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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.