Neuropathology of acquired brain injury

Which of the following is NOT an acquired brain injury (ABI)

[blank_start]Traumatic Brain Injury[blank_end] is damage to living brain tissue caused by an external mechanical force or motion. It is characterized by a period of altered consciousness (amnesia or coma) that can be very brief (minutes) or very long (months/indefinitely).

Which of the following is correct?

Causesof traumatic brain injury •falling ([blank_start]43%[blank_end]) •car crash ([blank_start]22%[blank_end]) •violence ([blank_start]15%[blank_end]) •sport accidents ([blank_start]7%[blank_end])

Choose ALL correct answers

When considering TBI Damage caused by the effects of the physiological processes set in motion by the initial injury are known as:

Which of the following is NOT classified as a primary injury resulting from TBI

Choose the correct definition:

The Formation of microscopic bubbles within the brain tissue as it is pulled away from the skull when the head suddenly stops or accelerates. This is known as

[blank_start]Diffuse axonal injury[blank_end] involves the stretching, twisting and shearing of axons throughout the cortex

Which hematoma occurs within the cortex

Seqcondary consequences of extracerebral (extracranial) hemorrhage

Coma patients generally lack a regular sleep/wake cycle

What is the name given to the state of confusion and memory disturbance that occurs immediately following traumatic brain injury?

Chose the correct standard assessment of TBI severity:

What is the most common complaint 12 months after TBI?

[blank_start]Cardiovascular Accident (CVA)[blank_end] a focal neurological disorder of abrupt development due to a pathological process in the blood vessels.

Which of the following risk factors concerning stroke are NOT true:

Which of the following is NOT a RISK factor for stroke

[blank_start]Atherosclerosis[blank_end] is a thickening of arterial walls characterized by the deposition of fatty material on their inner walls. Associated with hypertension, smoking, diabetes, obesity, and elevated levels of cholesterol.

[blank_start]Thrombosis[blank_end] is the formation of a blood clot inside a blood vessel, obstructing the flow of blood through the circulatory system. An [blank_start]embolism[blank_end] is the lodging of a traveling intravascular mass within a blood vessel, this can cause a blockage in a blood vessel and obstruct blood flow. [blank_start]Hemorrhage[blank_end] is a rupture to a blood vessel causing blood to escape into the surrounding tissue.

A [blank_start]transient ischemic[blank_end] attack is a brief episode of neurological dysfunction resulting from an interruption in the blood supply to the brain, sometimes as a precursor of a stroke. (Two words)

An [blank_start]ischemic[blank_end] stroke involves the blockage of a blood vessel and subsequent reduction in the supply of oxygen to surrounding brain tissue

Choose the correct incidence of stroke.

[blank_start]Hemorrhagic[blank_end] stroke may be cause by the weakening of a vessel wall due to pathological alterations, e.g aneurysm, or secondary to atherosclerosis.

Type of bleeding that occurs within the skull but outside of the brain tissue, falls into three subtypes.

The three types of extra-axial hemorrhage include

Bleeding that occurs between the arachnoid mater and the dura is called a [blank_start]subdural[blank_end] hemorrhage

Mostly affect subcortical structures like thalamus, basal ganglia and brainstem. Mortality rate up to 70%-80%. This is true of:

[blank_start]Ischemia[blank_end] •Primary effects of infarct (occlusion) •Secondary effects(edema, physiological reactions etc.) [blank_start]Hemorrhage[blank_end] •Primary effects (leakage of blood, blood pressure) •Secondary ischemia (ischemic damage due to blood pressure)

Prosopagnosia is classically associated with lesions to

If a stroke patient showed deficits in the recognition of this image, we would expect that: A) patients with left sided lesions resulting in deficit would have trouble identifying small details (D's) but could still readily identify the larger L shape. B) patients with right sided lesions resulting in deficit would have trouble identifying overall images (L) but could still readily identify the smaller D shapes. C) patients with right sided lesions resulting in deficit would have trouble identifying small details (D's) but could still readily identify the larger L shape. D) patients with left sided lesions resulting in deficit would have trouble identifying overall images (L) but could still readily identify the smaller D shapes.

The following deficits are more closely associated with damage to which side of the cortex? Visuoconstructive disorders Aprosody Auditory agnosia

The following deficits are consistent with injury in which hemisphere? Aphasia Acalculia Agraphia

Occlusion of the anterior cerebral artery is associated with which cluster of symptoms?

Occlusion of the middle cerebral artery is associated with which cluster of symptoms?

[blank_start]Diaschisis[blank_end] is a sudden loss (or change) of function in a portion of the brain connected to a distant, but damaged, brain area. The site of the originally damaged area and of the diaschisis are connected to each other by neurons. The loss of the damaged structure disrupts the function of the remaining intact systems and causes a physiological imbalance. The injury is produced by an acute focal disturbance in an area of the brain, from traumatic brain injury or stroke, for example. This is an example of [blank_start]a secondary[blank_end] brain damage.

