Traumatic Brain Injury

GCS

Glasgow Coma Scale, 15 points scale

Commands

how long it takes for the patient to respond to commands, only measured after the patient regains consciousness

PTA

Post Traumatic Amnesia, how long it takes to record new memories after the injury, better predictor for cognitive deficits

Mississippi PTA

measuring longer term memory after injury than regular PTA does, goes up to 70 days

MRS

Magnetic Resonance Spectroscopy, assesses presence of peptides and hormones in the brain

Glutamate

elevates as a response to TBI

NAA

N-acetylaspartate, a peptide that signals neuron integrity/if the membrane is intact, NAA is lower with more severe TBI, cognitive functions decrease

Creatine

neuroprotective compound that comes from amino acids, derived from foods like seafood and red meat or taken as a supplement, levels decrease with a TBI bc it gets used up quicker

Choline

produced in response to inflammation, increases in TBI, cognitive functions decrease

SWI

Susceptibility Weighted Imaging, detects micro-bleeds in the brain

DTI

Diffusion Tensor Imaging, shows white matter tracts, can identify where neuron projections are missing/compromised connectivity due to TBI, not good for individual cases though

Closed Head Injuries

injury to the head that DOESN’T penetrate the skull

Acceleration (Closed Head)

going from not moving to moving rapidly, ex being punched

Deceleration (Closed Head)

going from moving to not moving rapidly, ex a car accident

Coup Contact (Closed Head)

head is pushed forward, brain collides with the front of the skull

Countercoup Contact (Closed Head)

head snaps back, brain bounces off the back of the skull

Focal Injury

contusion (bruise) along frontal and temporal lobes, frontal causes personality changes, temporal affects memory and agnosias

Diffuse Injury

injury affects deep levels of the brain, neurons can’t withstand stretch of injury, traumatic forces shear axons, brainstem and deep white matter are most vulnerable, can be fatal, if TBI happens deep in the brainstem it causes a coma

Retrograde Degeneration (Diffuse)

cell death

Anterograde Degeneration (Diffuse)

everything distal from affected axon dies

Penetrating Injury

injury when the skull is penetrated, object lodged in the brain (focal, hemorrhage), possible infection and bleeding, gunshots are most common type

Mild TBI

concussion is one example, any loss of consciousness (lasts < 30 mins) or memory (PTA lasts < 24 hrs), any alteration of mental status, symptoms go away after 90 days

Post Concussive Disorder (mTBI)

symptoms persist for more than 90 days after injury

Frontal Lobe Syndrome

irritability, impulsivity, social norm variations, impaired self awareness