TRAUMATIC BRAIN

INJURY
Lisa Brenner, PhD, ABPP
Departments of Psychiatry,
Neurology, and Physical Medicine and Rehabilitation
University of Colorado School of Medicine
 TBI Definition
Traumatic Brain Injury - A bolt or jolt to the
head or a penetrating head injury that disrupts
the function of the brain
Not all blows or jolts to the head result in a TBI.
The severity of such an injury may range from
mild (a brief change in mental status or
consciousness) to severe (an extended period
of unconsciousness or amnesia) after the injury.
Post-injury individuals may experience
symptoms
These symptoms can result in short- or long-
term problems with functioning

CDC 2005
 Mild TBI Definition
American Congress of
Rehabilitation Medicine

Traumatically induced
disruption of brain function
that results in loss of
consciousness of less than 30
minutes duration or in an
alteration of consciousness
manifested by an incomplete
memory of the event or being
dazed and confused.
McCallister 2005
TBI - Mechanisms
 Mechanism of Injury
Acceleration/Deceleration

John Kirk, Ph.D.

Thanks John Kirk, Ph.D.

 Blast Injury
Blast injuries are injuries that result from the
complex pressure wave generated by an
explosion.
The explosion causes an instantaneous rise in
pressure over atmospheric pressure that creates a
blast overpressurization wave

Air-filled organs such as the ear, lung, and

gastrointenstinal tract and organs surrounded
by fluid-filled cavities such as the brain and
spinal are especially susceptible to primary
blast injury

www.dvbic.org/blastinjury.html
 Blast Injury
Primary
Barotrauma

Secondary Objects
being put into motion

Tertiary Individuals
being put into motion

Susan O'Brien, MD
TBI -Severity
Posttraumatic Amnesia
Trauma

Encoding events
Retrograde
LOC Posttraumatic
Amnesia Amnesia

TIME

Thanks John Kirk, PhD

 Injury Severity
Mild Moderate Severe

Altered or LOC<30 LOC<6 hours with LOC>6 hours with

minutes with normal abnormal CT and/or abnormal CT
CT and/or MRI MRI and/or MRI

GCS 13-15 GCS 9-12 GCS<9

PTA<24 hours PTA<7 days PTA>7days

Department of Veterans Affairs

2004
 Common TBI Symptoms
NOT to be confused with the
injury itself

TBI is a historical event

 Common Mild
TBI/Postconcussive
Symptoms
Headache Depression
Poor Anxiety
concentration Dizziness
Memory difficulty Light sensitivity
Irritability Sound sensitivity
Fatigue
Immediately post-injury 80% to 100% describe
one or more symptoms
Most individuals return to baseline functioning
within a year
Ferguson et al. 1999, Carroll et al. 2004; Levin et al. 1987
Terrio, H., Brenner, L.A., Ivins, B., Cho, J.M., Helmick, K.,Schwab, K., Scally, K., Bretthauser, R., Warden, D.
Traumatic Brain Injury Screening: Preliminary Findings Regarding Prevalence and Sequelae in a US Army
Brigade Combat Team. Journal of Head Trauma Rehabilitation. 2009
Terrio, H., Brenner, L.A., Ivins, B., Cho, J.M., Helmick, K.,Schwab, K., Scally, K., Bretthauser, R., Warden, D.
Traumatic Brain Injury Screening: Preliminary Findings Regarding Prevalence and Sequelae in a US Army
Brigade Combat Team. Journal of Head Trauma Rehabilitation. 2009
Motor and Sensory Deficits
Slowed motor response (often due to
processing delay vs. motor deficit)
Paralysis, disturbed balance and
coordination, ataxia, tremors,
parkinsonism, bradykinesia, and
weakness
Distorted pain, touch, temperature
and positional information
 Common Neuropsychological
Complaints
Disordered consciousness General intellectual deficits
Disorientation Deficits in
Memory deficits processing/sequencing
Decreased abstraction information
Illogical thoughts
Decreased learning ability
Perseveration
Language/communication
deficits Confabulation
Poor judgment Difficulty with
generalization
Poor quality control
Poor attention
Inability to make decisions
Fatigue
Poor initiative Reduced motor speed/poor
Poor depth perception hand eye coordination
Dizziness Visual neglect

Rosenthal et al. 1983

 Common Behavioral
Complaints
Restlessness Paranoid Ideation
Agitation Hypomania
Combativeness Confabulation
Emotional Irritability
Lability Impulsivity
Confusion Egocentricity
Hallucinations Emotional Lability
Disorientation
 Common Behavioral
Complaints
continued
Impaired Aggressiveness
Judgment
Apathy
Impatience
Immaturity
Depression
Disinhibition
Hypersexuality
Loss of interest
Hyposexuality
Anxiety
Dependency
Silliness
 Common Behavioral
Complaints
continued
Impaired Aggressiveness
Judgment
Apathy
Impatience
Immaturity
Depression
Disinhibition
Hypersexuality
Loss of interest
Hyposexuality
Anxiety
Dependency
Silliness