorrhage; penetrating
causes of secondary injury
dec BF
neurochemicals
cerebral edema
inc ICP
infection
hemorrhage
hypoxic ischemic injury
discuss blast injury
military or police
primary - oscillations of blast inc CSF or venous psi; compression of thorax and abdoment
secondary - shrapnel or other objects
tertiary - victim flung backwards and hits head
