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• 1 Lecture 3 Stroke and TBI

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• What is the definition of Traumatic Brain Injury?

  Damage to living brain tissue caused by an external mechanical force or motion.

• What characterizes TBI?

  A period of altered consciousness (amnesia or coma) that can be very brief (minutes) or very long (months/indefinitely).

• Who are at risk in TBI?

  - Men more than women
  - Young more than old
  - Urban more than rural
  - Low socioeconomic status more than high socioeconomic status

• What is open brain injury?

  Occurs when an object fractures the skull, enters the brain, and injures the brain tissue in the process.

• What is closed brain injury?

  Occurs when the head accelerates and then rapidly decelerates or collides with another object and brain tissue is damaged by violent smashing, shaking, stretching, and twisting of brain tissue and additionally is damages by physiological reactions following the injury.

• Closed TBI vs.  Open TBI

  - cTBI more prevalent than oTBI
  - cTBI less often results in death than oTBI
  - cTBI causes diffuse tissue damage, oTBI tend to damage localized areas of the brain
  - cTBI results often in disabilities which are generalized and highly variable, oTBI results in more discrete and predictable disabilities

• What are three subtypes of primary brain damage?

  - Bruising of the parenchyma: concussion (hersenschudding)
  - Laceration of nerve fibers (scheuren)
  - Disruption of blood vessels (verstoren)

• What is the definition of coup and contre-coup?

  Coup: disruption of the tissue at the point of impact.
  Contre-coup: indirect disruption fo tissue located opposite to the site of impact.

• What is the law of inertia?

  The brain lags behind when the head is suddenly accelerated or decelerated. The brain continues to move at the original velocity against the bony ridges within the skulls, causing bruises and microbleeding.

• What are subtypes of secondary brain injury?

  - Intracerebral: delayed axotomy (result of severe axonal injury), increased intracranial pressure, disturbed blood flow, coagulopathy, pyrexia.
  - Extracerebral: hypoxia (cerebral anoxia)