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

2. 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

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

4. 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

5. 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

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

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

8. 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

9. 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

10. 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

11. 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