TBI - Moderate and severe traumatic brain injury

subarachnoid hemorrhage

Bleeding into the subarachnoid space, where the cerebrospinal fluid circulates., below dura mater

Severe TBI - Recovery Trajectory

Coma -> Vegetative State - > Minimally Conscious State -> Confused State (not all TBI have vegetative state or minimally conscious state)

Moderate & Severe TBI (most common symptoms)

Fatigue, irritability, decreased initiation, apathy, sound sensitivity, processing speed, attention (divided attention, decreased concentration, destractibility), learning and memory, executive functions - deficits common @ 1 year

mild TBI classification the severity

GCS score between 13 and 15, unconsciousness less than 30 minutes, PTA less than 24 hours

severe TBI classification severity

GCS score between 3 and 7, post-traumatic amnesia greater than 24 hours, PTA greater than 7 days

hematoma

accumulation of blood in specific space

epidural Hemorrhage - vein vs. artery

arterial hemorrhages show faster progression of symptoms a greater likelihood of brain herniation

Glasgow Coma Scale

assesses depth of consciousness, including eye opening, best verbal response, best motor response

subdural hemorrhage

blood below dura mater, brain compression and germination, typically in brain convexity... deterioration can be very slow particularly in older adults.

intracerebral/intraparenchymal hemorrhage

blood in brain matter, can result in mass effect.

central herniation

brainstem and/or medial temporal lobes

moderate TBI classifications severity

it must be the ratio of unconsciousness between 30 minutes and twenty-four hours, GCS score between 8 and 12, post-traumatic Amnesia between 1 to 7 days

Subfalcine Hernation

large unilateral supratentorial masses resulting in cingulate and associated structures to herniated under falx cerebri

coup/ contre-coup

largest contusion as often at the centre-coup

types of head injuries

linear, including diastatic fractures resulting in a linear fracture that extends into the suture. As well as depressed skull fracture

Retrograde Amnesia

loss of memory before the TBI - can be for months before the accident

retrograde amnesia

loss of memory for duration preceding Proceeding TBI

Transtentorial/uncal herniation

medial temporal lobe

Traumatic Axonal Injuries

- "deep white matter injuries" or "diffuse axonal injuries" - Result of severe rotational or linear accelleration/deceleration forces - More common at gray & white matter interfaces of cerebral cortex, long fibers of internal capsule, and crossing fibers between 2 hemispheres (e.g., corpus callosum)

Ventricular Dilation

- AKA Hydrocephalus ex vacuo - Can occur after Severe TBI - CSF can get disrupted resulting in hydrocephalus characterized by ventricular dilation - Can also occur from gradual dying off and removal of cells (i.e., hydrocephalus ex vacuo)

Hydrocephalus Ex Vacuo

- AKA Ventricular Dilation - Can occur after Severe TBI - Gradual dying off and removal of cells

Moderate TBI

- No vegetative state, no minimally concsious state

Cortical Atrophy

- Shrinking - Along with ventricular dilation, cortical atrophy can be seen on neuroimaging 6 weeks - 1 year post injury.

breakdown of mild, moderate, severe prevalence

80% or mild, 10% moderate, 10% severe

Traumatic Brain Injury (TBI)

Acquired Injury to brain that results in alteration in cognitive or behavioral status. Often associated alteration of consciousnesses.

Minimally Conscious State

Inconsistent awareness of self and environment, inconsistent following commands (typically a temporary stage)

intraventricular hemorrhage

Intraventricular hemorrhage in which it spills over into ventricular system.

Severe TBI

LOC >24 hours, PTA > 7 days, GCS = 3-7

Retrograde Amnesia

Memory loss before TBI (for moderate - severe more common). Can be days to months in severe TBI

Posttraumatic Amnesia (PTA)

Memory loss following TBI (including coma) *Often accompanied by neurobehavioral problems such as agitation, disorientation)

Posttraumatic Confusion (PTC)

Period of PTA + Neurobehavioral Symptoms --> Can last days to weeks and is considered resolved once person can make new memories

Persistent Vegetative State

Unawareness of self & environment for >30 days with some preserved brainstem functioning (e.g., eye opening)

coma

describes patient whose eyes are continuously closed and cannot be aroused wakeful state

central herniation

downward displacement of brainstem with herniation through foramen magnum

hematomas around the brain

epidural, subdural, and subarachnoid

Symptoms of Uncal Herniation

hemiplegia (compression of corticospinal tract), dilated or blown pupil, and coma (respiratory failure and death)

epidural hemorrhage

hemorrhages between skull and dura mater which can be life-threatening. clinically prison says in the show loss of consciousness followed by recovery of consciousness for a few hours, followed by rapid deterioration in hours to day

tonsillar herniation (form of central herniation)

involves cingulate gyrus, brainstem, and cerebellum through forsaken magnum

Moderate TBI Sx

irritability - temper - blurred vision - sound sensitivity, apathy - fatigue

traumatic axonal injuries

often referred to as diffuse axonal injury is, shearing injuries, or deep white matter injuries.

post-traumatic amnesia

period of memory disruption falling traumatic brain injury

loss of consciousness

refers to being rendered in a sleep-like state.

Tentorium

roof above the lower portions of the brain, including brainstem and cerebellum

falx

separates left and right hemispheres.

edema

swelling in brain

hemorrhagic stroke subsequently traumatic brain injury

symptoms can onset two to four days after trauma occurred, patient going from presenting well to appearing obtunded

Moderate & Severe TBI (Uncommon symptoms)

uncommon: deficits in language, visusospatial functions (aphasia rare, communication problems usually related to PS, att. & Exec)

vegetative state

wakefulness without awareness, a person can speak or communicate through gestures or I will Prince, make grown, move in response to pain, but no evidence of meaningful cognitive emotional functions

persistent vegetative state

when someone has been in a vegetative state for anywhere between 1 month to 1 year depending on definition