TRAUMATIC BRAIN INJURY: EPIDEMIOLOGY, ANATOMY AND PATHOPHYSIOLOGY

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TRAUMATIC BRAIN INJURYEPIDEMIOLOGY, ANATOMY AND
PATHOPHYSIOLOGY

• MARY PEPPING, Ph.D.
• Associate Professor
• University of Washington School of Medicine

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THE PATIENTS WHO SUSTAIN SEVERE TBI

• MALES/FEMALES 75/25
• UNDER AGE 30
• ALCOHOL AS A RISK FACTOR
• ACCELERATION/
• DECELERATION INJURIES
• OUTCOMES - 1/3 WORKING AFTER /gt 24 HOURS COMA

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Primary Secondary Brain Injury

• SECONDARY INJURIES
• SWELLING OR MASS EFFECTS
• MIDLINE SHIFT
• BRAINSTEM HERNIATION
• HEMATOMAS
• OBSTRUCTIVE HYDROCEPHALUS

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Primary Secondary Brain Injury

• SECONDARY INJURIES (continued)
• INFECTION
• ANOXIA
• INFARCTION FROM BONE BREAKS/BLOOD CLOTS
• NECK INJURY AND DISSECTING CAROTID ARTERIES
• CHEMICAL CHANGES IN CELLULAR FUNCTION

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Primary Secondary Brain Injury

• INITIAL IMPACT
• CONTUSIONS, RUPTURED VESSELS, FRACTURED SKULL
• COUP AND CONTRE-COUP INJURIES
• STRETCHING AND SHEERING OF NEURONS
• SEVERE WHIPLASH/SPINAL INJURY

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TYPICAL INJURIES - DIFFUSE TBI WITH MAJOR FOCI
Case 1

• SIGNIF FRONTAL INJURY - DISINHIBITED
• ORBITAL FRONTAL CORTEX DAMAGE
• IMPULSIVITY, AGITATION
• INAPPROPRIATE SOCIAL PRESENTATION

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CASE 2 - SIGNIF FRONTAL INJURY SLOWED

• LATERAL FRONTAL CORTEX DAMAGE
• PSYCHOMOTOR RETARDATION
• CHILDLIKE AFFECT AND RESPONSES

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CASE 3 - SIGNIFIGANT FRONTAL-TEMPORAL INJURY

• ANTERIOR TIPS OF FRONTAL AND TEMPORAL LOBES
• CLASSIC CONSTELLATION OF TBI PROBLEMS
• REDUCED MEMORY, ATTENTION, AWARENESS,
  PROBLEM-SOLVING, ORGANIZATION, FLEXIBILITY

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CASE 4 - SIGNIF RIGHT TEMPORAL-PARIETAL INJURY

• PARANOIA, VISUAL SPATIAL DEFICITS, MISPERCEPTION
  OF OTHER PEOPLES FACIAL EXPRESSIONS OR
  INTENTIONS, POOR VISUAL MEMORY
• LEFT NEGLECT OR INATTENTION

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CASE 5 - SIGNIFICANT LEFT HEMISPHERE IMPAIRMENT

• APHASIA, REDUCED NAMING, VERBAL FLUENCY
• PROBLEMS WITH VERBAL EXPRESSION
• PROBLEMS WITH COMPREHENSION
• CHANGES IN READING, WRITING, ARITHMETIC
• RIGHT NEGLECT OR INATTENTION

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CASE 6 - SIGNIF GLOBAL INJURY W/BRAIN STEM

• CRANIAL NERVE INVOLVEMENT
• SWALLOWING, DROOLING, MOTOR SPEECH
• VISUAL DISTURBANCES DOUBLE VISION
• GREATLY REDUCED SPEED OF THOUGHT AND MOVEMENT
• PROBLEMS WITH SPASTICITY, WALKING, STANDING