[blank_start]Anosognosia[blank_end]: a patient’s lack of awareness or the underestimation of a specific deficit in functioning due to a brain lesion.

[blank_start]Denial[blank_end] often demonstrate resistance and sometimes angry reaction when given feedback about their disability [blank_start]Anosognosia[blank_end] neurological lesion [blank_start]Denial[blank_end] psychological process protecting from depression or anxiety [blank_start]Anosognosia[blank_end] often show perplexity or indifference when receiving information about their deficits [blank_start]Anosognosia[blank_end] more stable in its manifestations [blank_start]Denial[blank_end] less stable in its manifestations

In stroke the the penumbra refers to:

Neuropsychological assessment is usually conducted on patients within the acute phase of recovery.

Age is an important risk factor in the assessment of outcomes in TBI: Which of the following is NOT true

A single head injury doubles the risk of subsequent head injury, a second TBI will increase the risk eightfold

Repeated concussions and head injuries are most common in

Young people experience a higher incidence of TBI than older people

Patients with prior history of X tend to have poorer outcomes from TBI X significantly increases the likelihood of TBI TBI patients who experience damage to the frontotemporolimbic injury diminishes impulse control increasing the likelihood of X. What is X

A worker is found unconscious on a building site with burns and scarring along arms a chest Epileptic seizures on admission to hospital Normal CT scan/MRI but abnormal EEG Generalized cognitive slowness at intake but intact verbal ability. The above case is suggestive of:

Complete the following: TBI - Traumatic brain injury (example) CHI - [blank_start]Closed head injury[blank_end] PHI - [blank_start]Penetrating head injury[blank_end] ABI - [blank_start]Acquired brain injury[blank_end] GCS - [blank_start]Glasgow coma scale[blank_end] LOC - [blank_start]Loss of consciousness[blank_end] PTA - [blank_start]post traumatic amnesia[blank_end]

[blank_start]Concussion[blank_end] is a mild form of TBI

A head injury always involves brain injury

Closed head injuries (CHI) can include (mark ALL correct)

Traumatic brain injury is the most common cause of brain injury in children and young adults.

Name as many secondary problems relating from traumatic brain injury as you can remember. Answers/suggestions below:

More than half of all TBI in which population are a result of falls?

Who has the highest mortality rate in MVA's

Of the following age groups which show the highest incidence of TBI (choose three)

[blank_start]Men[blank_end] sustain twice as many head injuries as [blank_start]women[blank_end], with this difference most pronounced during peak trauma years (15 - 24). After 65 TBI are more numerous amongst [blank_start]women[blank_end].

The incidence of TBI is approximately [blank_start]150[blank_end] in 100,000. However for mild TBI, the most common form of CHI many never seek medical care. Some of the highest rates have been observed in South Africa and South Australia.

When considering outcome predictions which of the following is NOT true

For patients with a short duration loss of consciousness (LOC) the GCS is an effective and accurate predictor of outcomes

PTA typically lasts about 4 times the length of a coma and correlates well with GCS.

Fill the following estimations of TBI outcome using PTA duration: Very Mild: [blank_start]< 5[blank_end] Minutes Mild: [blank_start]5 - 60[blank_end] Minutes Moderate: [blank_start]1-24[blank_end] Hours Severe: [blank_start]1 - 7[blank_end] Days Very Severe: [blank_start]1- 4[blank_end] weeks Extremely Severe: [blank_start]> 4[blank_end] weeks

Coma duration is a more accurate outcome predictor than length of post traumatic amnesia

Penetrating head injury is associated with a high rate of acute post injury seizure, occurring in up to [blank_start]80[blank_end]% of patients.

Memory impairments and changes in emotional and executive functioning are common in TBI, this appears to be related to high incidence of [blank_start]frontotemporal[blank_end] injury

Match the following types of hemorrhages with their locations Inside ventricular space - [blank_start]intraventricular[blank_end] [blank_start]Within the brain[blank_end] - intraparenchymal On the cortical surface - [blank_start]subarachnoid[blank_end] [blank_start]Outside the brain proper[blank_end] - extraparenchymal

The most life threatening effects of cerebral swelling are on [blank_start]brainstem[blank_end] structures concerned with vital functions

A patient presents who has had a brief loss of consciousness following a head injury. They experienced a brief disturbance in memory and orientation following return of consciousness. Upon admission to hospital they received a GCS score of 13. A MRI follow up later that evening demonstrated no abnormalities. Following spending the night in hospital the patient underwent a brief NPA and performed mostly in above average ranges, though in the low average range for on a verbal retrieval task. They reported feeling a little tired but otherwise ok. This is likely an example of [blank_start]mild traumatic brain injury[blank_end].

