Neuro Rehab traumatic brain injury (TBI) / acquired brain injury

hematoma

contact force result in focal injury (translational force)

epidural

___________ hematoma: skull fracture lacerates a meningeal artery

➮rapid accumulation

➮high pressure

➮medical emergency

subdural

____________ hematoma:

➮venous; slow bleed

➮brain movement tears veins

➮may be asymptomatic for hours

subarachnoid

_____________ hematoma:

➮smaller vessels between gyri and sulci

➮often involve CSF obstruction

➮can cause increased ICP/hydrocephalus

➮also seen in aneurysm rupture

contusion

intracerebral ________________:

➮punctate hemorrages

➮intact cortex

edema

__________ is a secondary complication of TBI

➮imaging looks grey; lose detail of gyri/sulci

➮all brain function affected

midline shift

brain compression and ________ _________ are secondary complications of TBI

➮ventricles shifted to one side

➮compression on side CL to bleed

➮ventricle can be "pinched" closed

coup

with acceleration/deceleration mechanisms of TBI, the point of impact = __________ injury

contrecoup

with acceleration/deceleration mechanisms of TBI, the opposite pole of the brain may also be injured from the rebound = _______________

frontal

most commonly, coup is _____________ and anterior temporal lobes & contrecoup is occipital

diffuse axonal injury/DAI

acceleration/deceleration and rotational forces on the rain results in compression, strain, shearing, and displacement of axons

coma

diffuse axonal injury (DAI) is a major cause of _________ in severe injuries

➮tearing of the associative fibers in the rostral midbrain and corpus callosum

➮in milder injuries, the brainstem is not affected

loss of consciousness/LOC

with diffuse axonal injury (DAI), diffuse white matter damage can result in _________ ____ _______________; duration of unresponsiveness parallels the extent of the DAI

t

t/f duration of loss of consciousness is directly related to the extent of diffuse axonal injury

ischemia/hypoxia

_________/__________ may be the primary cause of brain injury

➮i.e. drowning, carbon monoxide, myocardial infarction

Sommer's sector

"________'__ ____________" of the hippocampus is most vulnerable to ischemia/hypoxia

➮limited blood supply

➮travels through a narrow fissure

➮large pyramidal neurons have high O2 demand

hippocampus

Sommer's sector is a part of the ___________ that is most vulnerable to ischemia/hypoxia

➮limited blood supply

➮travels through a narrow fissure

➮large pyramidal neurons have high O2 demand

4-15

___-____ mmHg is normal ICP in supine

40

ICP >___mmHg = neurologic deficit

➮absolute contraindication to getting patient up

➮use caution/clinical judgment with any ICP above normal

brainstem

______________ damage: can be due to injury or swelling, hemorrhage

➮consider specific structures located here and how they relate to clinical presentation

➮CN's

➮RAS (consciousness)

➮cerebellar peduncles

extracranial

traumatic injury to _____________ blood vessels:

➮cervical hyperextension - internal carotid artery

➮sudden hyperextension and rotation of neck - vertebral artery

internal carotid

cervical hyperextension can cause traumatic injury to this artery

vertebral

sudden hyperextension and rotation of the neck can cause traumatic injury to this artery

seizure

there is an increased risk of ________ as a secondary complication of TBI if it is a penetrating injury

infection

____________ is a secondary complication of TBI if skull is open

heterotopic ossification/HO

➮abnormal calcifications at parts of the body with neurologic deficit (joints, fascial planes)

➮secondary complication of TBI

secondary

____________ complications of TBI

➮seizures

➮infections

➮cranial nerve damage

➮increased risk of alzheimer's/PD

➮heterotopic ossification

➮vestibular dysfunction

➮respiration

➮bowel/bladder

➮family issues

1.4

incidence of TBI: ___.___ million/year

2.5-6.5

prevalence of TBI: ___.___-___.___ million living with TBI

0-4

age ___-___ is a high risk group for TBI due to shaken baby syndrome etiology

15-24

>50% of TBI occur in ages ___-___ due to risky behavior

elderly

the __________ are a high risk group for TBI due to falls

c

of the following, which etiology is most common for TBI?

a. MVA

b. struck by/against

c. falls

d. assaults

e. other: concussive blasts, overdoses, infection, electrocution, etc.

