Traumatic Brain Injury Diagnostic Overview

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

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

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

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.

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

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

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

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

Causes MVA, bicycle, etc. - more than 50% Falls - 25% Violence - 20% Men more than women 15 - 24 years old and 75+ years

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.

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

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

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.

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