Brain Structure and Stroke Mechanisms

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Questions and Answers

What is the primary characteristic of a concussion?

  • Only associated with sports injuries
  • Exclusively life-threatening injury
  • Immediate and transient alteration in brain function (correct)
  • Permanent brain damage

Which of the following represents a closed traumatic brain injury (TBI)?

  • A skull fracture from a fall
  • A gunshot wound to the head
  • A concussion resulting from a motor vehicle accident (correct)
  • A stab wound to the brain

Which of the following is a common sequela of traumatic brain injury related to alcohol use?

  • Cognitive dysfunction due to sustained neuroinflammation (correct)
  • Increased protective reflexes
  • Instant recovery after injury
  • Decreased risk of developing disorders

What role does beta-amyloid play in Alzheimer's Disease?

<p>It blocks signaling and communication between neurons (D)</p> Signup and view all the answers

Which of the following symptoms is NOT typically associated with Alzheimer's Disease?

<p>Diminished reflexes (A)</p> Signup and view all the answers

What type of TBI is characterized by axonal damage that is widely distributed in the brain?

<p>Diffuse axonal injury (C)</p> Signup and view all the answers

Which test is primarily used for cognitive screening in Alzheimer's Disease diagnosis?

<p>Memory assessment (D)</p> Signup and view all the answers

What is one of the first clinical manifestations of spinal cord injury?

<p>Loss of movement (D)</p> Signup and view all the answers

What mechanism primarily describes secondary injury in traumatic brain injury?

<p>Long-term cascade of biochemical and physiological events (D)</p> Signup and view all the answers

Individuals with which condition may have a higher risk of developing Alzheimer's Disease after a traumatic brain injury?

<p>Chronic Traumatic Encephalopathy (CTE) (D)</p> Signup and view all the answers

Which of the following is a sign of neurogenic bowel?

<p>Increased colonic transit time (D)</p> Signup and view all the answers

What is the main consequence of inadequate tissue perfusion in pressure ulcers?

<p>Tissue ischemia (B)</p> Signup and view all the answers

How often should a patient be turned to manage pressure ulcers?

<p>Every 2 hours (D)</p> Signup and view all the answers

What is a potential complication associated with neurogenic bowel?

<p>Excessive stool retention (D)</p> Signup and view all the answers

What symptom is NOT typically associated with neurogenic bowel?

<p>Frequent urination (D)</p> Signup and view all the answers

What should be assessed regularly in patients at risk of pressure ulcers?

<p>Skin condition over bony prominences (D)</p> Signup and view all the answers

Which statement about managing pressure ulcers is false?

<p>Positioning is not critical in prevention. (C)</p> Signup and view all the answers

What is a common symptom of a neurogenic bowel condition?

<p>Evacuation difficulty (B)</p> Signup and view all the answers

What aspect is important when managing pressure ulcers?

<p>Keeping skin dry and clean (B)</p> Signup and view all the answers

What is a characteristic of lesions formed due to pressure ulcers?

<p>They can be influenced by mechanical tissue destruction. (D)</p> Signup and view all the answers

What is the primary function associated with the frontal lobe of the brain?

<p>Concentration, planning, and problem solving (B)</p> Signup and view all the answers

Which type of stroke is characterized by a blood clot that impedes blood flow?

<p>Ischemic stroke (A)</p> Signup and view all the answers

What are the symptoms of a stroke affecting the right side of the brain?

<p>Left-sided weakness and slurred speech (B)</p> Signup and view all the answers

What condition arises when there is a decrease in oxygen supply to the brain?

<p>Cerebral hypoxia/ischemia (D)</p> Signup and view all the answers

Which type of edema is characterized by brain swelling due to increased fluid in the brain?

<p>Cerebral edema (D)</p> Signup and view all the answers

What is a major cause of hemorrhagic stroke?

<p>Uncontrolled hypertension (C)</p> Signup and view all the answers

What neurological function is primarily affected by a stroke on the left side of the brain?

