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61 Cards in this Set
- Front
- Back
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Aneurysm
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blood filled sac formed by disease related stretching of an artery or blood vessel
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Anoxia
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absence of oxygen supply to an organ’s tissue leading to cell death
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Apoptosis
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cell death that occurs naturally as part of normal development, maintenance, and renewal of tissues within an organism
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Arachnoid Membrane
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1 of 3 membranes that cover the brain; it is between the pia mater and the dura. Collectively these three membranes form the meninges
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Brain Death
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an irreversible cessation of measurable brain function
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Cerebrospinal Fluid (CSF)
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fluid that bathes and protects the brain and the spinal cord
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Coma
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a state of profound unconsciousness caused by disease, injury, or poison.
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Compression Cranial Neuropathies
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degeneration of the nerves in the brain caused by pressure on those nerves
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Computed Tomography (CT)
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scan that creates a series of cross-sectional X-rays of the head and brain (CAT)
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Contusion
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distinct area of swollen brain tissue mixed with blood released from broken blood vessels
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CSF Fistula
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tear between 2 of the three membranes, the dura and the arachnoid membranes that encase the brain
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Deep Vein Thrombosis
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formation of a blood clot within a vein
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Dementia Pugilistica
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brain damage caused by cumulative and repetitive head trauma: common in career boxers
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Dura
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tough, fibrous membrane lining the brain; the outer most of the 3 membranes collectively called the meninges
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Early Seizures
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seizures that occur within 1 week of TBI
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Epidural Hematoma
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bleeding into the brain between the dura and the skull
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Hematoma
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heavy bleeding into or around the brain caused by damage to a major blood vessel in the head
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Hypoxia
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decreased oxygen levels in an organ such as the brain; less severe than anoxia
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Magnetic Resonance Imaging (MRI)
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a non-invasive diagnostic technique that uses magnetic fields to detect subtle changes in the brain tissue
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Itrancranial Pressure
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build up of pressure in the brain as a result of injury
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Locked-In Syndrome
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condition with patient is aware & awake, but cannot move or communicate due to complete paralysis of the body
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Persistent Vegetative State
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ongoing state of severely impaired consciousness in which the patient is incapable of voluntary motion
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Plasticity
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brain’s ability to adapt to deficits and injury
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Pneumocephalus
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condition which air is trapped with the intracranial cavity
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PCS ?_____
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complex and poorly understood problem that may cause a headache after a HI; many cannot recall event or variable period of time prior to injury
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?
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condition marked by mental deterioration and emotional apathy following trauma
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Seizures
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abnormal activity of nerve cells in the brain causing strange sensations, emotions, and behavior, or sometimes convulsions, muscle spasm and loss of consciousness
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Shaken Baby Syndrome
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severe form of HI after a small child or infant is shaken forcefully to cause the brain to bounce against the skull
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Stupor
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state of impaired consciousness in which the patient is unresponsive but can be aroused briefly by a strong stimulus
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Subdural Hematoma
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bleeding confined to the area between the dura and the arachnoid membranes
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Vegetative State
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condition in which the patient is unconscious and unaware of their surroundings, & continues to have sleep/wake cycle, with periods of alertness
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Ventriculostomy
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surgical procedure that drains the cerebrospinal fluid from the brain by creating an opening in one of the ventricles
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Traumatic Brain Injury
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Acquired, not congenital
Caused by external physical force Not degenerative |
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Prognosis
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On a continuum: Very mild (concussion) to extensive damage resulting in death or permanent disability
1.25 million yearly 25% hospitalized; 20% moderate-severe 1/6 of those will die incidence of TBI –200-250 per 100,000 decrease in last decade TBI patients fill an increasing number of rehabilitation beds each year |
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Poor prognostic signs
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Longer coma, low coma score, longer post traumatic amnesia (PTA; the period of time taken post injury for the patient to register information from day to day)
Extent of damage – focal injuries imposed on diffuse injuries; severe DAI Older patients more susceptible to hemorrhage/higher risk of mortality and greater incidence of persistent cognitive problems Previous head injury Lower levels of intelligence (because there is less to work with) |
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PTA
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Post Traumatic Amnesia
the period of time taken post injury for the patient to register information from day to day |
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Most Common Causes of TBI
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Teenagers & young adults –MVA (motor vehicle accident) - (over ½ believed to be related to alcohol)
Children – Falls Older adults – Falls |
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Other etiologies of head injury
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-Gun shot wounds
-Shaken Baby Syndrome -Football -Soccer -Motorcycles -Boxing -Assaults |
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Risk factors for TBI
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-Twice as frequent in men as women
-Most occur between the ages of 15 and 24 -Age -Gender -Alcohol use -Poor academic performance (don’t have insight; learning disabilities; can’t reason; don’t think ahead) -Low socioeconomic status (environment) -Sports involvement In particular: soccer, football, etc. -History of previous TBI (Brain might not think as clearly as it used to) |
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What are the types of head injuries?
