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47 Cards in this Set

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open or closed?

_____head injury is associated with generalized/diffuse cerebral impairment.

_____head injury is associated with discrete focal lesions.

_____head injury is associated with a higher seizure risk.
closed

open

open
Which demographic group has the highest incidence of TBI?
males, ages 16-24
What are 2 of the most common causes of TBI?
MVA, falls
also industrial, assault, sports
Which of the following is NOT a risk factor for TBI (may be more than 1 answer):

- LD
- previous hospitalization for TBI
- hypotension
- smoking
- ADHD
- seizures
- boxing/soccer
- high education
- unemployment
- heart disease
hypotension
smoking
high education

Hypertension, psychiatric illness, drug abuse, divorce and low SES/education are also risk factors.
DAI =

A. diffuse axonal injury
B. discrete axonal inflammation
C. discrete axonal injury
D. deep axonal inflammation
A. diffuse axonal injury
Neuropathologically, what happens to neurons in DAI?
breaking, shearing and stretching of myelinated axons
What type of injuries result in DAI?
acceleration/deceleration and rotational injuries with subsequent loss of consciousness
T or F:

DAI is an immediate injury.
False.
DAI occurs over time as a result of compression/stretching, swelling and evolving changes (changes in glucose transport, blood flow, toxins, etc.)
Local abrasions (i.e., tearing, swelling) can result in what?
FCC
focal or subcortical contusion
Name 3 mechanisms of FCC.
- coup/contrecoup
- depressed skull fracture
- inertial/rotational force
- skull features
- hematomas
- subcortical bleeds
Which of the mechanisms of FCC can result in CVA-like effects?
subcortical bleeds
An infarction in the distribution of an artery can lead to:

A. hippocampal-interior injury
B. hypoxic-inflammatory injury
C. head-ischemic injury
D. hypoxic-ischemic injury
D. hypoxic-ischemic injury (HII)
HIIs result from a lack of oxygen and are frequently secondary to what?
physical injuries, chest injuries, airway obstruction
HIIs are associated with edema and:

A. decreased ICP; increased arterial pressure
B. increased ICP; increased arterial pressure
C. decreased ICP; decreased arterial pressure
D. increased ICP, decreased arterial pressure
D. increased ICP, decreased arterial pressure
Name one brain structure that is particularly susceptible to HII and one associated consequence.
hippocampus

severe, pervasive memory disorder
_____ and _____ are 2 delayed effects of HII.
white matter degeneration (ventricular enlargement) and disturbed CSF flow (hydrocephalus)
Contusions, coup/contrecoup and shearing are examples of (primary or secondary) mechanisms of brain injury after closed head injury.
primary
Name 3 secondary mechanisms of brain injury after CHI (closed head injury).
- intracranial hemorrhage
- white matter edema
- hyperemia
- ischemic brain damage
- elevated ICP
- brain shift/herniation
Calcification, gliosis, necrosis, phagocytosis, astrocyte activity and chromatolyses are examples of _____events following brain damage.
degenerative
Name these degenerative events:

1. shrinkage/degeneration after severing of axon
2. death of neurons that innervate or are innervated by damaged neuron
3. degeneration of severed neuron
4. death of remaining axon, cell body and dendrites
1. terminal
2. transneuronal
3. anterograde (Wallerian)
4. retrograde
Name 5 physiological events associated with CHI.
- diaschesis
- shock
- edema
- decreased CO2
- decreased blood flow
- decreased metabolic activity
- decreased brain activity
- change in neurotransmitter levels
- changes in electrical activity
- autoneurotoxicity
Which recovery mechanism is due to the resolution of hematomas, diminished swelling and normalization of blood flow?
spontaneous recovery
T or F:

Collateral sprouting is always beneficial.
False
Name 2 theories of recovery from CHI that are not well-supported.
- vicaration
- substitution
Re-emergence of inhibited or disrupted functions in areas adjacent to the primary damage is ________________.
diaschesis
What is behavioral compensation?
using a new or different behavioral strategy
NGF is a _____ secreted by _____to facilitate growth, regeneration and reenervation.
protein

glial cells
Lesion size, age, intelligence and personality affect recovery from TBI. Name 2 other variables, associated with less lateralization, which can also affect recovery.
sex and handedness

(less lateralization is associated with being female and left-handedness)
A. GCS
B. coma duration or LOC
C. PTA duration
D. SES/education level

Whis severity measure is the BEST predictor of recovery?
C. PTA duration
PTA duration is usually about ___ x the length of coma.

A. 1
B. 2
C. 4
D. 6
C. 4
What measure is used to evaluate PTA?
GOAT
mild or moderate TBI symptoms?

- headache, memory problems, difficulty with everyday living, frontal and/or temporal lobe damage
moderate
mild or severe TBI symptoms?

- attention, verbal retrieval, emotional distress, fatigue, depression
mild
Name 6 PCS symptoms.
fatigue, irritability, decreased attention, headache, dizziness, memory deficits, anxiety, insomnia, phono/photophobia, hypochondriacal concern
PCS is associated with (mild, moderate, severe) TBI.
mild
Most recovery from TBI occurs in _____ months.
6-9
1. PIQ or VIQ - which is more likely to decline more following TBI?

2. memory or overall IQ - which is more likely to improve more quickly with TBI?
PIQ

IQ
List 5 general principles of cognitive rehabilitaton.
"1. stimulation (early period) is useful; 2. forced use of body parts is helpful; 3. practice should be extensive and excessive; 4. training tasks should be relevant to real life; 5. family members, etc. should be included; 6. motivation is important; 7. continue training after plateaus; 8. break tasks down into simple components"
T or F for adult TBI:

'Recovery is least likely in complex behaviors with many components through behavioral compensation.'
False
Recovery is most likely in this context.
T or F for adult TBI:

'Recovery is most pronounced after incomplete lesions (e.g., concussion, penetrating head injury).'
True
T or F for adult TBI:

'There are never residual and permanent deficits; extensive recovery is the exception.'
False
What GCS score is associated with moderate TBI?
9-12
mild TBI = LOC of x duration (pick the single best response)

A. < 5 minutes
B. < 15 minutes
C. < 20-30 minutes
D. < 1 hour
C. < 20-30 minutes
What is akinetic mutism?
patient has the ability to respond, but is unable to initiate (bilateral lesions of mesial frontal lobes, mesial temporal, cingulate gyrus)
'Coma is a result of diffuse, severe destruction of _____ and decreased _____ to the brain.'
white matter

circulation
Second Impact Syndrome (SIS) is defined as _____.
repeated concussions over brief periods

SIS typically follows an initial brain injury while the patient is still symptomatic.
SIS findings include:

A. increased cerebral blood flow, increased ICP, decreased cerebral perfusion
B. decreased cerebral blood flow, decreased ICP, decreased cerebral perfusion
C. decreased cerebral blood volume, increased ICP, decreased cerebral perfusion
D. decreased cerebral blood volume, decreased ICP, increased cerebral perfusion
A. increased cerebral blood volume, increased ICP, decreased cerebral perfusion