50000

___________/year die from TBI

40-50

those who survive TBI will live ____-____ years after injury

5.3

at least ___.___ million Americans (~2% of the population) currently have a long-term need for help with ADLs as a result of TBI

a

which TBI imaging is best for fracture, hematoma, ventricular enlargement, & atrophy (& therefore most commonly selected)

a. CT

b. MRI

c. PET/SPECT/fMRI

b

which TBI imaging is best for soft tissue discrimination?

a. CT

b. MRI

c. PET/SPECT/fMRI

c

which TBI imaging is best for looking at regional blood flow metabolism, cerebral perfusion, or changes in neuronal activity?

a. CT

b. MRI

c. PET/SPECT/fMRI

13-15

a score of ___-___ on the glasgow coma scale is mild

80

____% of TBIs are mild (13-15) on glasgow coma scale

9-12

a score of ___-___ on the glasgow coma scale is moderate

10

_____% of TBIs are moderate (9-12) on glasgow coma scale

3-8

a score of ___-___ on the glasgow coma scale is severe

10

____% of TBIs are severe (3-8) on the glasgow coma scale

3-8

a person in a coma will score between ___-___ on the glasgow coma scale

3-15

possible glasgow coma scale scores range from ___-____, with lower scores indicating greater severity

life

_________-saving measures for TBI include resuscitation, intubation, and ventilation

brain

________-saving measures for TBI include craniotomy, ICP monitoring, VP shunt, and hypothermia

hypothermia

cold therapy for TBI with goal of decreasing metabolic demand

mannitol

__________ is a diuretic for brain swelling with acute TBI

diuretic

mannitol is a ___________ for brain swelling with acute TBI

haldol

______________ is a coma-inducing medication/sedative for acute TBI

sedative

haldol is a coma-inducing medication, or _____________, used for acute TBI

seizure

tegretol and dilantin are anti-__________ medications after acute TBI

tegretol

______________ and dilantin can be prescribed for trauma-induced seizures from TBI

dilantin

tegretol and ______________ can be prescribed for trauma-induced seizures from TBI

moderate to severe

CPG for mild to moderate/moderate to severe TBI:

➮stimulants may help with attention and fatigue by increasing dopamine & adrenalin in the brain (Ritalin)

➮amantadine (symmetrel) improves status of long-term coma-like states

➮revistigmine (exelon) or donepezil may help with memory by increasing ACh in the brain

stimulants

CPG for moderate to severe TBI:

➮_______________ may help with attention and fatigue by increasing dopamine & adrenaline in the brain (Ritalin)

➮amantadine (symmetrel) improves status of long-term coma-like states

➮revistigmine (exelon) or donepezil may help with memory by increasing ACh in the brain

Ritalin

CPG for moderate to severe TBI:

➮stimulants may help with attention and fatigue by increasing dopamine & adrenaline in the brain (___________)

➮amantadine (symmetrel) improves status of long-term coma-like states

➮revistigmine (exelon) or donepezil may help with memory by increasing ACh in the brain

dopamine

CPG for moderate to severe TBI:

➮stimulants may help with attention and fatigue by increasing ______________ & adrenaline in the brain (Ritalin)

➮amantadine (symmetrel) improves status of long-term coma-like states

➮revistigmine (exelon) or donepezil may help with memory by increasing ACh in the brain

symmetrel

CPG for moderate to severe TBI:

➮stimulants may help with attention and fatigue by increasing dopamine & adrenaline in the brain (Ritalin)

➮amantadine (____________) improves status of long-term coma-like states

➮revistigmine (exelon) or donepezil may help with memory by increasing ACh in the brain

long

CPG for moderate to severe TBI:

➮stimulants may help with attention and fatigue by increasing dopamine & adrenaline in the brain (Ritalin)

➮amantadine (symmetrel) improves status of short/long-term coma-like states

➮revistigmine (exelon) or donepezil may help with memory by increasing ACh in the brain

exelon

CPG for moderate to severe TBI:

➮stimulants may help with attention and fatigue by increasing dopamine & adrenaline in the brain (Ritalin)

➮amantadine (symmetrel) improves status of long-term coma-like states

➮revistigmine (_____________) or donepezil may help with memory by increasing ACh in the brain

acetylcholine/ACh

CPG for moderate to severe TBI:

➮stimulants may help with attention and fatigue by increasing dopamine & adrenaline in the brain (Ritalin)

