Traumatic Brain Injury
Terms
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open or closed?
_____head injury is associated with generalized/diffuse cerebral impairment.
_____head injury is associated with discrete focal lesions.
_____head injury is associated with a higher seizure risk. -
closed
open
open - Which demographic group has the highest incidence of TBI?
- males, ages 16-24
- What are 2 of the most common causes of TBI?
-
MVA, falls
also industrial, assault, sports -
Which of the following is NOT a risk factor for TBI (may be more than 1 answer):
- LD
- previous hospitalization for TBI
- hypotension
- smoking
- ADHD
- seizures
- boxing/soccer
- high education
- unem -
hypotension
smoking
high education
Hypertension, psychiatric illness, drug abuse, divorce and low SES/education are also risk factors. -
DAI =
A. diffuse axonal injury
B. discrete axonal inflammation
C. discrete axonal injury
D. deep axonal inflammation - A. diffuse axonal injury
- Neuropathologically, what happens to neurons in DAI?
- breaking, shearing and stretching of myelinated axons
- What type of injuries result in DAI?
- acceleration/deceleration and rotational injuries with subsequent loss of consciousness
-
T or F:
DAI is an immediate injury. -
False.
DAI occurs over time as a result of compression/stretching, swelling and evolving changes (changes in glucose transport, blood flow, toxins, etc.) - Local abrasions (i.e., tearing, swelling) can result in what?
-
FCC
focal or subcortical contusion - Name 3 mechanisms of FCC.
-
- coup/contrecoup
- depressed skull fracture
- inertial/rotational force
- skull features
- hematomas
- subcortical bleeds - Which of the mechanisms of FCC can result in CVA-like effects?
- subcortical bleeds
-
An infarction in the distribution of an artery can lead to:
A. hippocampal-interior injury
B. hypoxic-inflammatory injury
C. head-ischemic injury
D. hypoxic-ischemic injury - D. hypoxic-ischemic injury (HII)
- HIIs result from a lack of oxygen and are frequently secondary to what?
- physical injuries, chest injuries, airway obstruction
-
HIIs are associated with edema and:
A. decreased ICP; increased arterial pressure
B. increased ICP; increased arterial pressure
C. decreased ICP; decreased arterial pressure
D. increased ICP, decreased arterial pressure - D. increased ICP, decreased arterial pressure
- Name one brain structure that is particularly susceptible to HII and one associated consequence.
-
hippocampus
severe, pervasive memory disorder - _____ and _____ are 2 delayed effects of HII.
- white matter degeneration (ventricular enlargement) and disturbed CSF flow (hydrocephalus)
- Contusions, coup/contrecoup and shearing are examples of (primary or secondary) mechanisms of brain injury after closed head injury.
- primary
- Name 3 secondary mechanisms of brain injury after CHI (closed head injury).
-
- intracranial hemorrhage
- white matter edema
- hyperemia
- ischemic brain damage
- elevated ICP
- brain shift/herniation - Calcification, gliosis, necrosis, phagocytosis, astrocyte activity and chromatolyses are examples of _____events following brain damage.
- degenerative
-
Name these degenerative events:
1. shrinkage/degeneration after severing of axon
2. death of neurons that innervate or are innervated by damaged neuron
3. degeneration of severed neuron
4. death of remaining axon, cell body and -
1. terminal
2. transneuronal
3. anterograde (Wallerian)
4. retrograde - Name 5 physiological events associated with CHI.
-
- diaschesis
- shock
- edema
- decreased CO2
- decreased blood flow
- decreased metabolic activity
- decreased brain activity
- change in neurotransmitter levels
- changes in electrical activity
- autoneurotoxicity - Which recovery mechanism is due to the resolution of hematomas, diminished swelling and normalization of blood flow?
- spontaneous recovery
-
T or F:
Collateral sprouting is always beneficial. - False
- Name 2 theories of recovery from CHI that are not well-supported.
-
- vicaration
- substitution - Re-emergence of inhibited or disrupted functions in areas adjacent to the primary damage is ________________.
- diaschesis
- What is behavioral compensation?
- using a new or different behavioral strategy
- NGF is a _____ secreted by _____to facilitate growth, regeneration and reenervation.
-
protein
glial cells - Lesion size, age, intelligence and personality affect recovery from TBI. Name 2 other variables, associated with less lateralization, which can also affect recovery.
-
sex and handedness
(less lateralization is associated with being female and left-handedness) -
A. GCS
B. coma duration or LOC
C. PTA duration
D. SES/education level
Whis severity measure is the BEST predictor of recovery? - C. PTA duration
-
PTA duration is usually about ___ x the length of coma.
A. 1
B. 2
C. 4
D. 6 - C. 4
- What measure is used to evaluate PTA?
- GOAT
-
mild or moderate TBI symptoms?
- headache, memory problems, difficulty with everyday living, frontal and/or temporal lobe damage - moderate
-
mild or severe TBI symptoms?
- attention, verbal retrieval, emotional distress, fatigue, depression - mild
- Name 6 PCS symptoms.
- fatigue, irritability, decreased attention, headache, dizziness, memory deficits, anxiety, insomnia, phono/photophobia, hypochondriacal concern
- PCS is associated with (mild, moderate, severe) TBI.
- mild
- Most recovery from TBI occurs in _____ months.
- 6-9
-
1. PIQ or VIQ - which is more likely to decline more following TBI?
2. memory or overall IQ - which is more likely to improve more quickly with TBI? -
PIQ
IQ - List 5 general principles of cognitive rehabilitaton.
- "1. stimulation (early period) is useful; 2. forced use of body parts is helpful; 3. practice should be extensive and excessive; 4. training tasks should be relevant to real life; 5. family members, etc. should be included; 6. motivation is important; 7. continue training after plateaus; 8. break tasks down into simple components"
-
T or F for adult TBI:
'Recovery is least likely in complex behaviors with many components through behavioral compensation.' -
False
Recovery is most likely in this context. -
T or F for adult TBI:
'Recovery is most pronounced after incomplete lesions (e.g., concussion, penetrating head injury).' - True
-
T or F for adult TBI:
'There are never residual and permanent deficits; extensive recovery is the exception.' - False
- What GCS score is associated with moderate TBI?
- 9-12
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mild TBI = LOC of x duration (pick the single best response)
A. < 5 minutes
B. < 15 minutes
C. < 20-30 minutes
D. < 1 hour - C. < 20-30 minutes
- What is akinetic mutism?
- patient has the ability to respond, but is unable to initiate (bilateral lesions of mesial frontal lobes, mesial temporal, cingulate gyrus)
- 'Coma is a result of diffuse, severe destruction of _____ and decreased _____ to the brain.'
-
white matter
circulation - Second Impact Syndrome (SIS) is defined as _____.
-
repeated concussions over brief periods
SIS typically follows an initial brain injury while the patient is still symptomatic. -
SIS findings include:
A. increased cerebral blood flow, increased ICP, decreased cerebral perfusion
B. decreased cerebral blood flow, decreased ICP, decreased cerebral perfusion
C. decreased cerebral blood volume, increased ICP, decr - A. increased cerebral blood volume, increased ICP, decreased cerebral perfusion