Traumatic Brain Injury

Question 1

What are the 2 most common causes of TBIs

Answer 1

about 50% are from MVA
2nd most common are falls
especially in elderly

Question 2

What type of brain matter is damaged with an acceleration/deceleration of the brain

Answer 2

damages gray matter

Question 3

what is damaged with rotational force?

Answer 3

damages the white matter

Question 4

what is damaged with shearing?

Answer 4

this is a diffuse axonal injury that damages teh corpus callosum, cerebellar and cerebarl peduncles and subcortical white matter as well as the long axons of fornix
most often the most disabling damage that can cause immediate LOC

Question 5

what is a coup

Answer 5

direct injury

Question 6

what is a counter coup

Answer 6

rebound effect that can be a more devestating injury

Question 7

3 signs of basilar fracture

Answer 7

•	Periorbitial ecchymosis (raccoon sign)
•	Anosmia- absences of smell
•	CSF rhinorrhea
o	Fluid exiting the nose especially with lying down
o	Occurs from tearing of the dura

Question 8

type of fracture highly associated with epidural hematoma

Answer 8

linear skull fracture

Question 9

What is the difference between a subdural hygroma and hydrocephalus?

Answer 9

• Subdural hygroma is a collection of trapped CSF in the subarachnoid space and acts like a subdural hematoma which is accumulation of blood under the dura
• Hydrocephalus is CSF building up in the ventricles

Question 10

Explain the vicious cycle of acute head injuries.

Answer 10

• Increased pressure occurs from the initial bleeding and swelling  limited blood flow  increased capillary dilation  increased edema lack of nutrients neuronal death  further swelling

Question 11

What is the difference between decorticate and decerebrate posturing?

Answer 11

• Decorticate posturing is cortical white matter damage and cortical structures (diencephalon) that involves LE extension and UE flexion
• Decerebrate posturing is usually mid and upper brainstem damage that involves extension of all 4 extremities and is more deteriorating

Question 12

What are the 3 types of hematomas

Answer 12

epidural
subdural
intracerebral

Question 13

symptoms of epidural

Answer 13

• Epidural
o Develops between skull and dura
o Seen in more young patients
o Associated with linear skull fractures 90% of the time
o Headache, vomiting, decreasing neuro status
o “talk and die”
 Seem fine after brief LOC then sudden fast deterioration
o Half as common as subdural

Question 14

symptoms of subdural

Answer 14

•	Subdural
o	Between dura and arachnoid
o	40 and older are susceptible
o	Alcoholics are vulnerable
o	Signs/symptoms are similar to epidural
	BUT seizures are much more common

Question 15

symptoms of intracerebral

Answer 15

•	Intracerebral
o	Blood mass within the brain tissue
o	> 5 ml
o	Most often in temporal or frontal lobe
o	Associated with severe trauma
o	Significant focal neuro deficits

Question 16

A patient has a TBI. 2 Weeks after the TBI, they have a seizure. Is this likely to recur?

Answer 16

• Can occur within minutes to hours after initial injury
• If it occurs > 1 week after injury it is likely to reoccur
o Increased likelihood with gunshot wounds, intracerebral hematomas and intracranial infections

Question 17

3 signs of hyrdroephalus

Answer 17

changes in personality
gait issues
urination issues

Question 18

3 signs tested with Glascow coma scale

Answer 18

eye opening
motor response
verbal response

Question 19

scores of glascow coma scale and meaning

Answer 19

• A lower score= worse prognosis
o 3 is the worst score
o 15 is a perfect score

Question 20

What are some common symptoms of post-concussion syndrome and what kind of time frame can they last for?

Answer 20

•	Complaints can last for days, weeks, months, even 1-2 years
o	Consist of headache,
o	 dizziness, 
o	incoordination of fingers/hands, 
o	staggering gait with stairs,
o	 decreased mental performance

Question 21

What are 3 factors that would predict a poor prognosis with a TBI?

Answer 21

•	Longer term seizures
•	Normal pressure hydrocephalus
•	Cognitive impairment
•	Emotional/behavioral impairments
•	Language/communication deficits
•	Motor impairments
o	Paralysis, loss of fractionation, action tremors, ataxia, apraxia, motor planning
•	Sensory impairments
•	Visual and perceptual impairments
•	Cranial nerve signs