Traumatic Brain Injury

Psych 36 - Biopsychology

Brain Injuries

2 Categories:

Open head injuries

penetration of skull

Closed head injuries

concussions

#1 Cause of Brain Injuries: Falling

Open Head Injuries

Involve penetration into the skull

Severity dependent on areas affected

If involvement and damage to both hemispheres, ventricles or multiple lobes -usually fatal

PhineasGage
Open Head Injury

Glasgow Coma Scale

Scores range from 3-15:

Severe = GCS < 9

Concussions

Mild Traumatic Brain Injury (mTBI) - Concussion

symptoms include - confusion, mood/personality change, motor difficulty, headache, vomiting, photophobia, memory loss, not feeling right

may have delayed onset of symptoms

Coup - Compression of skull onto neural tissue

Countercoup - secondary area of damage from the force of the blow hitting the skull opposite the coup

Bleeding, Tearing & Shearing

Subdural hematoma

bleeding under the dura matter from severe coup or counter coup

White matter injury

(axonal damage) - twisting and tearing of the brain inside the skull due to the blow

Secondary damage

caused by changes in blood flow, oxygen levels, and excitotoxic cell damage

Toxic Leakage & Swelling

Often neurons are torn or ruptured leaking out toxic neurotransmitters (glutamate), chloride, potassium, sodium Swelling, inflammation from tissue damage

may increase pressure, producing additional damage

Moderate hypothermia - cooling the brain

may protect against neurotoxicity

Imaging TBI

damage caused by open head injuries can be seen using brain imaging techniques CT and MRI scans of concussions may appear normal Diffuse tensor imaging (DTI) provide a method for identifying damage to the connections in TBI

Post-Concussive Syndrome (PCS)

Concussion symptoms persist for weeks or months Mood, memory, personality, concentration problems - can lead to chronic disability, depression May be related to damage to pituitarys ability to release growth and sex hormones

Second-Impact Syndrome

Insufficient time to heal after concussion creates:

Greater vulnerability to additional damage

Inability to regulate pressures in the brain

Cody Lehe - suffered mild concussion (mTBI)

Experienced post-concussive symptoms A second hit at practice caused SIS, permanent disability

Culture of Resistance

First study of elementary aged football players (7 & 8 year olds):

107 hits in a 5-game season Many topped 80 gs - equivalent to hits sustained by college-level players

47% of high school football players suffered a concussion in 2006. 35% of players say they had more than one concussion in the same season.
National Center for Injury Prevention.

Athletes & Concussions

High school athletes - 3 or more concussions

abnormal responses to concussions - and damage more extensive for additional concussions athletes with two or more brain injuries have lower GPAs

Multiple concussions increase the risk of long-term damage to the brain, doctors say.

Chronic Traumatic Encephalopathy (CTE)

Normal Brain

Evidence of link between head trauma and long-term, degenerative brain disease
CTE involves progressive loss of cognitive function and memory, increasing aggression and dementia - can include Parkinsonian symptoms Marked by degeneration and presence of deposits of dense tau protein in the frontal and temporal lobes, the amygdala & the hippocampus higher risk for those with some Apolipoprotein E (ApoE) genotypes

Brain with CTE

John Doe - High School Athlete

18 year old, multi-sport athlete suffered multiple concussions

Dementia Pugilistica

Dementia Pugilistica: associated with slurred speech, memory impairment, Parkinson-like syndrome Formerly referred to as punchdrunk syndrome

Dementia Pugilistica is thought to be the same as CTE

mTBI & CTE

Long term effects of repeated concussions NFL recently settled $765 million dollar lawsuit Greater awareness of the dangers associated with repeated mTBI

Depression in the NFL

Soldiers & mTBI

War in Iraq/Afghanistan Concussions from highpressure IED blast waves highest rate of mTBI of any period in 10 years of combat 1200 per quarter in 2011 better rates of diagnosis greater vigilance Imaging is typically normal

Soldiers & Traumatic Brain Injury

Visible and invisible wounds of war 160,000 soldiers diagnosed with mTBI since start of war in 2000

15-23% of all service members have a concussion signature wound of Iraq/Afghanistan soldiers Many also suffer from PTSD, made worse by mTBI

mTBI Incidence in Soldiers

http://www.dvbic.org/

Soldiers & mTBI

Post-concussion syndrome (PCS) 97% reported experiencing one or more symptoms from the concussion 3 months later

20-40% of active duty soldiers enter subsequent deployment with postconcussion symptoms Screening, treatment and rehabilitation services following return from deployment excessively delayed

Soldiers & mTBI

Some soldiers denied treatment due to pre-existing condition if PTSD also present Stigma associated with seeking treatment Suicide is now the leading cause of death for soldiers in the army Researchers warn that soldiers may also be prime candidates for CTE