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Traumatic Brain Injuries (TBI) - Coggle Diagram
Traumatic Brain Injuries (TBI)
Definition
• Brain damage caused by external force
• Can be closed head injury or open head injury
• Examples: concussion, contusion, diffuse axonal injury, hematoma
Etiology
• Traumatic: falls, motor vehicle accidents (MVA), sports, assaults, blasts
• Non-traumatic: overdose, anoxia, infections (meningitis/encephalitis), tumors, epilepsy, degenerative diseases
Pathophysiology
• Coup & Contrecoup injuries
• Focal vs diffuse injury
• Hemorrhage: epidural, subdural, subarachnoid, intracerebral, intraventricular
• Axonal shearing, cerebral edema
Clinical Features & Level of Consciousness
• Physical Status
• Decorticate & decerebrate rigidity
• Cogwheel rigidity
• Spasticity, hypo/hypertonicity
• Cognitive Status
• Impaired attention & memory
• Reduced self-awareness, poor judgment
• Psychosocial Status
• Loss of self-concept & social roles
• Difficulty living independently
• Visual Status
• Blurred vision, nystagmus
• Hemianopia, ptosis
• Perceptual Status
• Visual agnosia, body schema deficit
• Apraxia, aphasia
• Level of Consciousness
• Glasgow Coma Scale (E, V, M)
• Rancho Los Amigos Scale (Levels I–VIII)
• Post-Traumatic Amnesia Scale (PTAS)
• Medical & Surgical Management
Diagnosis
• CT scan / MRI
• TBI classification: Mild, Moderate, Severe
• Monitor GCS, LOC, PTA
• Craniotomy, Craniectomy
• Ventriculoperitoneal Shunt (hydrocephalus)
• Endoscopic Ventriculostomy
• Cranioplasty
• Control ICP, oxygenation, hemodynamics
Prognosis
• Complications
• Hypotension
• Hypoxia
• Increased intracranial pressure (ICP)
• Seizures
• Hydrocephalus
• Depends on:
• Duration of coma
• Duration of PTA
• Location & size of lesion
• Access to immediate treatment
• Multiple injuries
• Mortality: severe focal 40%, severe diffuse 25%
the Rancho Los Amigos Levels of Cognitive Functioning Scale:
(Low Response Levels (Severe Impairment))
Level I – No Response
• Patient is in deep coma.
Level II – Generalized Response
•Inconsistent and delayed responses.
Level III – Localized Response
•Responses are specific to the stimulus (example:turning head to sound, withdrawing from pain).
The Rancho Los Amigos Levels of Cognitive Functioning Scale:
(Confused Levels (Moderate Impairment))
Level IV – Confused-Agitated
•Very restless, aggressive, or bizarre behavior.
Level V – Confused-Inappropriate, Non-Agitated
•Can follow simple commands with structure.
Level VI – Confused-Appropriate
•Follows simple directions consistently.
The Rancho Los Amigos Levels of Cognitive Functioning Scale:
(Higher Functioning Levels (Mild Impairment/ Recovery)
Level VII – Automatic-Appropriate
•Superficially oriented, but poor problem-solving and limited insight.
Level VIII – Purposeful-Appropriate
•Alert, oriented, independent in home & community skills.
The Rancho Los Amigos Levels of Cognitive Functioning Scale:
(Extended Levels (High Functioning))
Level IX – Purposeful-Appropriate (Standby on request)
•Can shift between tasks and use memory aids independently.
Level X – Purposeful-Appropriate (Modified Independent)
•Handles multiple tasks in all environments.
Postural Patterns
•Decerebrate Rigidity → Extension arms/legs (brainstem lesion).
•Decorticate Rigidity → Flexed arms, extended legs (cortical lesion).
Tone & Movement
•Bruxism → Teeth grinding.
•Spasticity → Velocity-dependent ↑ tone (UMN lesion).
•Rigidity → Constant resistance (Parkinson’s).
•Bradykinesia → Slow movement (Parkinson’s).
Movement Disorders
•Torticollis → Twisted neck.
•Myoclonus → Sudden jerks.
•Tremor → Rhythmic shaking.
•Dystonia → Sustained abnormal posture.
•Athetosis → Slow writhing.
•Chorea → Rapid dance-like.
•Hemiballismus → Violent flinging (one side).
•Tics → Repetitive motor/vocal.
•Pseudobulbar Athetoid Syndrome → Bulbar palsy + athetoid movements.