traumatic brain injury Flashcards
Traumatic brain injury scope of the problem
3.8 million concussions per year due to sports and recreation, 2.5 million ED visits, 57thousand deaths
Primary causes in hospitalized patients: Falls, Struck by or against an object, motor vehicle crash
TBI definition
TBI is defined as an alteration in brain function or other evidence of brain pathology, caused by an external force
Glasgow coma scale Eye opening- 4 spontaneous, 1 nothing Best verbal response- orineted and converses, 1 nothing Motor- 6 to 1 3-15
Mild- 13-15
Modereate- 9-12
Severe- 3-8
Also can use structreal brain damage
signs of alteration in brain function
Depends on ones definition of TBI but may include Glasgow Coma scale score <15, loss of consciousness, memory loss for events (around the time of injury (peritraumatic amnesia) or before the injury retrograde amnesia, or after the injury post tramatic amnesia) RGA, PTA
Other evidence of altered metal status, symptoms of headache dizziness, tired, sensitive to light/noise
If PTA<7 days they have a good prognosis
Chief mechanism in TBI
Axonal stretch aka Diffuse axonal injury
Stage 1: stretch of <5% nodal ionic fluxes (mechanoporation at nodes of ravier)
Stage 2: stretch 5-10% Reversible cytoskeletal damage (osmotic balance, mild swelling and disruption axoplasmic transport)
Stage 3: stretch of 15-20% leads to secondary axotomy (multiple mechanisms that disrupt restoration of normal ionic homeostasis and axoplasmic flow)
Stretch >20% - primary axotomy
Acute management of severe TBI
Airway stabilization, neuroimaging, sometimes intracranial pressure monitoring and other neurosurgical procedures
Evaluation and treatment of extracranial injuries
Management of hypotension, hypothermia, hypoxia, fevers, electrolyte imbalances
May stop antiplatelet, anticoagulant medications if hemorrhage is present
Start on anticonvulsant medications
Neurometabolic cascade of concussion
Mechanoporation: Calcium influx, Potassium efflux–> Starts cascade of excitotoxicity
Receptor dysfunction, free radicals, inflammation
Pores open up due to mechanical flux
Blood biomarkers of concussion/TBI
GFAP and UCH L1 are increased with concussion
Linear ve rotational impact
A linear impact is more likely to cause contusions and skull fractures and epidural hematoma, but a rotational is more likely to cause Concussion, DAI, subdural and intracerebral hematoma
Glasgow outcome scale
- Dead
- Vegetative State
- Severe disability (need help at home cant work)
- Moderate disability (independent at home, impaired ability work)
- Good recovery (can work but maybe not to full pre-injury capacity, may have subtly difficulties that arent disabling
Common post concussion symptoms
Cognitive- poor short term memory, feeling confused, poor concentration, mentally slowed down
Physical- headache, blurred vision Early, nausea/vomiting early, light or noise sensitive, dizzy poor balance, low energy
Emotional- irratability, more emotional, sadness, anxiety
Sleep disturbance- excessive sleepiness early, disruptedd circadian rhythm, difficulty falling asleep
Confounding contricutors to symptoms
Poly trauma, vestibular dysfunction, cervical spine injury, pre injury problems, environment contextual factors, side effects of drugs and medications, injury related stressors trauma
who is slower to recover or does not recover fully
More severe brain injuries- upper limits of mild TBI- more acute symtpoms, imaging abnormalities
recovery course of TBI
prognosis after TBI is related to tBI severity, single uncomplicated mild TBI/concussion is relatively benign with excellent prognosis, a small subset of concussed pts have persisiting symptoms likely related to multiple factors
Treatment for concussion
probably active rehab
A more severe injury requires more rest