➮amantadine (symmetrel) improves status of long-term coma-like states

➮revistigmine (exelon) or donepezil may help with memory by increasing _______ in the brain

consciousness

_____________ is the knowledge of one's self and one's environment

conscious behavior

__________ __________ is determined by content and arousal, but arousal does not guarantee cognition

f

t/f arousal guarantees cognition

a

coma consciousness:

a. none

b. partial

c. full

a

unresponsive wakefulness consciousness:

a. none

b. partial

c. full

b

minimally conscious state consciousness:

a. none

b. partial

c. full

c

locked-in syndrome consciousness:

a. none

b. partial

c. full

absent

coma sleep/wake is absent/present

present

unresponsive wakefulness sleep/wake is absent/present

present

minimally conscious state sleep/wake is absent/present

present

locked-in syndrome sleep/wake is *absent/present

a

reflex and postural responses only best describes:

a. coma

b. unresponsive wakefulness

c. minimally conscious state

d. locked-in syndrome

b

postures or withdraws to noxious stimuli first occurs with:

a. coma

b. unresponsive wakefulness

c. minimally conscious state

d. locked-in syndrome

b

occasional nonpurposeful movement first occurs with:

a. coma

b. unresponsive wakefulness

c. minimally conscious state

d. locked-in syndrome

c

a person with this condition localizes noxious stimuli:

a. coma

b. unresponsive wakefulness

c. minimally conscious state

d. locked-in syndrome

c

a person with this condition reaches for objects:

a. coma

b. unresponsive wakefulness

c. minimally conscious state

d. locked-in syndrome

c

a person with this condition holds or touches objects in a manner that accommodates size and shape:

a. coma

b. unresponsive wakefulness

c. minimally conscious state

d. locked-in syndrome

c

a person with this condition demonstrates automatic movements (e.g. scratching)

d

motor function for a person with this condition is quadriplegic

a. coma

b. unresponsive wakefulness

c. minimally conscious state

d. locked-in syndrome

a

a person with this condition has no auditory function

a. coma

b. unresponsive wakefulness

c. minimally conscious state

d. locked-in syndrome

b

a person with this condition has startle response to sound (reflex)

a. coma

b. unresponsive wakefulness

c. minimally conscious state

d. locked-in syndrome

b

a person with this condition has brief orienting to sound

a. coma

b. unresponsive wakefulness

c. minimally conscious state

d. locked-in syndrome

c

a person with this condition localizes sound location

a. coma

b. unresponsive wakefulness

c. minimally conscious state

d. locked-in syndrome

c

a person with this condition has inconsistent command following

a. coma

b. unresponsive wakefulness

c. minimally conscious state

d. locked-in syndrome

d

a person with this condition auditory function is preserved

a. coma

b. unresponsive wakefulness

c. minimally conscious state

d. locked-in syndrome

a

a person with this condition has no visual function

a. coma

b. unresponsive wakefulness

c. minimally conscious state

d. locked-in syndrome

b

a person with this condition has startle visual function (reflexive)

a. coma

b. unresponsive wakefulness

c. minimally conscious state

d. locked-in syndrome

b

a person with this condition has brief visual fixation

a. coma

b. unresponsive wakefulness

c. minimally conscious state

d. locked-in syndrome

c

a person with this condition has sustained visual fixation

a. coma

b. unresponsive wakefulness

c. minimally conscious state

d. locked-in syndrome

c

a person with this condition has sustained visual pursuit

a. coma

b. unresponsive wakefulness

c. minimally conscious state

d. locked-in syndrome

d

a person with this condition usually has vertical eye movement and blinking intact

a. coma

b. unresponsive wakefulness

c. minimally conscious state

d. locked-in syndrome

a b

a person with conditions ___ and ___ have no communication

a. coma

b. unresponsive wakefulness

c. minimally conscious state

d. locked-in syndrome

c

a person with this condition has contingent vocalization

a. coma

b. unresponsive wakefulness

c. minimally conscious state

d. locked-in syndrome

c

a person with this condition has inconsistent but intelligible verbalizing or gesture

a. coma

b. unresponsive wakefulness

c. minimally conscious state

d. locked-in syndrome

d

a person with this condition is aphonic and anarthritic (but may be able to communicate through preserved eye movement and blinking)

a. coma

b. unresponsive wakefulness

c. minimally conscious state

d. locked-in syndrome