Traumatic Brain Injuries

Question 1

TBI defined by the CDC

Answer 1

injury to the head arising from a blunt or penetrating trauma or from accel/decel forces resulting in one or more of the following: decreased consciousness, amnesia, neurologic abnormality, skull fracture, intracranial lesions, head injury listed as cause of death

Question 2

mild TBI

Answer 2

traumatically induced physiological disruption of brain function at the time of accident and/or focal neurological deficits that may or may not be transient. Loss of consciousness does NOT exceed 30 minutes, glasgow coma score is between 13-15 thirty minutes after impact and post-traumatic amnesia doesnt exceed 24 hours

Question 3

most common cause of TBI?

Answer 3

falls.

Question 4

risk factors associated with TBI

Answer 4

alcohol use, prescription drug use, low income in metropolitan area, being male, being age 0-4, 15-24, and 65+.

Question 5

mortality with TBI

Answer 5

men 3x more likely to die. highest rates of death in age 65 and up.

Question 6

primary cause pathophys

Answer 6

diffuse axonal injury, vascular tear, focal cortical contusions, intracranial/extracerebral hemorrhage

Question 7

secondary cause pathophys

Answer 7

ischemia, hopoxia, vasospasm, edema, necrosis/apoptosis, inflammation, seizure

Question 8

diffuse axonal injury

Answer 8

deceleration of the brain within the skull causing shearing or torsional forces of brain tissue. mainly occurs in midline structures (corpus callosum, brainstem)

Question 9

neurometabolic cascade

Answer 9

1. hypermetabolic glycolytic state
2. decreased cerebral glucose mechanism
3. reduced cerebral blood flow and glucose delivery
4. energy crisis! mismatch of energy demand to vascular energy supply

Question 10

neurotransmitters affected by TBI

Answer 10

catecholamines, serotonin, acetylcholine, glutamate

Question 11

affects of TBI

Answer 11

cognitive, motor, sensory, emotional, behavioral

Question 12

braintree stage 1

Answer 12

coma. unresponsive, eyes closed, no sign of wakefulness

Question 13

braintree stage 2

Answer 13

vegetative state. can’t localize pain. no cognitive awareness

Question 14

braintree stage 3

Answer 14

minimally conscious state. inconsistent, purposeful behavior. can localize/respond to pain

Question 15

braintree stage 4

Answer 15

confusional state. interactive and communicating, appropriate object use begins. still in post traumatic amnesia, can’t remember day to day activities

Question 16

braintree stage 5

Answer 16

post-confusional. resolution of post-traumatic amnesia, achieving functional independence. may not be able to read facial cues.

Question 17

braintree stage 6

Answer 17

social competence. resumption of basic household independence. can be left alone for hours at a time.

Question 18

emotional and behavioral changes

Answer 18

post-traumatic agitation, personality changes, psychiatric disorders, substance misuse disorders

Question 19

sandel and mysiw Post traumatic agitation

Answer 19

subtype of delirium in which survivor is in the state of post-traumatic amnesia and there are excesses of behavior that include some combo of aggression, akathisia, disinhibition, and/or emotional lability

Question 20

lombard and zafonte post-traumatic agitation

Answer 20

a state of aggression during post-traumatic amnesia. occurs in absence of other physical, medical, or psychiatric causes. can be manifested by intermittent or continuous verbal or physical behaviors.

Question 21

treating post traumatic agitation

Answer 21

identify agitation. address precipitating factors. treat.

Question 22

classes of meds used to treat PT agitation

Answer 22

beta blockers, antiepileptic/anticonvulsants, antidepressants, antipsychotics. NO FDA approved medications!

Question 23

personality changes in TBI

Answer 23

frontal-subcortical circuits: modulate complex human emotional expression and behavior. these can get messed up

Question 24

two psychiatric disorders that commonly follow TBI

Answer 24

depression and anxiety

Question 25

is there an increase in substance misuse after TBI?

Answer 25

yes lol