Tag: Nursing Facility Physician 

Primary and secondary Brain injury in Chino Hills

A large percentage of the people killed by brain trauma do not die right away but rather days to weeks after the event; rather than improving after being hospitalized, some 40% of TBI patients deteriorate. Primary brain injury(the damage that occurs at the moment of trauma when tissues and blood vessels are stretched, compressed, and torn) is not adequate to explain this deterioration; rather, it is caused by secondary injury, a complex set of cellular processes and biochemical cascades that occur in the minutes to days following the trauma. These secondary processes can dramatically worsen the damage caused by primary injury and account for the greatest number of TBI deaths occurring in hospitals.

Secondary injury events include damage to the blood–brain barrier, release of factors that cause inflammation, free radical overload, excessive release of the neurotransmitter glutamate (excitotoxicity), influx of calcium and sodium ions into neurons, and dysfunction of mitochondria. Injured axons in the brain’s white matter may separate from their cell bodies as a result of secondary injury,  potentially killing those neurons. Other factors in secondary injury are changes in the blood flow to the brain; ischemia (insufficient blood flow); cerebral hypoxia (insufficient oxygen in the brain); cerebral edema (swelling of the brain); and raised intracranial pressure (the pressure within the skull). Intracranial pressure may rise due to swelling or a mass effect from a lesion, such as a hemorrhage.  As a result, cerebral perfusion pressure (the pressure of blood flow in the brain) is reduced; ischemia results. When the pressure within the skull rises too high, it can cause brain death or herniation, in which parts of the brain are squeezed by structures in the skull.  A particularly weak part of the skull that is vulnerable to damage causing extradural haematoma is the pterion, deep in which lies the middle meningeal artery, which is easily damaged in fractures of the pterion. Since the pterion is so weak, this type of injury can easily occur and can be secondary due to trauma to other parts of the skull where the impact forces spreads to the pterion.

Source: Wikipedia

Mechanism Of Brain Injury in Riverside

Physical forces

The type, direction, intensity, and duration of forces all contribute to the characteristics and severity TBI. Forces that may contribute to TBI include angular, rotational, shear, and translational forces.

Even in the absence of an impact, significant acceleration or deceleration of the head can cause TBI; however in most cases a combination of impact and acceleration is probably to blame. Forces involving the head striking or being struck by something, termed contact or impact loading, are the cause of most focal injuries, and movement of the brain within the skull, termed noncontact or inertial loading, usually causes diffuse injuries. The violent shaking of an infant that causes shaken baby syndrome commonly manifests as diffuse injury. In impact loading, the force sends shock waves through the skull and brain, resulting in tissue damage. Shock waves caused by penetrating injuries can also destroy tissue along the path of a projectile, compounding the damage caused by the missile itself.

Damage may occur directly under the site of impact, or it may occur on the side opposite the impact (coup and contrecoup injury, respectively). When a moving object impacts the stationary head, coup injuries are typical,while contrecoup injuries are usually produced when the moving head strikes a stationary object.

Primary and secondary injury

A large percentage of the people killed by brain trauma do not die right away but rather days to weeks after the event; rather than improving after being hospitalized, some 40% of TBI patients deteriorate. Primary brain injury(the damage that occurs at the moment of trauma when tissues and blood vessels are stretched, compressed, and torn) is not adequate to explain this deterioration; rather, it is caused by secondary injury, a complex set of cellular processes and biochemical cascades that occur in the minutes to days following the trauma. These secondary processes can dramatically worsen the damage caused by primary injury and account for the greatest number of TBI deaths occurring in hospitals.

Secondary injury events include damage to the blood–brain barrier, release of factors that cause inflammation, free radical overload, excessive release of the neurotransmitter glutamate (excitotoxicity), influx of calcium and sodium ions into neurons, and dysfunction of mitochondria. Injured axons in the brain’s white matter may separate from their cell bodies as a result of secondary injury, potentially killing those neurons. Other factors in secondary injury are changes in the blood flow to the brain; ischemia (insufficient blood flow); cerebral hypoxia (insufficient oxygen in the brain); cerebral edema (swelling of the brain); and raised intracranial pressure (the pressure within the skull). Intracranial pressure may rise due to swelling or a mass effect from a lesion, such as a hemorrhage. As a result, cerebral perfusion pressure (the pressure of blood flow in the brain) is reduced; ischemia results. When the pressure within the skull rises too high, it can cause brain death or herniation, in which parts of the brain are squeezed by structures in the skull.  A particularly weak part of the skull that is vulnerable to damage causing extradural haematoma is the pterion, deep in which lies the middle meningeal artery, which is easily damaged in fractures of the pterion. Since the pterion is so weak, this type of injury can easily occur and can be secondary due to trauma to other parts of the skull where the impact forces spreads to the pterion.

