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Chapter 4

PSYC31 - Ch. 4, 6.docx

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Michael Inzlicht

Chapter 4 Neuropathology Acquired DisordersTraumatic Brain InjuryHead InjuryPeak ages for TBI are in the 1524 year range People older than 64 years and children younger than 5 are the next group most at riskMales sustain TBI at a greater rate than females except in the olderthan64 age range and children younger than age 5 Severity of a TBI whether closed or open head is measured in combination of the following1Length of posttraumatic amnesia PTAthe period between receiving a head injury and regaining continuous daytoday memory for events aGCS measures depth of coma through the persons responsiveness level in eye opening motor movement and verbal communication bScores of 38 are classified as severe TBIiSome researchers say that 68 is severe TBI while 35 is very severe TBIcScores of 912 are moderate TBIdScores of 13 and 15 are mild TBI2Depth of unconsciousness usually measured immediately after resuscitation using the Glasgow Coma Scale GCS3Length of unconsciousnesspresence of neurological signsOpen Head InjuryOpen head injury a brain injury which occurs when an object penetrates the skull and exposes the brain to the elementsMost common cause is a gunshot woundbut any sharp object will doAmount of damage in an open head injury is related to the amount of energy exerted on brainAn object that penetrates the brain and fragments causing internal ricochet or debris to be driven further into the brain is likely to cause more brain involvementA clean wound causes less damage since damage is mainly along the path of the objectSecondary effects of open head injury may include hypotension low bp hypovolemia low blood volume contusions and intracranial hematomas Neuropsychological difficulties incudes specific cognitive defects and behavioral changes related to the site of the lesion Patients also tend to show general diffuse brain impairment such as difficulties in concentration attention memory and overall mental slowingTreatment time is crucial the sooner the treatment the greater the potential for survivalPrevention and treatment of infections is also crucial since the brains been exposed Surgery is dependent on the type of injurysome fragments may not be able to be removed or may involve lifethreatening proceduresOpenheaded injury is related to epilepsy with an estimate of 80 of patients experiencing seizures within the first 24 hoursImprovement tends to follow the standard TBI pattern of rapid recovery in the first 12 years followed by smaller gains and more accommodation to remaining deficits as time progressesClosed Head InjuryClosed head injury impact from an accident or injury causes brain damage but des not penetrate the skullClosed head injury occurs in two stages11The initial impact called the coup2Then the contrecoup the ricocheting of the brain back and forth or side to sideForce of the coup and contrecoup is critical The stronger the force the greater potential for damage Primary difficulties include diffuse white matter damage contusion bruising and hemorrhage Diffuse axonal injury is caused by the acceleration and deceleration of the brain impacting against the skullContusions often occur under the frontal and temporal lobes where shearing forces of the brain are impacting the sharpest and most confined parts of the skullContusions can occur under the point of impact or at the contrecoupsHemorrhages occur when blood vessels supplying oxygen to the brain are rupturedSecondary damages include injuries resulting from hematomas cerebral hemorrhage infection hydrocephalus and anoxic damage caused by breathing difficulties or low blood pressure All these difficulties may begin at the initial time of injury and lead to secondary damage to the brain There also may be neurochemical difficulties such as excitotoxicity cell membrane degradation cellular edema and cellular events such as changes in neuropeptides electrolytes and excitatory amino acids The age group of 1524 is most likely to sustain closed head injuries The most common are moving vehicle accidents cars motorcycles boats ATVsTheres also people who play sports that dont require protective headwear such as pro boxers or soccer Neuropsychological difficulties for people with closed head injury are similar to those with open head injury except they may be less severe Typical symptoms include impaired speed of information processing difficulties with concentration and attention memory deficits and problems with reaction time They often experience behavioralpersonality changes after injuriesMost suffer some form of depression or another emotional difficulty because of the changes in their life circumstances Theres also PTSD if the closed head injury was caused by a traumaTheyll often have an inability to control strong emotions such as anger or rage Research doesnt suggest that TBI patients incur a higher rate of divorceSome may have difficulties with the environment because they may look normal same mannerisms before injury even though their brain has massive injuryMost experience fatigueOne major difficulty is often a lack of awareness of their behavioral cognitive or physical deficits Treatment theres the need to prevent or control brain swelling Psychoactive medications may also be necessary for some Antidepressants have been used for depression 2
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