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TRAUMATIC BRAIN INJURY: EPIDEMIOLOGY, ANATOMY AND PATHOPHYSIOLOGY

TRAUMATIC BRAIN INJURY: EPIDEMIOLOGY, ANATOMY AND PATHOPHYSIOLOGY. MARY PEPPING, Ph.D. Associate Professor University of Washington School of Medicine. THE PATIENTS WHO SUSTAIN SEVERE TBI. MALES/FEMALES 75/25 UNDER AGE 30 ALCOHOL AS A RISK FACTOR ACCELERATION/ DECELERATION INJURIES

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TRAUMATIC BRAIN INJURY: EPIDEMIOLOGY, ANATOMY AND PATHOPHYSIOLOGY

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  1. TRAUMATIC BRAIN INJURY:EPIDEMIOLOGY, ANATOMY AND PATHOPHYSIOLOGY MARY PEPPING, Ph.D. Associate Professor University of Washington School of Medicine

  2. THE PATIENTS WHO SUSTAIN SEVERE TBI • MALES/FEMALES 75/25 • UNDER AGE 30 • ALCOHOL AS A RISK FACTOR • ACCELERATION/ • DECELERATION INJURIES • OUTCOMES - 1/3 WORKING AFTER =/> 24 HOURS COMA

  3. Primary & Secondary Brain Injury • SECONDARY INJURIES: • SWELLING OR MASS EFFECTS • MIDLINE SHIFT • BRAINSTEM HERNIATION • HEMATOMAS • OBSTRUCTIVE HYDROCEPHALUS

  4. Primary & Secondary Brain Injury • SECONDARY INJURIES (continued): • INFECTION • ANOXIA • INFARCTION FROM BONE BREAKS/BLOOD CLOTS • NECK INJURY AND DISSECTING CAROTID ARTERIES • CHEMICAL CHANGES IN CELLULAR FUNCTION

  5. Primary & Secondary Brain Injury • INITIAL IMPACT • CONTUSIONS, RUPTURED VESSELS, FRACTURED SKULL • COUP AND CONTRE-COUP INJURIES • STRETCHING AND SHEERING OF NEURONS • SEVERE WHIPLASH/SPINAL INJURY

  6. TYPICAL INJURIES - DIFFUSE TBI WITH MAJOR FOCI: Case 1 • SIGNIF FRONTAL INJURY - DISINHIBITED • ORBITAL FRONTAL CORTEX DAMAGE • IMPULSIVITY, AGITATION • INAPPROPRIATE SOCIAL PRESENTATION

  7. CASE 2 - SIGNIF FRONTAL INJURY – “SLOWED” • LATERAL FRONTAL CORTEX DAMAGE • PSYCHOMOTOR RETARDATION • CHILDLIKE AFFECT AND RESPONSES

  8. CASE 3 - SIGNIFIGANT FRONTAL-TEMPORAL INJURY • ANTERIOR TIPS OF FRONTAL AND TEMPORAL LOBES • CLASSIC CONSTELLATION OF TBI PROBLEMS • REDUCED MEMORY, ATTENTION, AWARENESS, PROBLEM-SOLVING, ORGANIZATION, FLEXIBILITY

  9. CASE 4 - SIGNIF RIGHT TEMPORAL-PARIETAL INJURY • PARANOIA, VISUAL SPATIAL DEFICITS, MISPERCEPTION OF OTHER PEOPLE’S FACIAL EXPRESSIONS OR INTENTIONS, POOR VISUAL MEMORY • LEFT NEGLECT OR INATTENTION

  10. CASE 5 - SIGNIFICANT LEFT HEMISPHERE IMPAIRMENT • APHASIA, REDUCED NAMING, VERBAL FLUENCY • PROBLEMS WITH VERBAL EXPRESSION • PROBLEMS WITH COMPREHENSION • CHANGES IN READING, WRITING, ARITHMETIC • RIGHT NEGLECT OR INATTENTION

  11. CASE 6 - SIGNIF GLOBAL INJURY W/BRAIN STEM • CRANIAL NERVE INVOLVEMENT • SWALLOWING, DROOLING, MOTOR SPEECH • VISUAL DISTURBANCES – DOUBLE VISION • GREATLY REDUCED SPEED OF THOUGHT AND MOVEMENT • PROBLEMS WITH SPASTICITY, WALKING, STANDING

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