TBI - intro

TBI definition

a brain injury from an outside force, leading cause of death in the world, may present with loss of consciousness

causes of a tbi

falls

struck by an object

motor vehicle accidents

assault and self harm

Risk factors

• low socioeconomic status

• peritraumatic psychiatric illness or family dysfunction 

• substance abuse 

• previous TBI 

• occupation 

penetrating TBI / open head injuries 

a foreign object passes through the skull

non-penetrating TBI/closed head injuries

• head accelerates and strikes an external object

• head experiences significant movement without contact of external object

coup injury 

damage at the point of impact 

contrecoup

damage opposite the original point of impact or acceleration

common areas of damage - orbital and lateral undersurfaces of frontal and temporal lobes

focal/localized injury 

• penetrating: shooting objects - focal point 

• non-penetrating: concussion  

cerebral edema

• swelling in the brain due to increased fluid build up in the tissue

• results in increased cerebral pressure

• also results in midline shift

Diffuse brain injury 

• common with coup/counter coup injuries 

• more wide spread 

• nerve cells die causing more swelling in the brain 

• the shearing and stretching that result in widespread, but patchy, damage to the axons is termed diffuse axonal injury 

hydrocephalus

• occurs when there is build up of excess cerebrospinal fluid in the brain that fails to drain

veterans with tbi - high risk group

TBI can occur due to combat related injuries

overlapping PTSD

primary brain injuries 

-immediate brain tissue destruction 

• cerebral contusion from penetrating and non-penetrating ( coup/counter coup injuries) 

• diffuse axonal injury (DAI) 

secondary brain injury 

• intracranial hemorrhage 

• raised intracranial pressure

• brain swelling 

• ischemia 

• infection  

delayed complications

• seizure disorders

• hydrocephalus

loss of consciousness (LOC =)/ Disorders of consciousness

• coma: period of unconsciousness or unawareness following brain injury

• vegetative - some eye opening but a complete lack of interaction with the external movement

Post traumatic amnesia ( PTA) 

includes patient memory for ongoing events is reliable consistent and accurate - can they retain new information 

tests for PTA

GOAT: looks at orientation to a person, place, time & circumstance

O-log: more appropriate for repeat administrations

posttraumatic stress disorder

an individual experience directly or be personally impacted by a stressful event

behaviors include: sleep disorders, aggression, cognitive dysfunction

impact of TBI 

most people have mild tbi 

damage to the frontal or frontolimbic regions in chi 

localized damage with OHI 

mild tbi

known as a concussion, neural injury resulting in changes in cognative, phyical, and psychological functioning

clinical phenotypes of mTBI

• cognitive

• ocular-motor

• headache/migraine

• vestibular - balance/hearing head

• anxiety/mood - crying

moderate TBI 

• normal or abnormal structural imaging results 

• loss of consciousness between 30 mintutes and 24 hours 

• PTA - greater than 1 day and fewer that 7 days 

• GCS between 9 and 12 

severe TBI

• normal or abnormal structural imaging results

• loss of consciousness - greater that 24 hours

• PTA - greater that 7 days

• GCS - between 3 and 8

cognitive impairment/difficulties

• changes in attention

• memory

• executive functions