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  Eye-Opening
 Ranks quality of  4 - Responds
response in 3 areas: Spontaneously
Eye Opening, Best  3 - Responds to voice
Motor Response, &  2 - Responds to pain
Best Verbal Response
 1 - No response
 Diagnosis cont’d
 Best Motor Response  2 - Decerebrate
 6 - Follows commands (produces an
 5 - Localizes to pain exaggerated posture
 4 - Withdraws from pain of extension in
 3 - Decorticate (produces response to pain)
an exaggerated posture of  1 - No response
upper extremity flexion
and lower extremity
extension in response to
pain
 Diagnosis cont’d
 Best Verbal Response  Scores of 8 or below
 5 - Oriented and conversational
indicate severe injury
 4 - Disoriented and
conversational  9-12 suggest
 3 - Inappropriate words moderate brain injury
 2 - Incomprehensible sounds
 1 - No response
 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  Focal injury refers to
trauma an injury that is
 “Closed head” injury confined to a specific
refers to injury not area of the brain
resulting from causing localized
penetration of the damage.
skull  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  Hematoma (SDH)
 Bleeding into brain tissue  Bleeding over the
 Infarction (stroke) surface of the brain
 Occipital/Temporal lobes exerts pressure and
 Occur when an artery is may need to be
compressed by the surgically drained
swelling of surrounding
tissues, restricting blood
flow and its essential
nutrients
 Prognosis
 Duration of coma  More severe the
 Severity of coma injury, the longer the
recovery period
immediate post-injury
 Recovery from
 Duration of post- diffuse damage takes
traumatic amnesia longer than from
 Location and size of localized damage
injury  Need for surgery does
 Severity of injuries to not necessarily
other body systems 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