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18 Cards in this Set
- Front
- Back
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Three Types of Head Injury. 1. P........... 2. C............... 3. C........... H............ I..........
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1. Penetrating 2. Crushing. 3. Closed head injury (CHI)
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Penetrating Head Injury
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skull pierced/broken & brain damaged. eg. bullet wound. Deficits depend on functions mediated by brain region (affected). CAN BE less severe damage because of focal involvement.
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Crushing Head Injury
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Head is caught btwn two objects (e.g.. under wheel). MOST RARE. But MOST severe damage to base of skull & nerves running through it rather than the brain itself.
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Closed Head Injury (CHI)
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When head suddenly accelerates, decelerates or rotates (e.g.. car hit from behind, head on collision, punch to head- KO). No penetrating wound. DAMAGE caused by movement of soft brain mass inside the hard, bony skull.
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Primary injuries in CH1
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-Occur @ moment of impact (caused directly by blow) - diffuse axonal injury (DAI); one of the most common & fatal brain injuries, damage more widespread than focal.- Arteries and veins may be torn. - Coup and contre coup injuries. F & T regions most common site of surface contusions. Can also have contusions on M surface of cerebral hemisphere & upper surface of corpus callosum
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Secondary injuries in CH1
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- occur as a result of systematic complications (potentially treatable). - intracranial haematoma; formation of a clot --> compression of brain. --> in coma or depressed ceased state --> delay. - bran swelling from hyperaemia or cerebral oedema. - diffuse or local. -damage to brain from hypoxia/ischaemia. - Intracranial pressure. - Infection. - Cerebral ischaemia (from respiratory failure on hypotension, from systematic primary injuries.
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Delayed complications
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-Post-traumatic epilepsy (increased chance of getting of epilepsy --> CHI). - Hydrocephalus, obstruction of flow of CSF can result in cog deterioration.
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Post traumatic amnesia
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Period after CHI, individual unable to encode any new info.
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Cognitive changes --> PTA
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Depend on severity of CHI; headache, dizzy, slowed processing, poorer attention, subtle mem dif, generally resolved in weeks
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Behaviour & Cog --> Mod-severe CHI
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Socially inappropriate behaviour, self centred, irritability, depressed, decreased emotional control and attention, fatigue, decreased planning & problem solving, abstract difficulties, lack of initiative and insight.
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Memory (Mod-Severe CHI)
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retrograde, anterograde- new learning impairment. delayed recall impairment, confabulation
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Recovery of CHI. 3-6m:......, >12m:....., >7y:.........
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rapid recovery, essentially plateauing, vey slow improvement.
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Restitution of function
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-occurs due to resolution of temporary physiological factors (e.g..odema, biochemical alterations)
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Substitution of function
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-Intact neuronal systems can sometimes take over the role of a damaged system. (evidence is limited to motor movement). -behavioural compensation and functional adaption are the GOAL of rehab
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Recovery aides
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-NO pharmacological intervention 4direct neural recovery. -limited/no alcohol intake for 12months. -Rest/sleep is important. Don't return early to work.
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Case study: A.L.
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22years old holiday in europe him speed car accident 2weeks b4 home. NEUROIMAGING. severe contusions FLs & TLs (countercoup) injury in occipital lobe, NO evidence of subcortical damage, in PTA for 1st 2 months. Poor stm. didn't know date, believed she was still inner last sem of uni. no new info. at 2mths retained basic info about having crash. behaved more childlike. MEMORY. recognised nurses, no names, insight v.poor didn't realise extent of her memory problem. DENSLEY amnestic, no novel info, no recall --> 20m, retro am unchanged from PTA.
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CHI, diffuse brain .........
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damage
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Subcortical, injury & T & FL vulnerability in .........
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CHI
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