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Traumatic Brain InjuryTraumatic Brain Injury
Diagnostic Overview
Overview & Incidence
TBI describes damage to the brain caused by a blow to the head.
Severity of related symptoms may range from minor to major, even death.
Estimated that 100 out of 100k in U.S. incur a TBI each year (approx. 52k deaths)
280k per year just in the U.S. $32 billion in hospitalization costs $17 billion in costs associated with fatalities
Symptoms
Aphasia Loss of memory Loss of coordinated
motor functioning Slurred speech Blurry vision Difficulty concentrating
or thinking, especially when attention is divided.
Anxiety or nervousness Loss of inhibition Impulsivity Inappropriate laughter Irritability Headache Muscle
Rigidity/Spasticity Muscle Weakness Seizures Tingling or numbness
3 (general) Stages of Symptoms
Coma - Loss of consciousness. May display reflexes (gripping a hand) Can be brief or last for days, weeks, or years. The longer a person is unconscious, the more severe the injury.
Concussion - brief loss of consciousness (seconds to minutes) with a good prognosis for recover.
Post-traumatic amnesia State of acute confusion Answering the same
question with different responses
Can not perform simple tasks; (reality orientation)
Losing train of thought Staring blankly at
someone
Recovery
Start to retain current month, year, etc. This stage can last for weeks, months, etc. At times, behavior can become an issue as
a pt. becomes aware of his/her loss of ability and experiences frustration and depression
Progress made rapidly initially and then plateaus.
Diagnosis
Glasgow Coma Scale Ranks quality of
response in 3 areas: Eye Opening, Best Motor Response, & Best Verbal Response
Eye-Opening 4 - Responds
Spontaneously 3 - Responds to voice 2 - Responds to pain 1 - No response
Diagnosis cont’d
Best Motor Response 6 - Follows commands 5 - Localizes to pain 4 - Withdraws from pain 3 - Decorticate (produces
an exaggerated posture of upper extremity flexion and lower extremity extension in response to pain
2 - Decerebrate (produces an exaggerated posture of extension in response to pain)
1 - No response
Diagnosis cont’d
Best Verbal Response 5 - Oriented and
conversational 4 - Disoriented and
conversational 3 - Inappropriate words 2 - Incomprehensible sounds 1 - No response
Scores of 8 or below indicate severe injury
9-12 suggest moderate brain injury
13 and above indicate mild brain injury
Diagnosis cont’d
Brain imaging techniques also used CAT or CT (computerized axial
tomography) MRI (magnetic resonance imaging)
Causes
MVA, bicycle, etc. - more than 50% Falls - 25% Violence - 20% Men more than women 15 - 24 years old and 75+ years
Types
Blunt or penetrating trauma
“Closed head” injury refers to injury not resulting from penetration of the skull
Focal injury refers to an injury that is confined to a specific area of the brain causing localized damage.
Diffuse injuries are characterized by damage throughout the brain.
Types & Causes cont’d
Diffuse Axonal Injury Results from a tearing of
nerve bundles and/or stretching of blood vessels.
Frontal & Temporal lobes are most susceptible.
Disorganization Impaired memory Problems related to
attention
Contusions Bruises that cause
swelling and bleeding resulting in tissue damage
Frontal & Temporal lobes Abnormal sensations Behavior impairment Problems related to vision Memory impairment
Types & Causes cont’d
Hemorrhage Bleeding into brain tissue
Infarction (stroke) Occipital/Temporal lobes Occur when an artery is
compressed by the swelling of surrounding tissues, restricting blood flow and its essential nutrients
Hematoma (SDH) Bleeding over the
surface of the brain exerts pressure and may need to be surgically drained
Prognosis
Duration of coma Severity of coma
immediate post-injury Duration of post-
traumatic amnesia Location and size of
injury Severity of injuries to
other body systems
More severe the injury, the longer the recovery period
Recovery from diffuse damage takes longer than from localized damage
Need for surgery does not necessarily indicate a worse prognosis.
Prognosis cont’d
Initial improvement may be due to reduction in swelling (edema)
Damaged neurons begin functioning again Plasticity - undamaged areas of the brain
may assume the functions of nearby damaged areas