ABPMR Brain Injury Medicine flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Glasgow Coma Scale severity bands

Severe traumatic brain injury is GCS 3-8, moderate is 9-12, and mild is 13-15. The score combines best eye, verbal, and motor responses, each rated separately.

Post-traumatic amnesia severity cutoffs

Post-traumatic amnesia lasting less than 24 hours indicates mild injury, 1 to 7 days moderate, and more than 7 days severe. Duration correlates better with functional outcome than initial GCS.

Rancho level IV behavior

Rancho Los Amigos level IV is confused and agitated: the patient is disoriented, restless, aggressive, and unable to cooperate with care. It is the level most associated with agitation management and safety precautions.

Minimally conscious state criteria

Minimally conscious state requires reproducible evidence of awareness, such as simple command following, intelligible speech, or purposeful object use. Unlike vegetative state, some awareness is intermittently present, so repeated structured examinations are needed.

Cerebral perfusion pressure formula

Cerebral perfusion pressure equals mean arterial pressure minus intracranial pressure. Adult severe traumatic brain injury guidelines target CPP 60-70 mmHg while keeping ICP below about 22 mmHg to preserve cerebral blood flow.

Coma Recovery Scale-Revised

The CRS-R is a standardized behavioral scale for disorders of consciousness, scoring auditory, visual, motor, oromotor, communication, and arousal functions. Repeated administration reduces misdiagnosis, since up to 40 percent of vegetative-state patients show covert awareness.

Agitated Behavior Scale

The ABS is a 14-item clinician-rated scale measuring agitation after brain injury, including aggression, disinhibition, and lability. Items are scored 1-4 and summed; serial scores guide medication and behavioral treatment decisions.

Apathy versus depression

Apathy involves reduced goal-directed behavior and motivation without sadness, guilt, or worthlessness, whereas depression includes dysphoric mood and negative self-evaluation. Apathy is more common with frontal or basal ganglia injury and responds to dopaminergic agents.

Pseudobulbar affect treatment

Pseudobulbar affect causes involuntary laughing or crying disproportionate to mood. Dextromethorphan-quinidine is FDA-approved; selective serotonin reuptake inhibitors are an alternative. Document episodes and mood congruence to distinguish it from depression.

Errorless learning technique

Errorless learning prevents wrong responses during memory training by giving immediate prompts and fading them. It benefits amnestic patients, especially those with severe memory impairment, because self-generated errors are not corrected by damaged recognition memory.

Bupropion seizure threshold risk

Bupropion lowers the seizure threshold and is generally avoided in patients with traumatic brain injury, prior seizures, or eating disorders. If used, sustained-release forms at low doses and concurrent anticonvulsant therapy may reduce risk.

Paroxysmal sympathetic hyperactivity

Paroxysmal sympathetic hyperactivity produces episodic tachycardia, hypertension, fever, tachypnea, diaphoresis, and dystonic posturing after severe brain injury. Diagnosis is clinical, and treatment includes beta-blockers, clonidine, gabapentin, and bromocriptine; triggers such as pain and constipation are treated first.

Heterotopic ossification markers

Heterotopic ossification after brain injury shows elevated alkaline phosphatase and localized swelling, warmth, and decreased range of motion. Triple-phase bone scan is sensitive early; plain radiographs show changes only after weeks. Prophylaxis is considered in high-risk patients.

SIADH versus cerebral salt wasting

Both cause hyponatremia after brain injury. SIADH shows euvolemia or slight hypervolemia with low urine output, while cerebral salt wasting shows hypovolemia with high urine sodium and output. Treatment differs: fluid restriction for SIADH versus saline replacement for salt wasting.

Late post-traumatic seizure definition

A late post-traumatic seizure occurs more than 7 days after injury and defines post-traumatic epilepsy. Risk factors include penetrating injury, intracranial hemorrhage, depressed skull fracture, and an early seizure; prophylaxis beyond the first week does not prevent it.

Post-traumatic pituitary dysfunction

Pituitary dysfunction occurs in a substantial minority after moderate to severe traumatic brain injury, commonly growth hormone or gonadotropin deficiency. Screen with morning cortisol, free T4, IGF-1, and gonadal hormones at 3 to 6 months if symptoms suggest.

