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