PATIENT FOCUSED.
INJURY-CENTERED SOLUTIONS.
INJURY-CENTERED SOLUTIONS.
Taking Traumatic Brain Injuries Head-On:
The Premier Center in Houston.
The Premier Center in Houston.
Concussion / Mild TBI
• Not necessarily "mild"
• Brain CT scan is typically Negative.
• May result in significant neurocognitive, behavioral, emotional, and other deficits.
• May have severe life-long significant impact on patients and those around them.
• Possible cortical damage, axonal damage, white matter fiber shearing, network lesions/disconnection syndromes, not necessarily seen on brain CT or conventional MRI scans.
Moderate TBI
• Typically results in a 24 hours - 7 days post-traumatic amnesia and/or loss of consciousness (LOC) for 30 minutes - 24 hours.
• Brain CT is usually abnormal, with signs of injury.
• Significant neurological and cognitive deficits may persist.
Severe TBI
• Loss of Consciousness typically more than 24 hours.
• Brain CT show obvious signs of injury.
• Severe cognitive and neurological deficits, with a potential for long-term disability or death.
• Longer time to recovery or no recovery at all.
• Higher risk of secondary brain injury from swelling, hypoxia and other complications due to the initial trauma.
• Prognosis is usually guarded.
T
raumatic brain injuries (TBIs) are extremely debilitating and can drastically alter the lives of not only those affected by them but also their families. A TBI occurs when there is a sudden blow or jolts to the head resulting in internal injuries.
• Headache
• memory deficits
• imbalance
• dizziness
• fatigue
• confusion
• depression
• apathy
• nausea
• anxiety
• irritability
• sleeping difficulties
• mental fogginess
• sensitivity to noise
• sensitivity to light
• visual changes
• tinnitus
(ringing in the ear)
• increased emotionality
• personality changes
• feeling slowed down
• increased thinking time
• difficulty concentrating
• slowed response time
• difficulty with problem-solving
• loss of appetite
Assessment
• Glasgow Coma Scale - Widely used to assess brain function after trauma (not accurate to to assess subtleties of mild TBI).
Imaging
• Computerized Tomography (CT) Scans or Magnetic Resonance Imaging (MRI) - to uncover physical changes in the brain (usually negative with mild TBI).
• Conventional MRI Scan - evaluates brain for structural lesion.
• MRI with Diffusion Weighted Imaging or Diffusion Tensor Imaging (DWI/DTI) – advanced MRI technique which assesses physical changes in white matter tracts from axonal damage.
• Volume Segmentation (Neuroquant, Neuroreader, etc) - assesses brain volumes.
• Functional MRI (fMRI) - assesses metabolic changes associated with specific tasks.
• Electroencephalogram (EEG) - measures electrical activity in the brain.
• Positron Emission Tomography (PET) - visualizes metabolic activity of the brain.
• MR Spectroscopy- assesses biochemical changes in the brain.
• Arterial Spin Labeling (ASL) - assesses the brain's perfusion (blood flow).
• Single-Photon Emission Computerized Tomography (SPECT) - assesses regional cerebral blood flow, glucose metabolism, and oxygen utilization.
• Magnetoencephalography - assesses electrical activity in the brain by measuring magnetic fields.
• Positron emission tomography - assesses cerebral blood flow and glucose metabolism.
NEUROLOGICAL TESTING
• History and Physical Exam - assesses for cognitive and physical deficits.
• Neuropsychological Testing -evaluates cognitive, behavioral, and emotional functioning
• Cognitive assessment - tests memory, language abilities, and other higher-level thinking skills.
• Neuropsychological testing - consists of a battery of tests to assess attention, memory, executive functioning, visual-spatial abilities and emotional status.
• Balance/Vestibular testing - assesses balance and dizziness.
• Ophthalmologic exam - assess disorder of the visual system.
• Neuropsychiatric assessment - assesses mood, behavior and other psychological factors.
• Reaction time tests - measures response times to visual or auditory stimuli.
• Motor/Sensory tests - evaluates strength, sensation, coordination, reflexes and gait.
