Mechanisms of Traumatic Brain Injury (TBI)

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Questions and Answers

Which of the following is a primary mechanism of injury associated with traumatic brain injury?

  • Hypoxemia
  • Contusions (correct)
  • Hydrocephalus
  • Edema

What type of injury results from shearing forces damaging neurons, often with minimal findings on imaging?

  • Coup Contrecoup Injury
  • Subdural Hematoma
  • Diffuse Axonal Injury (DAI) (correct)
  • Epidural Hematoma

Which of the following groups is at the highest risk for TBI-related deaths and hospitalization?

  • Middle-aged men (30-50 years)
  • Children under 5 years
  • Young adults (18-30 years)
  • Individuals aged 75 and older (correct)

Which injury is characterized by focal deficits after a penetrating head injury?

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

Which of the following is NOT considered a secondary mechanism of brain injury?

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

What type of injury often occurs due to falls and is more commonly observed in very young or elderly individuals?

<p>Diffuse Axonal Injury (C)</p> Signup and view all the answers

Which mechanism is primarily responsible for elevated intracranial pressure (ICP)?

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

What is a common long-term complication associated with penetrating head injuries?

<p>Increased risk of seizures (B)</p> Signup and view all the answers

Which of the following conditions is NOT a secondary mechanism of brain injury?

<p>Coup-contrecoup injury (D)</p> Signup and view all the answers

What primary mechanism of injury is characterized by direct force that results in localized tissue damage?

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

Which of the following most accurately describes diffused axonal injury (DAI)?

<p>It involves microscopic shearing forces with possible minimal imaging findings. (B)</p> Signup and view all the answers

Which of the following scenarios contributes to the mechanism of a traumatic brain injury (TBI) due to blunt trauma?

<p>A fall from a height with impact (C)</p> Signup and view all the answers

In the context of traumatic brain injuries, which population is considered most vulnerable to TBI-related consequences?

<p>Individuals over 75 years old (A)</p> Signup and view all the answers

What best describes the condition known as hydrocephalus in relation to brain injury?

<p>An accumulation of cerebrospinal fluid leading to increased ICP (B)</p> Signup and view all the answers

Which type of injury is often associated with an increase in the risk of developing epilepsy?

<p>Penetrating head injury (C)</p> Signup and view all the answers

What type of traumatic brain injury occurs predominantly due to external forces, such as blasts or assaults?

<p>Penetrating head injury (A)</p> Signup and view all the answers

What characterizes a coup-contrecoup injury in focal brain injury?

<p>Injury affects both the site of impact and the opposite side of the brain (D)</p> Signup and view all the answers

Which of the following conditions is primarily associated with secondary brain injury mechanisms?

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

Which area of the brain is least likely to be affected by Diffuse Axonal Injury (DAI)?

<p>Cerebellar vermis (D)</p> Signup and view all the answers

What mechanism contributes to the breakdown of neurons in traumatic axonal injury?

<p>Shearing forces caused by rapid acceleration and deceleration (B)</p> Signup and view all the answers

Which risk group is most likely to experience traumatic brain injury due to external violence?

<p>Survivors of intimate partner violence (D)</p> Signup and view all the answers

What primary factor is responsible for elevated intracranial pressure (ICP) in secondary brain injury?

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

Which type of traumatic brain injury is more commonly associated with military service members?

<p>Blast injuries (D)</p> Signup and view all the answers

What common long-term effect is more likely following a penetrating head injury compared to a closed head injury?

<p>Increased risk of seizures (B)</p> Signup and view all the answers

What primarily distinguishes primary brain injuries from secondary brain injuries?

<p>Primary injuries result in immediate structural damage, while secondary injuries arise from follow-up physiological processes. (B)</p> Signup and view all the answers

Which group is NOT identified as being at increased risk for traumatic brain injury is mentioned?

<p>Young athletes involved in high-impact sports (A)</p> Signup and view all the answers

Which condition is primarily linked to secondary brain injury mechanisms?

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

What is the principal reason that a penetrating head injury might lead to a higher incidence of epilepsy?

<p>The focal deficits often observed with penetrating injuries can disrupt normal brain function. (C)</p> Signup and view all the answers

Which of the following mechanisms is responsible for causing Diffuse Axonal Injury (DAI)?

<p>Shearing forces acting on the neurons during acceleration-deceleration actions (C)</p> Signup and view all the answers

Which area of the brain is least likely to exhibit damage in cases of Diffuse Axonal Injury (DAI)?

<p>Medial temporal lobes (A)</p> Signup and view all the answers

Which scenario is least likely to result in a traumatic brain injury due to falls?

<p>A teenager diving into a shallow pool without caution (A)</p> Signup and view all the answers

What is the primary effect of edema in relation to secondary brain injuries?

<p>It results in increased intracranial pressure, potentially causing further neuronal damage. (A)</p> Signup and view all the answers

Flashcards

Primary brain injury

Initial damage to the brain tissue caused directly by the impact of a traumatic event.

Secondary brain injury

Brain damage that develops after the initial injury, resulting from the body's response to the initial trauma.

Focal injury (brain)

Localized damage to the brain, often concentrated at the site of impact.

Diffuse Axonal Injury (DAI)

Widespread damage to the brain's nerve fibers, caused by shearing forces.

