Traumatic Brain Injury

Francisco R. Solis, MS IVSt. Barnabas Hospital

NYCOM-Class of 2007

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.

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.

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 2nd 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 3rd 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.

Traumatic Brain Injury

• Mechanism of injury

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

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

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

Assessment

• Glasgow Coma Scale– Eye opening:

• Spontaneous = 4 • To speech = 3 • To painful stimulation = 2 • No response = 1

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

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

Assessment

• Severity of TBI – GCS score (within 48 h) is as follows:

• Severe TBI = 1-8 • Moderate TBI = 9-12 • Mild TBI = 13-15

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.

Traumatic Brain Injury

• Classification– Focal: Confined to one area of the brain.

– Diffuse: Involving more than one area of the brain.

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.

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

Traumatic Brain Injury

• Prognostic Factors– Premorbid factors (medical diagnosis prior to

injury) – Length of unconsciousness– Areas of brain damage– Age of onset – Family Support

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

Traumatic Brain Injury

• Current Trends:– Incidence of TBI has been decreasing

because of introduction of preventive measures and better enforcement of drunk driving laws.

Traumatic Brain Injury

• Famous people with TBI– Mohammed Ali

References

• Brain Injury Association – http://www.biausa.org

• National Center for Neurogenic Communication Disorders– http://www.cnet.shs.arizona.edu

• American Academy of Neurology – http://www.aan.com

• http://en.wikipedia.org

• http://www.emedicine.com