<p>Comprehension and memory (A)</p> Signup and view all the answers

What condition describes excessive stimulation of neurotransmitters leading to injury?

<p>Excitotoxicity (C)</p> Signup and view all the answers

What is the primary symptom of a stroke affecting the brain stem?

<p>Abnormal eye movements (B)</p> Signup and view all the answers

Which phenomenon refers to the areas of the brain most susceptible to ischemia?

<p>Watershed zones (A)</p> Signup and view all the answers

What signifies ASIA A spinal cord injury?

<p>All or almost all function is lost below the injury (A)</p> Signup and view all the answers

What is the leading cause of spinal cord injury?

<p>Vehicle crashes (D)</p> Signup and view all the answers

Which type of force is associated with flexion injuries of the cervical spine?

<p>Hit from behind (A)</p> Signup and view all the answers

What is a consequence of autonomic dysreflexia?

<p>Elevated blood pressure (C)</p> Signup and view all the answers

Which spinal cord injury level typically does NOT impact respiratory function?

<p>T12 (A)</p> Signup and view all the answers

What defines tetraplegia?

<p>Loss of function in all four limbs and trunk (B)</p> Signup and view all the answers

Which option represents a clinical sign of neurogenic bladder?

<p>Urinary retention (D)</p> Signup and view all the answers

What is the primary neurological injury?

<p>Injury that happens at the moment of impact (C)</p> Signup and view all the answers

What characterizes an incomplete tetraplegia?

<p>Some motor/sensory function preserved below the injury (D)</p> Signup and view all the answers

Which sign is associated with respiratory problems in spinal cord injury?

<p>Change in respiratory rate (C)</p> Signup and view all the answers

What is the primary symptom of a stroke affecting the right side of the brain?

<p>Left-sided neglect (B)</p> Signup and view all the answers

Which mechanism is characterized by a decrease of oxygen supply to the brain?

<p>Cerebral hypoxia/ischemia (B)</p> Signup and view all the answers

Which type of stroke is caused by a rupture of a blood vessel?

<p>Hemorrhagic stroke (D)</p> Signup and view all the answers

What consequence arises due to excitotoxicity in the brain?

<p>Cell necrosis (D)</p> Signup and view all the answers

What type of edema involves fluid accumulation due to the breakdown of the blood-brain barrier?

<p>Vasogenic edema (D)</p> Signup and view all the answers

What significant effect does altitude have on alcohol tolerance?

<p>Decreases tolerance (D)</p> Signup and view all the answers

Which brain area is primarily responsible for motor control and planning?

<p>Frontal lobe (D)</p> Signup and view all the answers

What is a potential result of cerebral ischemia?

<p>Death of brain cells (A)</p> Signup and view all the answers

Which of the following symptoms is associated with a stroke affecting the brain stem?

<p>Nausea and vomiting (A)</p> Signup and view all the answers

What is defined as the areas of the brain that are farthest from the arterial supply and most susceptible to ischemia?

<p>Watershed zones (D)</p> Signup and view all the answers

What is a defining characteristic of closed traumatic brain injury (TBI)?

<p>No opening or cracking of the skull (D)</p> Signup and view all the answers

Which symptom is most commonly associated with mild traumatic brain injury (concussion)?

<p>Confusion and disorientation (B)</p> Signup and view all the answers

Which factor increases the likelihood of traumatic brain injury (TBI) while intoxicated?

<p>Increased risk of falls and accidents (D)</p> Signup and view all the answers

What is the primary post-mortem diagnostic criterion for Alzheimer's Disease?

<p>Presence of neurofibrillary tangles (A)</p> Signup and view all the answers

What cascade of events is associated with secondary brain injury following TBI?

<p>Delayed inflammation and increased intracranial pressure (D)</p> Signup and view all the answers

What is NOT a common symptom of Alzheimer’s Disease?

<p>Euphoria and excessive happiness (C)</p> Signup and view all the answers

Which condition is associated with the accumulation of beta-amyloid in the brain?