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Coup-Contrecoup Injury

A type of focal injury where the brain is impacted at one point (coup) and then at the opposite site (contrecoup) during a trauma.

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Hypoxemia

A lack of oxygen in the blood supplied to the brain.

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Edema (brain swelling)

Abnormal accumulation of fluid in the brain tissue.

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Mechanism of injury

The way a traumatic injury occurs, such as a fall, blunt trauma, or penetrating injury, determining the brain damage.

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What are primary brain injuries?

Direct damage to the brain tissue caused by the initial impact of a traumatic event. Examples include contusions, lacerations, hematomas, epidural hematomas, subdural hematomas, intracranial hematomas, diffused axonal injury, and cranial nerve injury.

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What are secondary brain injuries?

Brain damage that occurs after the initial injury, resulting from the body's response to the trauma. Examples include hypoxemia, hypotension, ischemia, edema, hydrocephalus, and elevated inter-cranial pressure.

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Contusion

A bruise on the brain caused by a direct blow, resulting in bleeding and swelling.

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Laceration

A tear or cut in the brain tissue caused by a penetrating object or a severe impact.

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Hematoma

A localized collection of blood outside of a blood vessel, forming a mass within the brain.

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What is a primary brain injury?

Direct damage to the brain caused by the initial impact of the trauma. Examples include contusions, lacerations, hematomas, epidural hematomas, subdural hematomas, intracranial hematomas, diffused axonal injury, and cranial nerve injury.

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What is a secondary brain injury?

Brain damage that happens after the initial injury due to the body's response to the trauma. This could be lack of oxygen, swelling, or pressure build-up.

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What is Diffuse Axonal Injury (DAI)?

Widespread damage to the brain's nerve fibers caused by shearing forces, like a whiplash effect. It happens when the brain moves rapidly within the skull.

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What are the effects of elevated Inter-cranial Pressure (ICP)?

Elevated ICP can squeeze the brain, leading to damage due to reduced blood flow and oxygen supply.

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How do falls cause TBI?

Falls are a common cause of TBI, especially in young children and older adults, due to decreased balance and bone density.

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Who are at increased risk for TBI?

Certain groups are at a higher risk for TBI: racial and ethnic minorities, service members, people experiencing homelessness, those in correctional facilities, survivors of intimate partner violence, and people living in rural areas.

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TBI and age

While TBI can affect people of all ages, individuals aged 75 and older have the highest rates of TBI-related deaths and hospitalization.

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How does brain swelling occur?

Abnormal accumulation of fluid in the brain tissue after a traumatic event.

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What is Hypoxemia?

A lack of oxygen in the blood supplied to the brain.

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Study Notes

Mechanisms of Traumatic Brain Injury (TBI)

  • Primary Injuries: Immediate damage caused by the force of impact

    • Focal Injuries: Specific, localized damage
      • Contusions (bruises)
      • Lacerations (tears)
      • Hematomas (blood clots): epidural, subdural, intracranial
      • Diffuse Axonal Injury (DAI): widespread damage to axons
      • Blast injury
      • Cranial nerve injury (damage to nerves controlling sensory and motor functions)
    • Coup-Contrecoup Injury: Impact at one point causing damage at the opposite point due to the brain moving against the skull (focal injury).
    • Diffuse Axonal Injury (DAI)/ Traumatic Axonal Injury (TAI): Shearing forces damage neurons; microscopic damage, minimal findings on scans; commonly affects:
      • Parasagittal white matter of the cortex
      • Corpus callosum
      • Brainstem (pontine-mesencephalic junction, superior cerebellar peduncles)
      • Wallerian-type axonal degeneration: breakdown due to shearing forces.
  • Secondary Injuries: Damage arising from the initial injury’s aftermath

    • Cellular Death: Caused by events following the initial injury: e.g., tissue damage.
      • Hypoxemia: Lack of oxygenated blood flow to the brain.
      • Hypotension: Low blood pressure.
      • Ischemia: Reduced blood supply to the brain.
      • Edema: Brain swelling.
      • Hydrocephalus: Buildup of fluid in the brain.
      • Elevated Intercranial Pressure (ICP): Increasing pressure inside the skull

Causes of TBI

  • Falls: Common in young and elderly
  • Blunt Trauma: Injuries from objects; e.g., sports, being hit by an object, vehicle accidents, assaults.
  • Vehicle-related injuries: Motor vehicle accidents (MVAs), bicycles accidents.
  • Assaults/Violence: Physical attacks including gunshot wounds, shaken baby syndrome.
  • Explosions/Blasts: More common in service members.
  • Penetrating Head Injuries: Injuries from objects that pierce the skull; more focal deficits. Potential for increased epilepsy risk.

Risk Factors for TBI

  • Age: 75+ at highest risk for TBI related deaths and hospitalizations.
  • Sociodemographic groups: Racial/ethnic minorities, service members/veterans, people experiencing homelessness, incarcerated populations, intimate partner violence survivors, rural residents.

Primary vs. Secondary Causes (Knowledge Check)

  • Primary Cause: The initial insult causing immediate damage.
    • Examples: Blunt force trauma, penetration, blast.
  • Secondary Cause: Damage resulting from the body’s response to the primary injury.
    • Examples: Hypoxia, edema, elevated intracranial pressure.

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