Traumatic Brain InjuryPsych 36 - Biopsychology

Brain Injuries2 Categories:Open head injuriespenetration of skullClosed head injuriesconcussions #1 Cause of Brain Injuries: Falling

Open Head InjuriesInvolve penetration into the skullSeverity dependent on areas affectedIf involvement and damage to both hemispheres, ventricles or multiple lobes -usually fatalPhineasGage Open Head Injury

Glasgow Coma Scale

Scores range from 3-15:

Severe = GCS < 9Moderate = GCS 9-12Minor = GCS >14

Concussions Mild Traumatic Brain Injury (mTBI) - Concussionsymptoms include - confusion, mood/personality change, motor difficulty, headache, vomiting, photophobia, memory loss, not feeling rightmay have delayed onset of symptoms

Coup - Compression of skull onto neural tissueCountercoup - secondary area of damage from the force of the blow hitting the skull opposite the coup

Bleeding, Tearing & ShearingSubdural hematomableeding under the dura matter from severe coup or counter coupWhite 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 & SwellingOften neurons are torn or ruptured leaking out toxic neurotransmitters (glutamate), chloride, potassium, sodiumSwelling, inflammation from tissue damage may increase pressure, producing additional damageModerate hypothermia - cooling the brain may protect against neurotoxicity

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

Post-Concussive Syndrome (PCS)Concussion symptoms persist for weeks or monthsMood, memory, personality, concentration problems - can lead to chronic disability, depressionMay be related to damage to pituitarys ability to release growth and sex hormones

Second-Impact SyndromeInsufficient time to heal after concussion creates:Greater vulnerability to additional damageInability to regulate pressures in the brainCody Lehe - suffered mild concussion (mTBI)Experienced post-concussive symptomsA 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 seasonMany topped 80 gs - equivalent to hits sustained by college-level players47% 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 & ConcussionsHigh school athletes - 3 or more concussionsabnormal responses to concussions - and damage more extensive for additional concussionsathletes with two or more brain injuries have lower GPAsMultiple concussions increase the risk of long-term damage to the brain, doctors say.

Chronic Traumatic Encephalopathy (CTE)Evidence of link between head trauma and long-term, degenerative brain diseaseCTE 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 hippocampushigher risk for those with some Apolipoprotein E (ApoE) genotypes Normal BrainBrain with CTE

John Doe - High School Athlete18 year old, multi-sport athletesuffered multiple concussions

Dementia Pugilistica Dementia Pugilistica: associated with slurred speech, memory impairment, Parkinson-like syndromeFormerly referred to as punch-drunk syndrome Dementia Pugilistica is thought to be the same as CTE

mTBI & CTELong term effects of repeated concussionsNFL recently settled $765 million dollar lawsuitGreater awareness of the dangers associated with repeated mTBI

Depression in the NFL

Soldiers & mTBIWar in Iraq/AfghanistanConcussions from high-pressure IED blast waveshighest rate of mTBI of any period in 10 years of combat1200 per quarter in 2011better rates of diagnosisgreater vigilanceImaging is typically normal

Soldiers & Traumatic Brain InjuryVisible and invisible wounds of war160,000 soldiers diagnosed with mTBI since start of war in 200015-23% of all service members have a concussionsignature wound of Iraq/Afghanistan soldiersMany also suffer from PTSD, made worse by mTBI

http://www.dvbic.org/mTBI Incidence in Soldiers

Soldiers & mTBIPost-concussion syndrome (PCS)97% reported experiencing one or more symptoms from the concussion 3 months later20-40% of active duty soldiers enter subsequent deployment with post-concussion symptomsScreening, treatment and rehabilitation services following return from deployment excessively delayed

Soldiers & mTBISome soldiers denied treatment due to pre-existing condition if PTSD also presentStigma associated with seeking treatmentSuicide is now the leading cause of death for soldiers in the armyResearchers warn that soldiers may also be prime candidates for CTE

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