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Traumatic Brain Injury (TBI) - Coggle Diagram
Traumatic Brain Injury (TBI)
Definition
Alteration in brain function or brain pathology caused by external force
Possible outcomes:
Loss of consciousness (LOC)
Post-traumatic amnesia (PTA)
Skull fracture
Neurological deficits (motor, sensory, cognitive)
Types of damage:
Focal
direct blow, skull fracture, coup/contrecoup
Diffuse
diffuse axonal injury, contusions
Injury types
Closed head injury (blunt trauma, no skull penetration)
Open head injury (penetrating injury)
Subtypes
Concussion, Chronic Traumatic Encephalopathy (CTE)
Etiology
Traumatic causes:
Falls (common in >65 years)
Motor vehicle accidents (15–40 years)
Assaults, sports injuries (5–24 years)
Military blast injuries
Non-traumatic causes:
Stroke, brain tumors
Infection (meningitis, encephalitis)
Hypoxia (near drowning, cardiac arrest)
Toxins (drugs, CO poisoning)
Degenerative diseases, epilepsy
Pathophysiology
Mechanisms:
Vascular Injuries
rupture of vessels causing hematomas
Coup injury
damage at impact site
Contrecoup injury
damage opposite to impact site
Diffuse axonal injuries
shearing forces damaging axons
Common injuries:
Epidural hematoma (EDH)
arterial bleeding, skull fracture
Subdural hematoma (SDH)
enous bleeding, between dura & brain
Subarachnoid hemorrhage (SAH)
bleeding beneath arachnoid membrane
Intraventricular hemorrhage (IVH)
an cause hydrocephalus
Clinical Features
Physical
Decorticate / decerebrate rigidity
Abnormal tone (hypo/hypertonicity)
Weakness, spasticity, ataxia
Primitive reflexes, postural deficits
Limited ROM, sensory changes
Cognitive
Memory loss (short & long term)
Poor initiation/termination of activities
Impaired executive function & judgment
Poor attention & concentration
Psychosocial
Role loss, self-concept disturbance
Depression, emotional instability
Loss of independence
Visual
Blurred vision, nystagmus, hemianopia
Strabismus, ptosis
Perceptual
Visual perception deficits
Body schema disturbance (neglect)
Apraxia, aphasia
Level of Consciousness (LOC) Assessment
Glasgow Coma Scale (GCS)
Eye, Verbal, Motor responses
Rancho Los Amigos Scale (RLAS)
Post-Traumatic Amnesia Scale (PTAS)
severity based on duration
8 levels of cognitive function
Diagnosis
Mild:
brief or no LOC, stable vitals, observation
Moderate:
close monitoring, CT scan, may not need ICU
Severe:
ICU care, ICP monitoring, repeated imaging
Complications
Hypotension
Hypoxia
Increased intracranial pressure (ICP)
Seizures
Hydrocephalus
Medical & Surgical Management
Craniotomy
remove skull section to drain hematoma
Endoscopic ventriculostomy
treat hydrocephalus
Ventriculoperitoneal shunt (VPS)
drain CSF
Cranioplasty
skull reconstruction after recovery
Decompressive craniectomy
relieve high ICP
Prognosis Factors
Severity (GCS, LOC, PTA)
Lesion location & size
Multiple injuries
Immediate specialized care