Traumatic Head Injury

Question 1

Pathophysiology of traumatic brain injuries

Answer 1

Often no visible scars, it is the physical force placed on the neuron.

Question 2

Axonal tensile strength

Answer 2

The extent to which a neuron can take stress before the axon is damaged

Question 3

What is resprouting?

Answer 3

The healing process of the brain

Question 4

Epidemiology: technology

Answer 4

• rise of technology has led to an increase in brain injuries
• cars put us at greater risk and the extent of the injuries are worse
• there is an improved understanding of TBIs due to rise in technology

Question 5

Ratio of mild/moderate/severe TBIs

Answer 5

70/20/5

Question 6

Three domains of the Glasgow Coma Scale

Answer 6

1. Language
2. Consciousness
3. Motor functioning

(Mild deficits: greater than 13. Severe: less than 5)
Also you can get a score of 3 if you’re dead.

Question 7

Pros and Cons of the GCS

Answer 7

+ it’s universal, which is very useful

- it’s hugely time sensitive, you can have a change in score within five minutes

Question 8

6 main complications with TBIs

Answer 8

1. Edema
2. Brain herniation
3. Extradural and subdural hemorrhaging
4. Intracranial bleeding
5. Skull fractures
6. Post traumatic epilepsy

Question 9

Edema

Answer 9

The swelling of the brain, which can be dangerous due to the fixed nature of the skull

Question 10

Brain herniation

Answer 10

Shift of the brain, movement into a smaller space or a different orientation

Question 11

Extradural and subdural hemorrhaging

Answer 11

A loss of blood or added intercranial pressure

Question 12

Intracranial bleeding

Answer 12

Particularly difficult to stop if the arteries are deep within the brain

Question 13

Post traumatic epilepsy

Answer 13

Could be caused by the addd pressure on the brain or the brain trying to autocorrect for the damages caused.

Question 14

Neuropsychological outcomes (6 prominent areas of deficits)

Answer 14

1. Amnesia
2. Memory
3. Attention
4. Inhibition
5. Vision
6. Motor

Question 15

Coup counter coup effect

Answer 15

Nature of most TBIs, it refers to the way in which the brain hits the front of the skull and then naturally bounces and hits the back of the skull

Question 16

Education and recovery

Answer 16

Individuals who have had an education have more built in adaptive responses, which allows for improved recovery

Question 17

Considerations for recovery of TBIs (10)

Answer 17

1. Location and extent of damage
2. Time since injury
3. Age (plasticity)
4. Premorbid intelligence
5. Premorbid personality
6. Premorbid functioning
7. Medical health
8. Emotional health
9. Support system
10. Type of treatment

Question 18

Natural recovery

Answer 18

• Diaschisis

- Plasticity

Question 19

Diaschisis

Answer 19

Synaptic pruning of the damaged cells

Question 20

Plasticity

Answer 20

• Axonal sprouting

- Denervation super-sensitivity (the neurons compensate for the damage by becoming super sensitive)

Question 21

Three main methods of recovery

Answer 21

Natural, cognitive training and psychotherapy

Question 22

Cognitive training for TBIs

Answer 22

Managing and compensating for new deficits

Question 23

Psychotherapy for TBIs

Answer 23

Helping people to understand and accept their deficits

Question 24

Concussions vs mild TBIs

Answer 24

Concussions are not mild, they can cause a great deal of damage
Also, mild TBIs damage structure and function, concussions affect function only.

Question 25

Five core properties of concussions

Answer 25

1. Caused by a knock to the head or body 2. Swift onset of short term impairment 3. Functional injury 4. Clinical symptoms (cognitive, emotional, physical and sleep) 5. Normal gross imaging reports

Question 26

Epidemiology of concussions in sports

Answer 26

6,2% of all sport injuries in the US.

Question 27

Collision vs contact sport

Answer 27

Collision: actively running into other players Contact: potential to make contact

Question 28

Pathophysiology of concussions

Answer 28

Transmission of biomedical forces to the brain

Question 29

Physical symptoms of concussion: (6)

Answer 29

- Nausea - Headache - Balance - Photosensitivity - Loss of consciousness - Blurred vision

Question 30

Outcomes of concussion: sleep (4)

Answer 30

- Insomnia - Excessive fatigue - Restless sleep - Difficulty waking up

Question 31

Outcomes of concussion: emotional (3)

Answer 31

- Depression - Anger/irritability - Anxiety (But it can be difficult to determine if this is as a result of the concussion or it is because athletes cannot play)

Question 32

Outcome of concussion: cognitive (3)

Answer 32

- Executive functioning - Verbal memory - Visuospatial

Question 33

Role of impact location on outcomes

Answer 33

None!

Question 34

Three step assessment process for concussions

Answer 34

1. Side line evaluation 2. Medical evaluation 3. Neuropsychological testing

Question 35

Side line evaluation

Answer 35

Usually the SCAT-3, which must be administered by a medical professional

Question 36

Medical evaluation

Answer 36

Generally a scan, if the scan comes back clear then it’s usually a concussion

Question 37

Neuropsychological testing

Answer 37

Pen and paper tests OR the ImPACT: immediate post concussion assessment and cognitive test. You need to score at least two standard deviations below your baseline score to fail. (Often athletes bomb their baseline test so that they can keep playing when injured)

Question 38

Rest treatment

Answer 38

Physical: no activity that increases your heartbeat Cognitive: minimal phone, tv, reading etc

Question 39

Problems with rest treatment (concerning BDNF)

Answer 39

Rest treatment may cause atrophy, bc the brain isn’t being used. BDNF is a hormone that promotes neuronal activity but is only released when people exercise.

Question 40

Chronic outcomes of concussions

Answer 40

1. Post-concussion syndrome | 2. Chronic traumatic encephalopathy

Question 41

Post concussion syndrome description

Answer 41

- Delayed recovery, symptoms usually last between 10 days and 3 weeks (athletes vs normies)

Question 42

Chronic traumatic encephalopathy

Answer 42

- “Punch drunk” - Associated with repeated trauma to the brain - Requires one perivascular ptau lesion

Question 43

Four stages of CTE

Answer 43

1. 1-2 tangles in sulci in the frontal, temporal or parietal lobes 2. 3 or more tangles in multiple lobes 3. Tangles in the subsections 4. Tangles everywhere (Its neurodegenerative, it will worsen)

Question 44

Debate around CTE

Answer 44

There are no set diagnostic criteria, so it’s not clear if it is a distinct pathology or just the early onset of already existing neurodegenerative diseases that are exacerbated by the repeated trauma. Also, why doesn’t it affect all sports players? Does it have a genetic component?