<p>Alzheimer's Disease (D)</p> Signup and view all the answers

Which imaging technique is commonly used to rule out tumors in the diagnosis of Alzheimer's Disease?

<p>Magnetic Resonance Imaging (MRI) (D)</p> Signup and view all the answers

What role do cholinesterase inhibitors serve in treating Alzheimer’s Disease?

<p>Improve cognitive symptoms (D)</p> Signup and view all the answers

Which statement about the impact of traumatic brain injury (TBI) is TRUE?

<p>Repeat mild TBI increases the risk of degenerative disorders (A)</p> Signup and view all the answers

What condition is characterized by a loss of slow stool propulsion leading to potential incontinence?

<p>Neurogenic bowel (D)</p> Signup and view all the answers

What is a common consequence of unrelieved pressure in patients at risk for pressure ulcers?

<p>Tissue ischemia (A)</p> Signup and view all the answers

What management strategy is crucial for preventing pressure ulcers?

<p>Turning the patient every 2 hours (C)</p> Signup and view all the answers

What symptom can indicate severe neurogenic bowel dysfunction?

<p>Early satiety (A)</p> Signup and view all the answers

Which of the following factors is NOT relevant to the management of pressure ulcers?

<p>Measuring patient weight (B)</p> Signup and view all the answers

What process occurs when blood vessels collapse due to excessive pressure, leading to skin issues?

<p>Thrombotic occlusion (D)</p> Signup and view all the answers

What should be included in regular skin checks for patients at risk of pressure ulcers?

<p>Location and stage of wounds (D)</p> Signup and view all the answers

Which of these might result from an inadequate lymphatic function in pressure ulcers?

<p>Fluid accumulation (C)</p> Signup and view all the answers

Which dietary consideration is important in managing pressure ulcers?

<p>Nutrient and hydration supplements (C)</p> Signup and view all the answers

What is the difference between tetraplegia and paraplegia?

<p>Tetraplegia results from cervical injury, whereas paraplegia results from thoracic or lower injury. (A)</p> Signup and view all the answers

Which of the following types of spinal cord injuries is typically caused by a force coming from behind?

<p>Flexion (B)</p> Signup and view all the answers

Which mechanism primarily contributes to secondary spinal cord injury?

<p>Inflammatory processes promoting further damage (C)</p> Signup and view all the answers

What is a common sign indicating autonomic dysreflexia?

<p>Elevated blood pressure by at least 20 mmHg from baseline (A)</p> Signup and view all the answers

What characterizes a neurogenic bladder resulting from suprasacral injuries?

<p>Constant filling but inability to void, leading to urinary retention (C)</p> Signup and view all the answers

What are primary concerns for nursing care in acute spinal cord injury?

<p>Maintaining stable blood pressure and monitoring cardiovascular function (B)</p> Signup and view all the answers

What is the last preserved functioning vertebra in a person with a spinal cord injury at the C4 level?

<p>C4 (C)</p> Signup and view all the answers

What type of spinal cord injury is most frequently associated with incomplete tetraplegia?

<p>Compression injuries (A)</p> Signup and view all the answers

Which of the following is commonly recognized as a leading cause of spinal cord injuries?

<p>Vehicle crashes (C)</p> Signup and view all the answers

What factors can lead to respiratory problems in spinal cord injury patients?

<p>Impairment of cough reflex due to abdominal muscle immobilization (A)</p> Signup and view all the answers

Flashcards

Ischemic Stroke

A stroke caused by a blood clot blocking blood flow to the brain.

Hemorrhagic Stroke

A stroke caused by a ruptured blood vessel in the brain.

Cerebral Hypoxia/Ischemia

Reduced oxygen supply to the brain. Can lead to brain damage.

Stroke Left Side Effects

Right-sided weakness, speech difficulty, comprehension and memory issues, left gaze preference.

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Stroke Right Side Effects

Left-sided weakness/paralysis, neglect of the left side, slurred speech.

