Frontal Lobe InjurySean Vanhille Miranda Cluff

Frontal lobe injury has always been around The first documented case of frontal lobe

injury was in 1835. The best known early case was that of

Phineas Gage in 1848.◦ http://www.youtube.com/watch?v=5B2pQkqM6nc

TBI (and frontal lobe injuries) are being seen more often

The invention of the CT and MRI scans PET and SPECT scans

History

Headache Dizziness Vomiting Nausea Drowsiness Blurred vision

Signs and Symptoms: Early signs

Difficulties with interpretation of touch, temperature, movement, limb position and fine discrimination

Partial or total loss of vision Weakness of eye muscles and double vision Blurred vision Problems judging distance Involuntary eye movements Intolerance of light Integration of sensory impressions into psychologically

meaningful data Decrease or loss of hearing Ringing in the ears Increased sensitivity to sounds (like Kyle) Loss or diminished sense of smell Loss or diminished sense of taste

Signs and Symptoms: Sensory

May become more excitable than before the injury◦ Mood changes/ Emotionally labile◦ Impulsiveness/ Decreased inhibitions◦ Lack of self-monitoring◦ Insensitivity to others/ Lack of empathy◦ Irritability◦ Aggression◦ Childishness◦ Outspoken, bombastic (pompous), tactless

May become more calm than before the injury◦ Apathy/Abulia (loss of will or motivation)◦ Depression◦ Decreased spontaneity◦ Emotional blunting

Difficulties in social settings, social judgments, and, specifically, socially inappropriate behaviors

Signs and Symptoms: Emotions and Personality

Inability to plan: “Memory of the future”-David Ingvar◦ Specifically sequencing different actions

Loss of flexible thinking/ Rigid behavior Persistence of a single thought or action/ Perservation Inability to focus on a task/ Easily distracted / Shifting or

maintaining attention Difficulty with problem solving Speed of processing Confusion Initiation deficits Disorganized Poor decision making Abstract reasoning

Signs and Symptoms: Cognitive

Working memory is severely impaired Selective episodic memory impairment is

described◦ Inability to re-live past experiences◦ It’s like the experiences happened to someone

else Source Amnesia

Signs and Symptoms: Memory

Paralysis of various body parts Rare cases of OCD develop Major depression Anosognosia

◦ The inability to see your own impairment (more common in the right hemisphere than the left)

Signs and Symptoms: Misc.

Anosognosia Selective episodic memory impairment Emotional and personality changes-you are

no longer you “Memory of the future” Diminished sense of smell Becoming bombastic

Summary of the “Suckiest” Symptoms

Now it’s your turn!

Neuropsychological Findings

Glasgow Coma Scale

Neuropsychological Findings

Mild: 13-15Moderate 9-12Severe 3-8

Loss of Consciousness Scale (LOC) Post Traumatic Amnesia (PTA) Galveston Orientation and Amnesia Test

(GOAT)

Neuropsychological Findings

Tests of Functionality◦ Stroop Test—subjects look at a list of color names

printed in discordant colors: “red” is printed in blue, etc. Then subject is asked to name the color instead of word

◦ Wisconsin Card Sorting Test—sort cards according to color, number, or form

◦ A word fluency test—generate as many words in 1 minute that start with a specific letter

◦ Drawing a series of shapes◦ Tapping a complex rhythm

Neuropsychological Findings

Radiological Evidences/Examples

Radiological Evidences/Examples

Bizarre Head Injuries with Nails

Bizarre Head Injuries

Beware of Paint Brushes!

There are three types of brain injury1. Brain Contusion - bruising of the brain matter

some bleeding2. Axonal Injury - axons break by twisting, stretching,

sheared3. Brain Hemorrhage- bleeding in the brain

Brain injury can happen a countless number of ways:1. Trauma2. Aneurisms/stroke3. Drugs4. Progressive neurodegeneration

Etiology

Frontal lobe Injury occurred in about 506 per 100,000 people

Ratio of males to females is 3:1 (2 studies) 70% of injuries causes by traffic accidents were

head injuries The peak incidence is between the ages of 15 and

24 and older than the age of 64 years. Vehicle accidents particularly motorcycle accidents,

account for the most frequent civilian cause of TBI. (falls are the second)

People from lower socioeconomic groups are significantly more likely to be affected by TBI.

Epidemiology

First receive treatment and care in an intensive care unit.

There are several rehabilitation treatment options

Patients need to have an individualized treatment program which can be modified to adapt to the changing needs of the patient.

Moderately to severely injured patients require individually tailored treatment programs in the areas of physical and occupational therapy, speech/language therapy, psychiatry, psychology, and social support.

Some patients may need medication for physical and emotional problems

Psychotherapy often target issues of self-awareness, egocentricity, and empathy.

Treatments

The rehabilitation of people with a frontal lobe injury is a long and difficult process requiring early identification and proper management.

The overall goal of rehabilitation treatment is to improve the patients ability to function at home and in society. Therapists help the individual adapt to disabilities or make modifications to the home to make everyday activities easier.

Treatment

Ritalin and other stimulatory drugs

Internet therapy

Experimental Treatments

Outcomes depend on the severity of the injury the area of the injury and the individual

Usually people who suffer frontal lobe injury have problems with social behaviors and executive functioning.

Women tend to have a better earlier outcome than men and have a shorter length of stay at a rehabilitation facility.

Many can’t return to work and struggle through everyday life. Only 20-30% return to work.

Effects of frontal lobe injury will always be present however symptoms can be relieved

Usual Outcomes