What proportion of moderate TBI patients who were previously working are able to return to work?

What is the best approximation of the incidence of severe traumatic brain injury

describe the course of recovery for severe TBI patients: [blank_start]After the first year[blank_end] - Improvements may continue from here on however progress gradually slows and will plateau below premorbid level. Improvements may continue, but are likely due to new learning and further development of compensational strategies than spontaneous recovery. [blank_start]After regaining consciousness[blank_end] - Patients often displays erratic behaviour, confusion, uncooperative, incoherence, anxiousness, aggressiveness, restlessness etc. PTA may continue for quite some time. [blank_start]In the weeks to months following[blank_end] - Fastest recovery is generally observed during this period. Tasks with a large yet simple attentional component tend to recover quickly but plateau after 6 months to one year. New learning progresses much slower, but ability to learn will not return to pre mordbid levels.

Fluctuation in course of improvement in TBI patients with which form of deficit?

Strokes are often painless

Tissue plasminogen activator (tPA) has been shown to be particularly effective if administered in the first few hours following what type of brain injury?

tPA - The medication used in the acute treatment of ischemic stroke stands for [blank_start]tissue plasminogen activator[blank_end]

Which of the following types of brain injury has an incidence of roughly 150 in 100,000

Obstructive (Ischemic) Stroke is the most common form of stroke, accounting for approximately [blank_start]80%[blank_end] of all stroke. Thrombotic stroke accounts for up to [blank_start]75%[blank_end] of all obstructive stroke and between [blank_start]60 and 70%[blank_end] of stroke generally. Embolic stroke accounts for [blank_start]20 - 30%[blank_end] of all OBSTRUCTIVE strokes.

[blank_start]Embolus[blank_end] - any intravascular mass capable of obstructing blood flood through the vasculature at a site distant from it's point of origin.

[blank_start]Embolic[blank_end] strokes tend to be of sudden onset and without the warning precursors (e.g headache, transient ischemic attack) that can accompany other kinds of stroke.

The area of brain supplied by the [blank_start]middle cerebral[blank_end] artery is most commonly affected region in both thrombotic and embolic (ie ischemic) stroke.

[blank_start]Embolic[blank_end] strokes are associated with hearth disease and usually occur at a younger age than [blank_start]thrombotic[blank_end] stroke.

For obstructive stroke patients with non-fluent aphasia, speech fluency usually returns after the [blank_start]first month[blank_end] if at all. By contrast confrontation naming is typically impaired at one month, with around one third of patients return to near normal levels by the [blank_start]sixth month[blank_end] of recovery.

[blank_start]Hemiplegia[blank_end] (lateralised paralysis) typically co-occurs with perceptual deficits. This co-occurrence is more common in [blank_start]left[blank_end] sided patients. However, hemiplegia and left sided inattention more commonly co-occur in patients with [blank_start]right[blank_end] sided lesions.

Depression following a stroke is more prevalent [blank_start]after the first six months.[blank_end]

Depression involving a primarily indifferent or apathetic attitude is more characteristic of [blank_start]right[blank_end] sided stroke.

Post-hospital development of depression is more common in [blank_start]right[blank_end]-sided stoke patients. Whereas the incidence of depression in [blank_start]left[blank_end] sided stroke patients tends to decrease after the acute stages.

At four years which of the following aspects is most predictive of quality of life?

[blank_start]Hemorrhagic[blank_end] stroke is the most devastating form of stroke, and carries the worst prognosis.

Hemorrhagic strokes have a mortality rate approximately between [blank_start]35 and 50%[blank_end] within the first 30 days. Although, mortality due to hemorrhagic stroke has been reduced over the years.

[blank_start]5 - 10%[blank_end] of all strokes are due to ruptured aneurysms.

Vasospasm, the constriction of surrounding blood vessels secondary to hemorrhage, can can result in ischemia and infarction.

Caused by a blockage in blood vessels but leaving no permanent change in cognitive function. Which of the following best accounts for these symptoms?

Stroke evolves following TIA in approximately [blank_start]30%[blank_end] of patients, and [blank_start]10 - 15%[blank_end] of all strokes are preceded by a TIA.

A 62 year-old building inspector was charged with criminal misconduct for issuing hundreds of building permits for plans that did not meet requirements. He responded with a profound depression, for which he was hospitalized. On NP evaluation he was alert, oriented, verbose, illogical but not irrational and feeling hurt and puzzled in regards to his convictions as he felt he had done his work well. While his scores on predominately verbal tests were generally well above average, his performances on construction tests were confused, and both free hand and copy drawing were confused and distorted. On questioning he provided a history of flu like symptoms occurring just before he began giving the improper permits. CT scan revealed an old lesion. This description is most consistent with:

"Silent" strokes are more common in the left hemisphere than the right hemisphere.