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Brain Stem Stroke

Extremely serious stroke affecting the brain stem, with severe consequences, including nausea, vomiting, and abnormal eye movements.

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Cerebral Edema

Brain swelling due to excess fluid.

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Vasogenic Edema

Fluid buildup outside brain cells due to blood-brain barrier disruption.

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Cytotoxic Edema

Cell swelling inside brain cells due to cellular injury.

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Excitotoxicity

Harmful over-stimulation of neurons (e.g., by glutamate).

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Traumatic Brain Injury (TBI)

A non-degenerative, non-congenital brain insult caused by external mechanical force.

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Closed TBI

TBI where the skull isn't broken open.

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Penetrating TBI

TBI caused by an object piercing the skull and brain.

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Concussion (Mild TBI)

A temporary brain function change after a blow to the head, with altered mental state.

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Primary TBI Injury

Initial immediate damage to the brain caused by the impact itself.

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Secondary TBI Injury

Later consequences from the initial TBI, including inflammation and increased pressure.

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Alzheimer's Disease

Most common dementia type, causing progressive memory, thinking, and behavior problems.

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Beta-amyloid plaques

Protein clumps that block brain communication in Alzheimer's.

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Spinal Cord Injury (SCI)

Damage to the spinal cord leading to loss of function below the injury.

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TBI and Alcohol

Increased risk of TBI with intoxication, and alcohol use disorders in TBI patients.

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Spinal Cord Injury

Damage to the neural elements of the spinal cord causing permanent changes in sensation and voluntary control below the injury site.

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Tetraplegia

Impairment or loss of motor/sensory function from damage to the cervical region, affecting all 4 limbs, trunk, and pelvic organs.

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Paraplegia

Impairment or loss of motor/sensory function from damage to the thoracic, lumbar, or sacral structures, affecting the trunk, legs, and lower pelvic organs.

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ASIA A

Complete loss of sensory/motor function below the injury level.

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ASIA B-E

Incomplete loss of sensory/motor function below the injury level, with progressively more function preserved as you go from B to E.

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Autonomic Dysreflexia

A dangerous condition occurring in SCI above T6, characterized by high blood pressure and bradycardia due to a stimulus below the injury.

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Paradoxical Breathing

A reversed breathing pattern where the chest contracts during inhalation and rises during exhalation.

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Neurogenic Bladder

Complete or partial loss of bladder control due to spinal cord injury, leading to incontinence, retention, or other complications.

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Hyper-reflexive Bowel

Involuntary contractions of rectal and anal muscles due to injury above T10, leading to constipation.

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Areflexic Bowel

Loss of voluntary control over bowel movements due to injury below T10, leading to incontinence.

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Neurogenic Bowel

A condition where bowel function is impaired due to nerve damage or dysfunction, causing problems with stool control and movement.

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Increased Colonic Transit Time

A sign of neurogenic bowel where stool moves too slowly through the colon, causing constipation.

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Constipation in Neurogenic Bowel

A common symptom of neurogenic bowel where stool is hard and difficult to pass due to slow movement through the colon.

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Abdominal Distention

A symptom of neurogenic bowel where the abdomen is swollen due to the buildup of stool and gas.

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Respiratory Compromise

A potential serious complication of neurogenic bowel where the ability to breathe is affected due to abdominal distention.

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Early Satiety

A symptom of neurogenic bowel where a person feels full quickly after eating, even with small amounts of food.

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Pressure Ulcers

Tissue damage caused by prolonged pressure on the skin, particularly over bony prominences.

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Tissue Ischemia

A condition where tissues are deprived of oxygen due to reduced blood flow.

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Management of Pressure Ulcers

Preventing and treating pressure ulcers by turning patients regularly, checking skin frequently, maintaining good hygiene, and supporting nutrition.

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Hypobaric Hypoxia

A decrease in oxygen supply to the brain due to a reduction in atmospheric pressure, often linked to altitude.

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Watershed Zones

Areas of the brain farthest from arterial supply, making them particularly vulnerable to ischemia during reduced blood flow.

