1. Traumatic Brain Injury Francisco R. Solis, MS IV St. Barnabas Hospital NYCOM-Class of 2007

2. Traumatic Brain Injury Traumatic Brain Injury (TBI) –Definition: a nondegenerative, noncongenital insult to the brain from an external mechanical force, possibly leading to permanent or temporary impairments of cognitive, physical, and psychosocial functions with an associated diminished or altered state of consciousness.

3. Traumatic Brain Injury Epidemiology –Each year in the United States: Approximately 1 million head-injured people are treated in hospital emergency rooms, Approximately 270,000 people experience a moderate or severe TBI, Approximately 60,000 new cases of epilepsy occur as a result of head trauma, Approximately 230,000 people are hospitalized for TBI and survive, Approximately 80,000 of these survivors live with significant disabilities as a result of the injury, and Approximately 70,000 people die from head injury.

4. Traumatic Brain Injury Mechanism of Injury –MVAs are the leading cause of TBI in the United States and account for approximately 50% of all TBIs. These include automobiles, motorcycles, bicycles and pedestrian struck. MVAs are also the leading cause of TBIs in individuals under the age of 75. –Falls are the 2 nd leading cause of TBI, accounting for 20-30% of all TBIs. In individuals aged 75 years and older, falls are the most common cause of TBI. –Firearms are the 3 rd leading cause of TBI (12% of all TBIs). –Sports, Recreation, Physical Violence (eg. child abuse) –Alcohol is a major factor in many TBIs and often is associated with the leading causes of TBI.

5. Traumatic Brain Injury Mechanism of injury

6. Traumatic Brain Injury Risk Factors –High risk populations: Young people Low-income individuals Unmarried individuals Members of ethnic minority groups Residents of inner cities Men Prior history of substance abuse

7. Assessment Signs and Symptoms: –Mild: headache mental confusion Lightheadedness dizziness double vision, blurred vision, or tired eyes, ringing in the ears, bad taste in the mouth, fatigue or lethargy, a change in sleep patterns, behavioral or mood changes, and trouble with memory, concentration, attention, or thinking

8. Assessment Signs and Symptoms: –Moderate to severe: loss of consciousness personality change severe, persistent, or worsening headache repeated vomiting or nausea, seizures inability to awaken, dilation (widening) of one or both pupils, slurred speech, weakness or numbness in the extremities, loss of coordination, and/or increased confusion, restlessness, or agitation

9. Assessment Glasgow Coma Scale –Eye opening: Spontaneous = 4 To speech = 3 To painful stimulation = 2 No response = 1

10. Assessment Glasgow Coma Scale –Motor response: Follows commands = 6 Makes localizing movements to pain = 5 Makes withdrawal movements to pain = 4 Flexor (decorticate) posturing to pain = 3 Extensor (decerebrate) posturing to pain = 2 No response = 1

11. Assessment Glasgow Coma Scale –Verbal response: Oriented to person, place, and date = 5 Converses but is disoriented = 4 Says inappropriate words = 3 Says incomprehensible sounds = 2 No response = 1

12. Assessment Severity of TBI –GCS score (within 48 h) is as follows: Severe TBI = 1-8 Moderate TBI = 9-12 Mild TBI = 13-15

13. Traumatic Brain Injury Classification –Closed Head Injury: Occurs when the head forcefully collides with another object (for example the windshield of a car) but doesn't fracture or penetrate the skull. –Open Head Injury: Occurs when an object (for example a bullet) fractures the skull and debris enter the brain.

14. Traumatic Brain Injury Classification –Focal: Confined to one area of the brain. –Diffuse: Involving more than one area of the brain.

15. Traumatic Brain Injury Focal –Associated with: Contusion: bruising of brain Intracranial hemorrhage (hematoma): heavy bleeding in the skull. Hemorrhage, due to rupture of a blood vessel in the head, can be extra-axial, meaning it occurs within the skull but outside of the brain, or intra-axial, occurring within the brain. Extra-axial hemorrhages: subdural hematoma, epidural hematoma, and subarachnoid hemorrhage. Intra-axial bleeds: intraparenchymal hemorrhage which occurs within the brain tissue itself and intraventricular hemorrhage which occurs into the ventricular system.

16. Traumatic Brain Injury Diffuse –Associated with: Concussion: a shaking of the brain in response to sudden motion of the head Diffuse axonal injury (DAI): extensive generalized damage to the white matter tracts of the brain and a major cause of unconsciousness after head trauma. 90% of patients with severe DAI never regain consciousness. Coma: profound state of unconsciousness

17. Traumatic Brain Injury Prognostic Factors –Premorbid factors (medical diagnosis prior to injury) –Length of unconsciousness –Areas of brain damage –Age of onset –Family Support

18. Traumatic Brain Injury Prevention: –Centers of Disease Control and Prevention (CDC) have issued the following safety tips for reducing the risk of suffering a TBI. Wearing a seatbelt Using child safety seats, booster seat, or seatbelt Wearing a helmet when riding a bike or motorcycle; playing a contact sports; using in-line skates or riding a skateboard; horseback riding; rock climbing; skiing or snowboarding Keep firearms and bullets stored in a locked cabinet Avoid falls by using a step-stool with a grab bar; installing handrails on stairways; using safety gates with young children

19. Traumatic Brain Injury Current Trends: –Incidence of TBI has been decreasing because of introduction of preventive measures and better enforcement of drunk driving laws.

20. Traumatic Brain Injury Famous people with TBI –Mohammed Ali

21. References Brain Injury Association –http://www.biausa.orgwww.biausa.org National Center for Neurogenic Communication Disorders –http://www.cnet.shs.arizona.eduhttp://www.cnet.shs.arizona.edu American Academy of Neurology –http://www.aan.comwww.aan.com http://en.wikipedia.org http://www.emedicine.com