Traumatic Brain Injury (TBI)¶
Jake Dovgan and Doug Bryant
Background¶
-
TBI is categorized as a disruption in brain function leading to decreased consciousness, memory deficits, neurological deficits, or intracranial lesion.
-
This disruption is a result of an external blow or force.
-
Most common causes of TBI are falls and MVC.
-
Falls are the most common cause of TBI in elderly population.
Assessment¶
-
Mechanism of injury
-
Initial GCS
-
Loss of consciousness and duration
-
Other injuries
-
Initial evaluation should include a non-contrasted head CT to rule out hemorrhage
-
Full neuro exam including but not limited to cranial nerves, strength, cognition (orientation), memory, reflexes, sensation, cerebellar testing, range of motion of joints, Babinski, and Hoffmann's
Classification¶
| Severity | GCS | Post-Traumatic Amnesia | Loss of Consciousness |
|---|---|---|---|
| Mild | 13-15 | \<1 day | \<30 minutes |
| Moderate | 9-12 | 1 day to 7 days | >30 minutes and \<24 hours |
| Severe | 3-8 | >1 week | > 24 hours |
Evaluation and Management¶
-
Secondary complications following TBI:
- In the acute setting, patients who have had a TBI are at risk for seizures, agitation, autonomic problems, bowel/bladder, wounds, vertigo, headaches, and cognitive impairment, venous thrombosis, and spasticity
-
If concerned about TBI would consult PM&R and Speech Therapy for assistance in management of complications and assessment of cognition.
-
If concerned for spasticity refer to “Spasticity section” for specific medication recommendations.