Intrathecal baclofen indications

Intrathecal baclofen treats severe generalized spasticity or dystonia unresponsive to oral agents, delivering drug directly to cerebrospinal fluid. It reduces sedation and systemic effects but risks catheter complications and withdrawal, which can be life-threatening.

Functional Independence Measure scoring

The FIM rates 18 items of self-care, sphincter control, mobility, locomotion, communication, and social cognition from 1 (total assistance) to 7 (complete independence). Total scores range 18-126 and track rehabilitation progress and burden of care.

Constraint-induced movement therapy

CIMT restrains the less affected upper limb while intensively training the paretic limb for several hours daily over consecutive weeks. It improves upper-extremity function in selected stroke and brain injury patients with adequate cognition and minimal pain.

Augmentative and alternative communication

AAC includes low-tech boards and high-tech speech-generating devices that support communication for patients with severe dysarthria or anarthria. Eye-tracking systems allow locked-in patients to communicate; assessment matches access method to residual motor control.

Metacognitive strategy training

Metacognitive strategy training teaches patients to self-monitor, plan, and adjust performance on real-life tasks. It improves executive function after brain injury more than repetitive drill practice and is delivered in context with therapist coaching and feedback.

Body-weight supported treadmill training

Body-weight supported treadmill training provides partial unloading and repetitive stepping practice for patients with weak or uncoordinated gait. It improves walking speed and endurance in stroke and incomplete spinal cord injury; evidence in traumatic brain injury is limited but supportive.

PECARN pediatric head CT rules

PECARN rules identify children at very low risk of clinically important traumatic brain injury after minor head trauma, avoiding unnecessary CT. Age-specific criteria use mechanism, history, and examination; children under 2 and those with severe symptoms need closer evaluation.

Abusive head trauma findings

Abusive head trauma in infants often presents with subdural hemorrhage, retinal hemorrhages, and encephalopathy, sometimes without external injury. Inconsistent history, delayed presentation, and injury patterns discordant with development should prompt reporting and multidisciplinary evaluation.

Geriatric anticoagulation and TBI

Older adults taking warfarin or direct oral anticoagulants have higher risk of intracranial hemorrhage after even minor head trauma. Guidelines favor liberal CT imaging and rapid reversal; preinjury anticoagulation is associated with worse outcomes and higher mortality.

Return-to-play concussion protocol

Athletes with concussion should not return to play the same day. A stepwise protocol advances from symptom-limited activity through light aerobic exercise, sport-specific drills, and contact, with 24 hours at each step and return to baseline if symptoms recur.

Age-adjusted pediatric Glasgow Coma Scale

The pediatric Glasgow Coma Scale adjusts verbal responses for age: cooing/babbling for infants, words for toddlers, oriented conversation for older children. Motor and eye scores match adult scoring.

Inpatient rehabilitation facility 60 percent rule

Medicare requires that at least 60 percent of an inpatient rehabilitation facility's total patient population have at least one qualifying condition, such as brain injury, stroke, or spinal cord injury, for the facility to maintain rehabilitation payment status.

Symptom validity testing

Symptom validity tests, such as the Test of Memory Malingering, detect exaggerated or feigned cognitive impairment. Scores below established cutoffs indicate invalid performance; results are interpreted alongside effort measures and clinical history, not as proof of malingering alone.

Surrogate decision-making standards

Surrogates decide for incapacitated patients using substituted judgment when prior wishes are known, or best interests otherwise. Hierarchy usually favors a health care proxy, then spouse, adult children, parents, and siblings, depending on state law.

Brain injury rehabilitation levels of care

Care ranges from acute trauma and intensive care to inpatient rehabilitation, day treatment, outpatient therapy, home health, and community-based programs. Placement depends on medical stability, therapy tolerance, cognitive status, and caregiver capacity.

Disorders of consciousness misdiagnosis rate

Behavioral examination misdiagnoses disorders of consciousness in roughly 40 percent of cases, often labeling minimally conscious patients as vegetative. Repeated CRS-R testing and multimodal assessment reduce error and guide ethical decisions about treatment and prognosis.