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BRAIN INJURY BASICS

Learn about major brain structures, functions, and classifications of brain injuries. Explore basic statistics, severity levels, and common causes of traumatic brain injury. Understand the differences between mild, moderate, and severe brain injuries.

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BRAIN INJURY BASICS

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  1. BRAIN INJURY BASICS Karen Brewer, Ph.D. Clinical Neuropsychologist UT Southwestern Medical Center

  2. Anatomy & Function of Major Brain Structures • Frontal Lobes • Temporal Lobes • Parietal Lobes • Occipital Lobe • Cerebellum • Brain Stem • Corpus Callosum • Limbic System

  3. Frontal Lobes

  4. Frontal Lobes • Executive functions: • Planning • Organization • “Remembering to remember” • Self-monitoring • Higher-order thinking skills: • Problem solving • Reasoning • Cognitive flexibility • Sequencing

  5. Frontal Lobes • Higher-order thinking skills: • Judgment • Insight • “Reading between the lines” • Attention/working memory • Motor functions – contralateral control • Basal area: • Bladder control • Taste/smell

  6. Temporal Lobes

  7. Temporal Lobes • Memory: • Verbal memory – left • Visual memory – right • Auditory processing – both hemispheres • Language function (comprehension & expression) – usually left • 99% right-handers • 90-95% left-handers

  8. Parietal Lobes

  9. Parietal Lobes • Tactile sensation - contralateral perception & integration of tactile information • Right-left discriminations • Left: reading comprehension, calculating • Right: visuospatial abilities (e.g., “mapping,” constructing)

  10. Occipital Lobes

  11. Occipital Lobes • Vision • Color perception

  12. Cerebellum

  13. Cerebellum • Motor control & coordination • Connects to brainstem

  14. Corpus Callosum

  15. Corpus Callosum • Connects the two cerebral hemispheres • Made up of huge tracts of white matter that carry messages from one hemisphere to another

  16. Limbic System

  17. Limbic System • Amygdala – manages emotions (especially anger) • Hypothalamus – manages hunger & satiation • Thalamus – major relay station for sensory input & integration

  18. Brain Stem

  19. Brain Stem • Passageway between the brain and the spinal cord • Basic life support functions: • Respiration • Heart rate/blood pressure • Where all the cranial nerves converge

  20. TBI Basic Statistics • Annual incidence of head trauma in the United States - 2 million people per year • Incidence of head injury steadily increases until ages 15-25, then declines; it rises again after age 60+.

  21. TBI Basic Statistics • 500,000 people will require hospitalization, and about 80,000 will suffer from some level of chronic cognitive and/or physical disability. • TBI is also the leading cause of death in adolescents and adults under 45 years of age, with an overall mortality rate of 25 per 100,000.

  22. TBI Basic Statistics • Boys are twice as likely to suffer a brain injury as girls. • Men are injured twice as frequently as women, but die due to head injury four times more often.

  23. TBI Basic Statistics • Brain Injury Severity Stats: • 76-85% are mild • 8-10% are moderate • 6-13% are severe

  24. TBI Basic Statistics • Most common causes of head injury – all age groups: • Motor vehicle accidents (> 50%) • Falls (21%) • Violence (12%) • Sports/recreational injuries (10%).

  25. TBI Basic Statistics • Health costs from TBI: estimated to be $35 billion per year in the U.S.

  26. Classifying Brain Injury Penetrating/Open TBI • Open TBIs are characterized by the velocity and location of the missile at impact: • The higher the velocity of the missile, the more severe the injury. • The lower the path of the missile, the more severe the injury.

  27. Classifying Brain Injury Closed TBI • Closed TBIs are classified as mild, moderate, or severe, depending on the neurological status of the patient soon after the injury

  28. Classifying Brain Injury • Mild - GCS of 13–15, LOC of less than 30 minutes, and/or PTA of less than 1 hour • Moderate - GCS of 9–12, LOC of 1–24 hours, and/or PTA of 30 minutes to 24 hours • Severe - GCS of 8 or less, LOC of more 24 hours, and/or PTA of more than 1 day