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Left Brain Stroke

A stroke affecting the left hemisphere of the brain, resulting in right-sided weakness, speech problems, and cognitive deficits.

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Right Brain Stroke

A stroke affecting the right hemisphere of the brain, resulting in left-sided weakness, neglect of the left side, and speech difficulties.

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Complete SCI (ASIA A)

All or almost all sensory/motor function is lost below the injury level.

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Incomplete SCI (ASIA B-E)

There is some residual motor/sensory function below the level of injury.

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What is a TBI?

A traumatic brain injury (TBI) is damage to the brain caused by an external force, such as a blow to the head or a penetrating object.

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What are the types of TBI?

TBIs can be classified as closed or penetrating. Closed TBIs involve no skull fracture, while penetrating TBIs involve an object entering the brain.

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What is a Concussion?

A concussion is a mild TBI characterized by a temporary disruption in brain function, often caused by a blow to the head.

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What damage does a Primary Injury cause?

A primary injury is the direct damage caused by the impact to the brain, such as skull fractures, lacerations, or contusions.

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What are examples of Secondary Injuries?

Secondary injuries are consequences that arise after the initial impact, including inflammation, increased intracranial pressure, and hypoxia.

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What is Diffuse Axonal Injury?

Diffuse axonal injury is a widespread damage to the brain's nerve fibers caused by stretching and tearing, often in TBI.

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What is Alzheimer's Disease?

Alzheimer's is a common type of dementia causing memory, thinking, and behavioral problems that worsen over time.

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What are Beta-amyloid Plaques?

Beta-amyloid plaques are clumps of protein that build up in the brains of people with Alzheimer's, interfering with brain communication.

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What are the 4 C's of Spinal Cord Injury Symptoms?

The 4 C's of spinal cord injury symptoms are: Loss of Control, Loss of Coordination, Loss of Comfort, and Loss of Consciousness.

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How does Alcohol affect TBI?

Alcohol use increases the risk of TBI and people with TBI are more prone to developing alcohol use disorders.

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Signs of Neurogenic Bowel

Common symptoms include constipation, abdominal distension, respiratory compromise, early satiety, nausea, evacuation difficulty, rectal bleeding and pain, and pressure ulcers.

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Study Notes

Brain Structure and Function

  • Frontal Lobe: Controls concentration, planning, problem-solving, speech, smell, and motor control.
  • Parietal Lobe: Processes touch, pressure, taste, and body awareness.
  • Temporal Lobe: Responsible for hearing, facial recognition.
  • Occipital Lobe: Processes visual information.
  • Cerebellum: Controls coordination.
  • Brainstem: Critical for vital functions; symptoms of stroke affecting this region can be deadly, including nausea, vomiting, vertigo, speech/swallowing problems, abnormal eye movements, and decreased consciousness.

Stroke Mechanisms

  • Symptoms: Stroke symptoms depend on the affected brain area, with the affected side typically opposite to the lesion location in the brain (crossed manner).
  • Left-brain Stroke: Right-sided weakness, difficulty forming words, and comprehension/memory deficits, frequently left gaze preference.
  • Right-brain Stroke: Left-sided weakness/paralysis, left-sided neglect, slurred or garbled speech.
  • Ischemic Stroke: Occurs from a blood clot (embolus) obstructing blood flow in a cerebral artery. This can be focal (specific area) or global (throughout the brain, like in cardiac arrest). Watershed zones are vulnerable areas furthest from arterial supply.
  • Hemorrhagic Stroke: Caused by a ruptured blood vessel, often due to uncontrolled hypertension or traumatic brain injury (TBI), with higher mortality rates than ischemic stroke.
  • Excitotoxicity: Excessively stimulated neurotransmitters (e.g., glutamate and NMDA) can damage the brain.