Source: Wikipedia

Chino Avenue congregtae Home

Causes of Brain Injury in Los Angeles

The most common causes of TBI in the U.S. include violence, transportation accidents, construction, and sports.Motor bikes are major causes, increasing in significance in developing countries as other causes reduce. The estimates that between 1.6 and 3.8 million traumatic brain injuries each year are a result of sports and recreation activities in the US. In children aged two to four, falls are the most common cause of TBI, while in older children traffic accidents compete with falls for this position. TBI is the third most common injury to result from . Abuse causes 19% of cases of pediatric brain trauma, and the death rate is higher among these cases. Although men are twice as likely to have a TBI.  Domestic violence is another cause of TBI, as are work-related and industrial accidents. Firearms and blast injuries from explosions are other causes of TBI, which is the leading cause of death and disability in war zones. According to Representative Bill Pascrell (Democrat, NJ), TBI is “the signature injury of the wars in Iraq and Afghanistan.” There is a promising technology called activation database-guided EEG biofeedback, which has been documented to return a TBI’s auditory memory ability to above the control group’s performance.

Source: Wikipedia

Types of brain injury in San Bernardino

Traumatic brain injury

A traumatic brain injury is an alteration of a structural, physiological, or chemical transmitter pathway as well as other brain pathology, and is caused by an external force. A post-traumatic brain injury is the alteration of the neurological function by the traumatic event. Multiple traumatic injuries can lead to chronic traumatic encephalopathy.

Concussion

A concussion is the most common type of brain trauma, and can be caused by direct damage to the head, gunshot wounds, violent shaking of the head (very common in children), or force from a whiplash type injury. A concussion occurs when the brain receives trauma from an impact or a sudden momentum or movement change. The blood vessels in the brain may stretch, and cranial nerves may be damaged.

Contusion

A contusion can be caused by direct damage to the head, when a bruise results in bleeding in the brain.

Coup-contrecoup injury

A coup-contrecoup injury occurs when the force impacting the head is not only strong enough to cause a contusion at the site of impact but also able to move the brain and cause it to slam into the opposite side of the skull, which causes an additional contusion.

Diffuse axonal injury

A diffuse axonal injury can be caused by a strong shake on the head, as in “shaken baby syndrome”, or by rotational forces, such as a car accident. Injury occurs when the brain lags behind the movement of the skull and causes the brain structures to tear. The tearing of nerve tissue disrupts the brain’s communication and chemical processes. This disturbance in the brain could cause brain damage or death. There are specific areas were connections can be broken within the brain substance that are indicative of a diffuse axonal injury.

Locked in syndrome

Locked-in syndrome is a rare neurological condition wherein the patient is unable to physically move any part of the body except the eyes. The patient is still conscious and able to think.

Penetrating injury

A penetrating injury occurs when a sharp object enters the brain, causing a large damage area. Penetrating injuries caused by bullets have a 91 percent mortality rate.

Acquired brain injury

An acquired brain injury is an injury to the brain that has occurred after birth and therefore isn’t hereditary, congenital, degenerative, or induced by birth trauma.

Anoxic brain injury

An anoxic brain injury occurs when the human brain doesn’t receive oxygen. Cells in the brain begin to die due to lack of oxygen.

Hypoxic brain injury

Hypoxic brain injury happens when the brain receives insufficient oxygen. A hypoxic brain injury, also called stagnant hypoxia, is caused by a reduction in blood flow or low blood pressure leading to a lack of blood flow to the brain.

Source:Wikipedia

In the article entitled “Altered Network Topology in Patients with Primary Brain Tumors after Fractionated Radiotherapy,” Naeim Bahrami, Carrie McDonald, and coauthors from the University of California San Diego, used MRI imaging to estimate cortical thickness across multiple brain regions. The results demonstrated that radiotherapy to one region of the brain that led to cortical thinning could affect the thickness of other brain regions that are structurally and functionally connected. These global network effects included decreased interactivity and integration of cortical subnetworks, and changes in the distribution of major network hubs in the brain, which are critical for cognitive processing.