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1.Open Head Injuries (OHI;
Penetrating) 2. Closed Head Injuries (Non- Penetrating) |
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Penetrating Head Injuries (OHI)
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High Velocity (ex. Car accident)
Low Velocity (ex. If someone hits you in the head) Increased mortality resulting from, e.g., Bleeding Increased risk of infection ICP (Intracranial Pressure) – factor because if the brain swells it pushes on the walls and pushes down on the brainstem Vulnerable brainstem in basal skull fracture However, if the initial post-onset period is survived, for improvement may be better than in CHI OHI is also more frequently associated with residual focal brain injuries – the rest of the brain won’t be as affected, unless there is intracranial pressure |
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Non-Penetrating Injuries
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Acceleration(Moving) Injuries
-Unrestrained head struck by a moving object -Head in motion strikes stationary object -More often associated with severe deficits -Angular rotation injuries particularly damaging Nonacceleration Injuries -Blows to a fixed or moveable head -Impression trauma |
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Closed Head Injuries (Non-Penetrating)
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a. Acceleration Injury – result of contact and inertial loading
1. Linear Acceleration (contusions) -coup injury (point of contact) -contrecoup injury (translational acceleration injury – movement between brain & skull opposite area of impact) 2. Angular acceleration injury (rotational injury) - twisting of brain and brainstem in skull) 3. Diffuse axonal injury (DAI) - stretching and shearing of axon; relates to the attempt of brain to follow movement of skull; related to overall severity and outcome in HI |
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Coup and Contrecoup
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Coup: Original place brain hits the skull; place of impact
Contrecoup: Brain bounces back and hits the opposite side of the skull; second place of impact |
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Linear Acceleration (Contusions)
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In closed head injury
1. Linear Acceleration (contusions) -coup injury (point of contact) -contrecoup injury (translational acceleration injury – movement between brain & skull opposite area of impact) |
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Angular Acceleration Injury
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(rotational injury) - twisting of brain and brainstem in skull)
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Diffuse Axonal Injury
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stretching and shearing of axon; relates to the attempt of brain to follow movement of skull; related to overall severity and outcome in HI
Common sites: Base of brain – subcortical nuclei and deep white matter Upper brainstem Superior cerebellar peduncles Diffuse axonal injury is one of the most common and devastating types of traumatic brain injury, occurring in about half of all cases of severe head trauma and also occurring in moderate and mild brain injury. It is a type of diffuse brain injury, meaning that damage occurs over a more widespread area than in a focal brain injury. |
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Severity of Head Trauma and Prognosis
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Continuum – very mild (concussion) to extensive damage resulting in death or permanent disability
Severity of HI is directly related to length of coma in CHI patients Coma definition - period of unconsciousness; depth of coma is measured by the Glasgow Coma Scale (Jennett et al. 1981) – & other scales mentioned. Poor prognostic signs: Longer coma, low coma score, longer post traumatic amnesia (PTA; the period of time taken post injury for the patient to register information from day to day) Extent of damage – focal injuries imposed on diffuse injuries; severe DAI Older patients more susceptible to hemorrhage/higher risk of mortality and greater incidence of persistent cognitive problems Previous head injury Lower levels of intelligence (because there is less to work with) |
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More Diffuse Axonal Injury (DAI)
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DAI, which refers to extensive lesions in white matter tracts, is one of the major causes of unconsciousness and persistent vegetative state after head trauma. Though diffuse axonal injury seldom kills, the outcome is frequently coma, with over 90% of patients with severe DAI never regaining consciousness. Those who do wake up often remain significantly impaired.
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Axonic Brain Injury
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Posturing (Decorticate/Decerebrate)
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Agitation
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a physiological response, which manifests as irritation, anger, aggression to internal and external stimuli, including confusion, frustration and overstimulation.
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Post Traumatic Amnesia
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PTA-the time following the coma in which the patient is unable to store new information or experiences in memory
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Retrograde Amnesia
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difficulty remembering events which occurred or information learned prior to the brain injury
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Anterograde Amnesia
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difficulty learning new information after the brain injury
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Errorless Learning
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Spaced Retrieval
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Mild Head Injury
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Youth and Recovery
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Age and Recovery
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General Observations and Recovery in TBI
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