Brain Injury Mechanisms

  • Trauma: Inflammation occurs following brain trauma.
  • Cerebral Hypoxia/Ischemia: Insufficient oxygen supply to the brain. Causes include decreased atmospheric pressure at high altitudes (hypobaric hypoxia), atmospheric pressure changes, carbon monoxide poisoning, severe anemia, lung failure. Brain cells die ~5 minutes after oxygen deprivation.
  • Edema: Brain swelling; vasogenic edema is extracellular fluid accumulation due to blood-brain barrier disruption, while cytotoxic edema involves intracellular fluid accumulation, damaging surrounding cells.

Traumatic Brain Injury (TBI)

  • Definition: Non-degenerative, non-congenital insult to the brain from external mechanical force. Common cause of disability and death in young adults.
  • Causes: Motor vehicle accidents, bicycle crashes, battlefield trauma, sports injuries, falls, assaults.
  • Types: Closed (no skull fracture) or penetrating (e.g., gunshot wounds).
  • Classifications: Mild (concussion), moderate, and severe, based on the Glasgow Coma Scale (GCS) score.
  • Primary Injury: Immediate effects of the impact (lacerations, skull fractures, contusions).
  • Diffuse Axonal Injury: Widely distributed axonal damage, often from acceleration/deceleration or rotational forces (common in MVA or falls).
  • Secondary Injury: Follow-up effects (inflammation, increased intracranial pressure, hypoxia, excitotoxicity, oxidative stress).

Alcohol and TBI Risk

  • Increased risk of TBI with intoxication; TBI increases risk of alcohol use disorders.
  • Neuroinflammation responses are linked to alcohol abuse (binge drinking induces neuroinflammation, sustained leads to cognitive dysfunction).

Repeat Mild TBI

  • Increased risk of long-term degenerative disorders (dementia, ALS, Parkinson’s, MS, CTE) as a result of cumulative damage.

Alzheimer's Disease

  • Definition: Most common dementia type, involving memory, thinking, and behavior problems, typically developing over 5-15 years.
  • Symptoms: Memory loss (short term), denial of memory loss, disorientation, impaired abstract thinking, personality/affect changes.
  • Causes: Accumulation of beta-amyloid plaques (disrupting neuron communication). Tangles (tau protein) and enlarged ventricles also occur.
  • Diagnosis: Cognitive screening; imaging tests (PET scans, CT scans, MRI) to assess brain structure;
  • Treatment: Cholinesterase inhibitors (e.g., Aricept), NMDA receptor antagonists, possible vaccines (phase 2 trials); behavioral management using antidepressants, antipsychotics, or anxiolytics.

Spinal Cord Injury (SCI)

  • Definition: Complete/partial damage to the spinal cord's neural elements.
  • Causes: Motor vehicle crashes, falls, violence, sports injuries.
  • Types of Injuries: Flexion, hyperextension, compression, flexion-rotation.
  • Primary vs. Secondary Injury: Primary is immediate; secondary occurs afterward (inflammation, increased ICP, hypoxia)
  • Level of Injury: Tetraplegia (quadriplegia) affects all four limbs, trunk, and pelvic organs (cervical injury); paraplegia affects trunk, legs, and lower pelvic organs (thoracic, lumbar, or sacral injury).
  • Severity: ASIA A (complete loss of function) and incomplete (ASIA B-E).
  • Clinical Manifestations: Loss of movement, sensation, bladder/bowel control, reflexes, sexual function, breathing difficulties, pain, weakness/paralysis, etc.
  • Autonomic Dysreflexia (AD): Life-threatening condition with high blood pressure, bradycardia, headache, due to stimulus below the level of the injury (suprasacral).
  • Respiratory Problems: Injury above C3 may require mechanical ventilation; involvement of intercostal muscles with Thoracic injury.
  • Neurogenic Bladder: Incontinence (suprasacral) or retention (sacral), leading to UTIs, renal impairment, etc..
  • Neurogenic Bowel: Constipation (hyper-reflexive above T10) or incontinence (areflexic below T10).
  • Pressure Ulcers: Risk of developing skin sores due to unrelieved pressure over bony prominences.

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