TRAUMATIC BRAIN INJURY: EPIDEMIOLOGY, ANATOMY AND PATHOPHYSIOLOGY MARY PEPPING, Ph.D. Associate Professor University of Washington School of Medicine

THE PATIENTS WHO SUSTAIN SEVERE TBI MALES/FEMALES 75/25 UNDER AGE 30 ALCOHOL AS A RISK FACTOR ACCELERATION/ DECELERATION INJURIES OUTCOMES - 1/3 WORKING AFTER =/> 24 HOURS COMA

Primary & Secondary Brain Injury SECONDARY INJURIES: SWELLING OR MASS EFFECTS MIDLINE SHIFT BRAINSTEM HERNIATION HEMATOMAS OBSTRUCTIVE HYDROCEPHALUS

Primary & Secondary Brain Injury SECONDARY INJURIES (continued): INFECTION ANOXIA INFARCTION FROM BONE BREAKS/BLOOD CLOTS NECK INJURY AND DISSECTING CAROTID ARTERIES CHEMICAL CHANGES IN CELLULAR FUNCTION

Primary & Secondary Brain Injury INITIAL IMPACT CONTUSIONS, RUPTURED VESSELS, FRACTURED SKULL COUP AND CONTRE-COUP INJURIES STRETCHING AND SHEERING OF NEURONS SEVERE WHIPLASH/SPINAL INJURY

TYPICAL INJURIES - DIFFUSE TBI WITH MAJOR FOCI: Case 1 SIGNIF FRONTAL INJURY - DISINHIBITED ORBITAL FRONTAL CORTEX DAMAGE IMPULSIVITY, AGITATION INAPPROPRIATE SOCIAL PRESENTATION

CASE 2 - SIGNIF FRONTAL INJURY – “SLOWED” LATERAL FRONTAL CORTEX DAMAGE PSYCHOMOTOR RETARDATION CHILDLIKE AFFECT AND RESPONSES

CASE 3 - SIGNIFIGANT FRONTAL-TEMPORAL INJURY ANTERIOR TIPS OF FRONTAL AND TEMPORAL LOBES CLASSIC CONSTELLATION OF TBI PROBLEMS REDUCED MEMORY, ATTENTION, AWARENESS, PROBLEM-SOLVING, ORGANIZATION, FLEXIBILITY

CASE 4 - SIGNIF RIGHT TEMPORAL-PARIETAL INJURY PARANOIA, VISUAL SPATIAL DEFICITS, MISPERCEPTION OF OTHER PEOPLE’S FACIAL EXPRESSIONS OR INTENTIONS, POOR VISUAL MEMORY LEFT NEGLECT OR INATTENTION

CASE 5 - SIGNIFICANT LEFT HEMISPHERE IMPAIRMENT APHASIA, REDUCED NAMING, VERBAL FLUENCY PROBLEMS WITH VERBAL EXPRESSION PROBLEMS WITH COMPREHENSION CHANGES IN READING, WRITING, ARITHMETIC RIGHT NEGLECT OR INATTENTION

CASE 6 - SIGNIF GLOBAL INJURY W/BRAIN STEM CRANIAL NERVE INVOLVEMENT SWALLOWING, DROOLING, MOTOR SPEECH VISUAL DISTURBANCES – DOUBLE VISION GREATLY REDUCED SPEED OF THOUGHT AND MOVEMENT PROBLEMS WITH SPASTICITY, WALKING, STANDING