TBI pathophysiology

Question 1

Primary brain damage - diffuse axonal injury

Answer 1

disruption and tearing of axons and small blood vessels from shear strain of angular acceleration
- results in neuronal death and petechial hemorrhages

Question 2

Primary Brain Damage - Focal injury

Answer 2

• contusion, laceration, mass effect from hemorrhage and edema (hematoma)

Question 3

Primary Brain damage - Coup-Contracoup

Answer 3

injury at point of impact and opposite point of impact

Question 4

Secondary brain damage/secondary cell death: Hypoxic-Ischemic injury

Answer 4

results from systemic problems that compromise cerebral circulation

Question 5

Secondary brain damage/secondary cell death: Swelling/Edema

Answer 5

can result in mass effect with increased intracranial pressures, brain herniation and death

Question 6

Secondary brain damage/secondary cell death: Electrolyte imbalance

Answer 6

can lead to mass release of damaging neurotransmitters

Question 7

What is a concussion

Answer 7

loss of consciousness, either temporary or permanent resulting from injury or blow to the head with impaired functioning of the brainstem reticular activating system
- can lead to Changes in HR, RR, BP

Question 8

Levels of TBI - Mild

Answer 8

• LOC: 0-30 mins
• Alternation of Consciousness: brief, >24 hrs
• Post-traumatic amnesia: <1 day
• GCS: 13-15
• Imagining: Normal

Question 9

Levels of TBI - Moderate

Answer 9

• LOC: >30 mins but <24 hr
• AOC: > 24 hrs
• PTA: > 1 day but < 7 days
• GCS: 9-12
• Imaging: normal or abnormal

Question 10

Levels of TBI - Severe

Answer 10

• LOC: > 24 hrs
• AOC: > 24 hrs
• PTA: > 7 days
• GCS: <9
• imaging: normal or abnormal

Question 11

What are the 6 recovery stages from diffuse axonal injury?

Answer 11

• coma
• unresponsive wakefulness syndrome/vegetative state
• mute responsiveness/minimally responsive
• confusional state
• emerging independence
• intellectual/social competence

Question 12

coma

Answer 12

a state of unconsciousness in which there is neither arousal nor awareness
- eyes closed
- no sleep/wake cycle

Question 13

unresponsive wakefulness syndrome/vegetative state

Answer 13

marked by the return of sleep/wake cycles and normalization of vegetative functions (respiration, digestion, BP)
- persistent vegetative state is determined if pt remains in state > 1 yr

Question 14

mute responsiveness/minimally responsive

Answer 14

state in which pt is not vegetative and does show signs, even if intermittent, of fluctuating awareness

Question 15

confusional state

Answer 15

mainly a disturbance of attention mechanisms; all cognitive operations are affected, pt is unable to form new memories, may demonstrate either hypo or hyperarousal

Question 16

emerging independence

Answer 16

confusion is learning and some memory is possible; significant cognitive problems and limited insight remains, frequently uninhibited social behaviors

Question 17

intellectual/social competence

Answer 17

-increasing independence although cognitive difficulties persists along with behaviors and social problems

Question 18

11 things to examine post TBI

Answer 18

• increased intracranial pressure
• LOC/cognitive function
• CN function
• emotional dusregulation
• changes in behavior
• speech and communication
• sensory deficits
• motor function
• functional mobility skills, ADLs
• level of general reconditioning
• sympathetic storming

Question 19

What is sympathetic storming

Answer 19

• result of hypothalamic stimulation of SNS with an increase in circulating corticoids and catecholamines

Question 20

How to examine for sympathetic storming

Answer 20

• examine for alterations in LOC, increased posturing, dystonia, hypertension, hyperthermia, tachycardia, tachypnea, diaphoresis, and agitation
• pt generally exhibits minimal altertness, minimal awareness and reflective motor response to stimulation