Traumatic Brain Injuries

• Head Injuries

Definition: any traumatic insult to the brain that results in physical,

intellectual, emotional, social, or vocational changes; occurs due to a blow or
external force applied to the head.

Classifications:

 Open trauma

- An opening in the scalp, skull, meninges, or brain tissue,

including dura, exposes the cranial contents to the environment;
higher risk for infection

 Closed trauma or blunt trauma

- More common; occurs when the head strikes a hard surface or a

rapidly moving objects strikes the head.

- Dura mater is intact, and no brain tissue is exposed to the

external environment

 Types of closed head injuries:

o Concussion: brief interruption in brain activity with or without

loss of
consciousness.
o Diffuse axonal injury: diffuse (means widespread) injury to
axons,
the corpus callosum, white matter, and the brainstem. This one is
bad. It is the cause of posttraumatic dementia as well as persistent
vegetative states. This one is a prime example of the coup-
contrecoup
injury.
o Contusion: blunt trauma causes a bruise to the cortical surface
of
the brain resulting in permanent damage to the brain tissue.
Bruised
and necrotic tissue are eventually replaced with scar tissue and/or
“crater.”
o Hematoma: vascular bleeding. The type of hematoma is
determined
 by the actual site of the bleeding vessels. Types of hematomas
include
epidural, subdural, and intracerebral hematomas.
o Epidural: bleeding that occurs between the skull and the dura.
o Subdural: bleeding between the dura and the subdural
(arachnoid)
space.
o Traumatic intracerebral: one or more hematomas. Occurs
anywhere
in the brain, but most common in the frontal or temporal lobes.

Causes:
• Falls
• Interpersonal alterations
• Motor vehicle collisions
• Sports-related incidents
Risk Factors:
• young children
• elderly people
• more common to men

Pathophysiology:
 Signs and Symptoms:

**Signs and symptoms are highly variable from client to client depending on
the type and degree of injury:
a. Alterations in sensory and motor function
b. Altered LOC including confusion, delirium
c. Stupor and/ or coma
d. Behavior changes including irritability, combativeness
e. Alteration in respiratory function
f. Abnormal eye movements
g. Abnormal pupil reflexes
Complicaitons:
 Increased intracranial pressure

 Infection (open trauma)

 Respiratory depression and failure

 Permanent neurologic deficits

 Brain herniation

Diagnostic Exams:

 Computed tomography (CT) scan

 Magnetic resonance imaging (MRI)

 Positron emission tomography (PET)

• Spinal Cord Injuries

Definition: injury to the spinal cord via trauma by external force; includes
fractures, contusions, and compressions of the vertebral column, usually as
the result of trauma to the head or neck.
Types Description Signs and
Symptoms

Complete transaction  All tracts of spinal  Loss of motor function

cord completely (quadriplegia or
disrupted paraplegia)
 All functions involving  Muscle flaccidity
spinal cord below  Loss of all reflexes
level of transaction and sensory function
lost below level of injury
 Complete and  Bladder, bowel and
permanent loss sexual dysfunction
with lumbar or sacral
disruption
 Paralytic ileus
 Loss of vasomotor
tone below level of
injury with low and
unstable blood
pressure
 Loss of perspiration
below level of injury
Incomplete  Center portion of cord  Motor deficits greater
transaction: affected in upper than in lower
Central cord  Typically from extremities
syndrome hyperextension injury  Variable degree of
bladder dysfunction
Incomplete  Occlusion of anterior  Loss of motor
transaction: spinal artery function, pain, and
Anterior cord  Occlusion occurs from temperature
syndrome pressure of bone sensations below
fragments level of injury

Incomplete  Hemisection of the  Ipsilateral paralysis or

transaction: cord paresis, contralateral
Brown-Sequard  Most common in loss of pain and
syndrome stabbing and gunshot temperature
wounds sensations below
level of injury
Causes:
 diving into shallow water
 falls
 gunshot or stab wounds
 motor vehicle collisions
 sports injuries
 lifting heavy objects
  hyperparathyroidism
 neoplastic lesions
Mechanisms involved with spinal cord trauma:

 Hyperextension from acceleration-deceleration forces and sudden

reduction in the anteroposterior diameter of the spinal cord

 Hyperflexion from sudden and excessive force, propelling in the neck

forward or causing an exaggerated movement to one side

 Verical compression from force being applied from the top of the
cranim along the vertical axis through the vertebra or from the lumbar
spine upward

 Rotational forces from twisting, which adds shearing forces

Pathophysiology:
 Signs and Symptoms:

Areflexia (loss of reflex function)

Respiratory dysfunction

Hypothermia

Paralytic ileus
 Urinary retention, incontinence

Thrombophlebitis

Paralysis with muscle spasms

- Paraplegia: paralysis of the lower portion of the body with lower trunk
involvement.

- Quadriplegia: paralysis or impaired function of all four limbs, trunk and pelvic
organs

Complications:

 Spinal shock

 Neurogenic shock

 Autonomic dysreflexia

Diagnostic Exams:

 Spinal X-rays

 Computed tomography (CT) scan

Sources:

http://books.google.com.ph/books?
id=ThYtQC8mzj8C&pg=PA253&lpg=PA253&dq=agnosia+pathophysiology&source=
bl&ots=Q8_0XoXEbg&sig=Se0ruEOs-
A0kc4CPxOawaNVFB2w&hl=en&ei=ogu5TPnVHomlcfjWlLAM&sa=X&oi=book_result
&ct=result&resnum=5&ved=0CCEQ6AEwBA#v=onepage&q&f=false