1. Traumatic Brain Injury
Diagnostic Overview

2. Overview & Incidence
TBI describes damage to the brain caused by a blow to the head.
Severity of related symptoms may range from minor to major, even death.
Estimated that 100 out of 100k in U.S. incur a TBI each year (approx. 52k deaths)
280k per year just in the U.S.
$32 billion in hospitalization costs
$17 billion in costs associated with fatalities

3. Symptoms Aphasia Loss of memory Loss of coordinated motor functioning
Slurred speech
Blurry vision
Difficulty concentrating or thinking, especially when attention is divided.
Anxiety or nervousness
Loss of inhibition
Impulsivity
Inappropriate laughter
Irritability
Headache
Muscle Rigidity/Spasticity
Muscle Weakness
Seizures
Tingling or numbness

4. 3 (general) Stages of Symptoms
Coma - Loss of consciousness. May display reflexes (gripping a hand) Can be brief or last for days, weeks, or years. The longer a person is unconscious, the more severe the injury.
Concussion - brief loss of consciousness (seconds to minutes) with a good prognosis for recover.
Post-traumatic amnesia
State of acute confusion
Answering the same question with different responses
Can not perform simple tasks; (reality orientation)
Losing train of thought
Staring blankly at someone

5. Recovery Start to retain current month, year, etc.
This stage can last for weeks, months, etc.
At times, behavior can become an issue as a pt. becomes aware of his/her loss of ability and experiences frustration and depression
Progress made rapidly initially and then plateaus.

6. Diagnosis Glasgow Coma Scale
Ranks quality of response in 3 areas: Eye Opening, Best Motor Response, & Best Verbal Response
Eye-Opening
4 - Responds Spontaneously
3 - Responds to voice
2 - Responds to pain
1 - No response

7. Diagnosis cont’d
Best Motor Response
6 - Follows commands
5 - Localizes to pain
4 - Withdraws from pain
3 - Decorticate (produces an exaggerated posture of upper extremity flexion and lower extremity extension in response to pain
2 - Decerebrate (produces an exaggerated posture of extension in response to pain)
1 - No response

8. Diagnosis cont’d Scores of 8 or below indicate severe injury
Best Verbal Response
5 - Oriented and conversational
4 - Disoriented and conversational
3 - Inappropriate words
2 - Incomprehensible sounds
1 - No response
Scores of 8 or below indicate severe injury
9-12 suggest moderate brain injury
13 and above indicate mild brain injury

9. Diagnosis cont’d Brain imaging techniques also used
CAT or CT (computerized axial tomography)
MRI (magnetic resonance imaging)

10. Causes MVA, bicycle, etc. - more than 50% Falls - 25% Violence - 20%
Men more than women
years old and 75+ years

11. Types Blunt or penetrating trauma
“Closed head” injury refers to injury not resulting from penetration of the skull
Focal injury refers to an injury that is confined to a specific area of the brain causing localized damage.
Diffuse injuries are characterized by damage throughout the brain.

12. Types & Causes cont’d Diffuse Axonal Injury
Results from a tearing of nerve bundles and/or stretching of blood vessels.
Frontal & Temporal lobes are most susceptible.
Disorganization
Impaired memory
Problems related to attention
Contusions
Bruises that cause swelling and bleeding resulting in tissue damage
Frontal & Temporal lobes
Abnormal sensations
Behavior impairment
Problems related to vision
Memory impairment

13. Types & Causes cont’d Hemorrhage Infarction (stroke) Hematoma (SDH)
Bleeding into brain tissue
Infarction (stroke)
Occipital/Temporal lobes
Occur when an artery is compressed by the swelling of surrounding tissues, restricting blood flow and its essential nutrients
Hematoma (SDH)
Bleeding over the surface of the brain exerts pressure and may need to be surgically drained

14. Prognosis Duration of coma Severity of coma immediate post-injury
Duration of post-traumatic amnesia
Location and size of injury
Severity of injuries to other body systems
More severe the injury, the longer the recovery period
Recovery from diffuse damage takes longer than from localized damage
Need for surgery does not necessarily indicate a worse prognosis.

15. Prognosis cont’d
Initial improvement may be due to reduction in swelling (edema)
Damaged neurons begin functioning again
Plasticity - undamaged areas of the brain may assume the functions of nearby damaged areas