  29. Mild Traumatic Brain Injury Mild Closed TBI (aka “concussion,” minor brain injury) • Involves transient physiological disturbances • May cause trauma to the scalp and/or cervical spine, and, in some cases, contusions or hematomas • No obvious anatomic injury to the brain • Results from low-velocity head trauma and may involve transient loss of consciousness and/or memory of events immediately before and after trauma • Usually produces normal CT/MRI scans and neurologic assessments

  30. Mild Traumatic Brain Injury • May result in post-concussion syndrome • Disabilities due to posttraumatic headaches, dizziness, sleep disturbances, and inability to concentrate and perform complex tasks • Over time, PCS may cause anxiety, depression, and/or other psychosocial problems

  31. Moderate/Severe Traumatic Brain Injury • Associated with high velocity impact (e.g., motor vehicle accidents, assaults, & falls) • Diagnosed when there is any one of the following associated with a brain injury: • Contusion • Hematoma • Hydrocephalus • Skull fracture

  32. Diffuse Axonal Injury • One of the most common and devastating types of brain injury (Iwata et al., 2004), occurring in almost half of all cases of severe head trauma. • Results from the motion of the brain within the skull, causing extensive damage to the axons (white matter). • This can produce a wide spectrum of injuries, ranging from brief physiological disruption to widespread axonal death.

  33. Diffuse Axonal Injury • Secondary damage may occur after the initial injury: • Brain swelling • Cerebral edema/Increased intracranial pressure • Hypoxia • Hematoma/hemorrhage • Metabolic abnormalities • Hydrocephalus • Fat embolism • Excessive release of excitatory amino acids (e.g., glutamate overproduction increases hypoxic injury to the hippocampus) • Oxidative free-radical production • Disruption of neurotransmitters

  34. Diffuse Axonal Injury • Delayed damage may occur as well: • White matter degeneration • Cerebral atrophy • Development of posttraumatic hydrocephalus • Development of posttraumatic seizures

  35. QUIZ All things being equal (good pre-injury health, no post-injury complications, etc.), which of the following people is most likely to have the best outcome if he/she suffers a moderate brain injury? • 2-year-old • 22-year-old • 42-year-old

  36. Common Cognitive Sequelae of TBI • Intellectual Decline • Verbal intelligence tends to be less vulnerable to mild and moderate brain injuries. • Nonverbal intellectual abilities (e.g., Performance IQ) more often affected due to problems with fluid problem solving and decreased information processing speed. • IQ tends to plateau 1-2 years after the injury, though improvements may be seen for up to 5 years.

  37. Common Cognitive Sequelae of TBI • Attention – • Auditory & visual • Mediated primarily by the frontal lobes • Arousal • Simple attention (e.g., focusing on what someone is saying, ability to repeat numbers) • Sustained attention (maintaining focus for >5 minutes) • Selective attention (ignoring unimportant information while focusing on what is important) • Divided attention (attending to more than one thing at a time; driving)

  38. Common Cognitive Sequelae of TBI • Information Processing - making sense of information presented to the brain • Mediated primarily by the frontal lobes and the white matter of brain • Quality vs. speed issues • Visual information processing • Auditory information processing • Working memory – requires manipulating information before processing it (e.g., multi-step mental math problems)

  39. Common Cognitive Sequelae of TBI • Verbal Memory • Mediated by the left temporal lobe in >90% of people (>95% right-handers; >85% left-handers) • Learning (storage), retrieval, & recognition • Contextual information (e.g., stories, conversations) • Noncontextual information (e.g., lists, isolated facts) • Symbolic information (e.g., math equations, spelling)

  40. Common Cognitive Sequelae of TBI • Visual Memory • Mediated by the right temporal lobe in most people • Learning, retrieval, & recognition • Contextual information (e.g., city streets, a famous person’s face) • Noncontextual information (e.g., an unfamiliar item)

  41. Common Cognitive Sequelae of TBI • Reasoning/Problem-Solving • Mediated primarily by the frontal lobes • Common deficit in TBI, but often not recognized by the patient. • The area of function that often distinguishes the children & adults that adapt well post-injury from those who do not.

  42. Common Cognitive Sequelae of TBI • Abstract Thinking/Planning/Organization • Mediated primarily by the frontal lobes, especially the prefrontal cortices • Often quite impaired in persons who are brain injured, but not recognized until after hospitalization.

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