“It has been an open scientific question as to whether radiation therapy causes atrophy to brain cortex,” states Christopher Pawela, PhD, Editor-in-Chief of Brain Connectivity. “Dr. Bahrami and colleagues have performed an elegant study in which they were able to link structural neurodegenerative changes in cortex to variations in network connectivity between brain regions. Their work provides insights on a possible mechanism of how radiotherapy degrades healthy brain tissue outside the tumor region leading to post-therapeutic cognitive decline.”

Explore further: Radiation therapy vital to treating brain tumors, but it exacts a toll

More information: Naeim Bahrami et al, Altered Network Topology in Patients with Primary Brain Tumors After Fractionated Radiotherapy, Brain Connectivity (2017). DOI: 10.1089/brain.2017.0494

A story of brain injury in San Bernardino

Hello, my name is Peter Lawryniuk. When I was 7 years old, I was hit by a car while riding my bicycle. I was in a coma for 11 days, and when I awoke, I needed to relearn how to walk, talk, eat, use my muscles, everything over again.It was difficult at times. The doctors thought that I might not be able to walk or talk again, not even make it past grade 9. One doctor thought positive. I am 37 years old now, and I can walk, talk, drive a car, and I work and volunteer in a daycare for the past 9 years. I also volunteer at the YMCA, and work one day a week at an open doors place for people with different disabilities. I wrote a song called miracles, and sing it on YouTube. I would like to share it here if I may, and hope that it can inspire others to never give up.

Traumatic brain injury in Chino

Traumatic brain injury (TBI), also known as intracranial injury, occurs when an external force injures the brain. TBI can be classified based on severity, mechanism (closed or penetrating head injury), or other features (e.g., occurring in a specific location or over a widespread area). Head injury is a broader category that may involve damage to other structures such as the scalp and skull. TBI can result in physical, cognitive, social, emotional, and behavioral symptoms, and outcome can range from complete recovery to permanent disability or death.

Causes include falls, vehicle collisions, and violence. Brain trauma occurs as a consequence of a sudden acceleration or deceleration within the cranium or by a complex combination of both movement and sudden impact. In addition to the damage caused at the moment of injury, a variety of events in the minutes to days following the injury may result in secondary injury. These processes include alterations in cerebral blood flow and the pressure within the skull. Some of the imaging techniques used for diagnosis include computed tomography and magnetic resonance imaging (MRIs).

Prevention measures include use of protective technology in vehicles, such as seat belts and sports or motorcycle helmets, as well as efforts to reduce the number of collisions, such as safety education programs and enforcement of traffic laws. Depending on the injury, treatment required may be minimal or may include interventions such as medications, emergency surgery or surgery years later. Physical therapy, speech therapy, recreation therapy, occupational therapy and vision therapy may be employed for rehabilitation. Counseling, supported employment, and community support services may also be useful.

TBI is a major cause of death and disability worldwide, especially in children and young adults. Males sustain traumatic brain injuries more frequently than do females. The 20th century saw developments in diagnosis and treatment that decreased death rates and improved outcome.

source:Wikipedia

Nursing home care in Chino , Congregate home for brain injury 

Vision is one of nature’s great gifts.

It’s essential to safety, work, and living a meaningful life. But vision is often compromised when traumatic brain injury (TBI) occurs, leaving patients with deficits that require specialized clinical care.

Head trauma can cause serious vision impairments. It may also affect hearing, mobility, and may damage the vestibular and proprioception systems (which provide a sense of balance and spatial orientation). All these systems are interconnected with vision.

Other trauma-induced visual problems may include:

• Double-vision; limited field of vision
• Eyes that do not track objects correctly
• Uncoordinated eye and body movements
• Sensitivity to light; fatigue
• Poor depth perception
• Difficulty reading

1. FRONTAL LOBE:
Eye Movement Planning
2. PARIETAL LOBE:
Visuospatial Map,
Visual Attention
3. MIDDLE TEMPORAL LOBE:
Motion Perception
4. INFERIOR TEMPORAL LOBE:
Object Perception
5. MIDBRAIN:
Visual Orientation
and Eye Movements
6. BRAINSTEM:
Eye Movements Integrated
with Vestibular Input
7. CEREBELLUM:
Moderates Eye Movements
8. OCCIPITAL LOBE:
Shape, Contrast, Color