Traumatic brain injury

Question 1

What is traumatic brain injury?

Answer 1

• It is an alterationin brain function or other evidence of brain pathology caused by external force
• 20% of patients admitted to hospital with TBI have sustained moderate to severe head injuries
• It is a subset of acquired brain injuries; the other common causes of ABI include vascular, metabolic, infectious and neoplastic

Question 2

What is the aetiology of TBI?

Answer 2

• Majority is from MVAs
• Falls, assaults,blast injury and sports injuries are other causes
• ATSI have a very high rate of assaults compared to the general population

Question 3

What is the mechanism of TBI?

Answer 3

• Haematoma, contusion and skull # can be caused by primary impact
• Infection, brain swelling and raised ICT may cause secondary brain injury
• The scan evidence most indicative of TBI is decreasing brain volume with time ehich correlates with diffuse axonal injury
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Question 4

How to diagnose TBI?

Answer 4

• Westmead PTA scale
• Other clinical severity scores such as GCS
• Neuro-imaging techniques

Question 5

What are the two indicators of damage severity?

Answer 5

• How long the person is in coma
• Length of time in PTA (>24 hrs is severe)
• Older age is a strong negative predictor of outcome

Question 6

What are the common consequences of TBI?

Answer 6

• Physical issues include-

1. Early and late seizures(anti-epileptics have poor prophylactic effect
2. Somatic symptoms such as pain, headache and sleep disturbances which persist for long
3. Post concussion syndrome which in most cases resolve in 3months

• Mental health issues include

1. Depression (Sertraline effective; >50% recover without Tx)
2. Anxiety (CBT is the first line)
3. Schizophrenia (Antipsychotics are agents of choice)

• Cognitive and behavioural issues

1. Impaired memory, language, planning and writing (Most resolve in 3 months in mild TBI; rehab is needed)
2. Personality and behavioural changes ar eoften chronic and no effective Tx

Question 7

What are the other treatment principles?

Answer 7

• Rehab team with input from neuropsychologists, nurses, physical therapists, OT, speech and social workers is very useful in severe TBI
• Consider caregiver stress and wellbeing
• Long term issues such as inability to attain independencesocial, work related issues need to be addressed