Lab Testing
• CSF and Blood Biomarkers (under research)
• Blood tests - to identify any infections or metabolic disorders
• Cerebrospinal fluid, collected through a lumbar puncture and analyzed to detect infection, inflammation, bleeding, or other abnormalities in the brain.
Recovery & Rehabilitation
• Physical therapy - to improve strength, coordination and balance.
• Occupational therapy - to help with activities of daily living.
• Speech/language therapy - to assist with communication and swallowing difficulties.
• Cognitive rehabilitation – helps the patient relearn thinking, reasoning, learning skills and problem-solving abilities affected by a TBI.
• Psychological counseling - to help the patient cope with emotions and behaviors that can be caused by a TBI.
• Vocational rehabilitation – assists individuals in returning to work or finding new employment following a traumatic brain injury.
• Assistive technology - specialized equipment such as talking computers, electronic organizers and communication devices to aid individuals with TBIs.
• Education - to help individuals learn strategies for compensating for deficits caused by the injury.
• Community reintegration programs - to assist in integrating back into society after a brain injury and provide support such as transportation, housing assistance and job placement.
• Support groups - to provide emotional and practical support for individuals and families affected by TBIs.
Neurosurgical procedures for TBI
Craniotomy for:
- Epidural hematoma - removal of a collection of blood between the dura mater and the skull.
- Subdural hematoma - evacuation of an excessive accumulation of blood from the space under the dura mater.
- Brain contusions - surgical procedures to evacuate contusions or bruises that have caused swelling in surrounding tissue.
Procedures:
• Intracranial pressure monitoring - insertion of a special device through the skull and into the brain to measure intracranial pressure.
• Craniotomy - surgical procedure involving removal of a sometimes large portion of the skull to allow access to the brain and perform decompression or removal of blood or foreign bodies from an injury site.
• Decompressive craniectomy - removal of part of the skull to relieve pressure on the brain.
• Ventriculostomy - placement of a tube into the ventricles for draining cerebrospinal fluid in order to reduce intracranial pressure.
Specialists
Specialists include, but are not limited to:
•neurosurgeons - diagnose and treat patients with TBI
•neuropsychologists - assess cognitive abilities, memory, and behavior
•physical therapists – assist with motor skill development
•occupational therapists - help to improve daily living activities
•speech/language pathologists - evaluate speech and language skills
•educationalists – provide special education services
•neurologists - diagnose and treat patients with TBI
•neuro-ophthalmologists - evaluate visual disturbances associated with TBI
•rehabilitation nurses - coordinate and provide nursing care
•social workers – provide counseling and help to identify available resources
•nutritionists – recommend dietary changes or supplements to improve brain health
•psychiatrists – diagnose, treat, and manage mental health issues.
•neurotologists - diagnose and treat hearing, balance, and other auditory issues associated with TBI.
•orthotists - assess the need for assistive devices to help improve mobility.
•endocrinologists - diagnose and treat endocrine disorders associated with TBI.
•pain management physicians - manage and treat chronic pain caused by TBI.
•respiratory therapists - assess and treat respiratory issues associated with TBI.
•vocational counselors - provide assistance in job placement
•psychologists - provide counseling and therapies to help individuals cope with TBI.
•psychotherapists - provide individual, family and group therapy to assist with emotional and psychological issues caused by TBI.
•case managers - coordinate care for individuals with TBI and oversee their recovery.
•support groups – provide emotional support and guidance to those affected by TBI.
•marriage counselors - provide guidance to couples who have been affected by TBI.
D
octor Gary Kraus is the Founder of Kraus TBI in Houston, Texas. He is Board Certified by the American Board of Neurosurgery, is Fellowship trained, and recognized as a top Houston neurosurgeon by his peers and patients. Dr. Kraus has special expertise in the area of non-surgical and minimally invasive treatments of spinal problems. Although he has performed thousands of surgical procedures, Dr. Kraus routinely treats pain patients without surgery. His patients find him to be approachable and his demeanor is kind and compassionate. Dr. Kraus has always held to a higher standard in patient care for which he receives many honors and awards.
