Introduction Traumatic Brain Injury

INTRODUCTION:
TRAUMATIC BRAIN
INJURY
Lecture by: M.K. Sastry
Program Director,
Post Graduate Studies and PhD Program
Brain function
 Brain functions are both distributed
and modular.
Brain function
 Modular: focal injury can lead to
specific impairment.
 e.g. Language deficits typically seen
after left but not right hemisphere
injury.
Brain function
 Distributed: large network involved
 Damage to any nodes or white

matter tracts lead to eye movement
deficits.
Brain function
 Knock on effects: damage to one node
degrades performance upstream.
 Damage to V1 effectively disables
V2.
Brain function
 Disconnection syndromes:
 Damage to white matter sufficient to

disable intact cortex.
Regeneration
 Peripheral nervous system can exhibit
profound rehabilitation.
 In general, CNS neurons do not
regenerate, though glial cells often do.
Regeneration
 Neurons can exhibit dendritic
sprouting.
 Changes in neurotransmitters and
blood flow also play a role.
Plasticity
 The brain is often able to
compensate in response to
small injuries.
 Most rehabilitation aims to
leverage this.
Plasticity
 Plasticity effects are age
related, typically younger
individuals show better
effects.
Plasticity
 Plasticity also changes with
time. Injury and recovery
often exhibits a
characteristic time course.
Plasticity
 Plasticity is typically a good
thing, but not always.
Types of Injury
 Focal versus Diffuse.
 Focal refers to discrete
spatial extent, for example
TBI due to mechanical
force (vulnerable regions)
or stroke due to blockage
(ischemic).
Types of Injury
 Focal versus Diffuse.
 Diffuse refers to
widespread injury to many
regions. For example TBI
due shearing of white
matter or stroke due to
bleeding (hemorrhagic).
Types of Injury
Types of Injury
TBI
 TBI classification remains vague.
 Mild injuries much more common.
S
e
v
er
e
Moderate
Mild
Classification
 GCS: Glasgow Coma Scale.
 PTA: Post traumatic Amnesia.

 LOC: Loss of consciousness.
Classification
 Mild TBI Terms.
 Complicated mTBI: injury visible in

brain scan.
 Post concussion injury: long term
deficits.
Classification
 Mild TBI Terms.
 Concussion: mTBI ~ brain clearly

injured, typically full functional
recovery. Permanent injury debated
Immediate and long term effects
of TBI
 Contusion (bruising)
results in increased
cranial pressure. Brain
can herniate. Life or
death situation.
of TBI
 TBI also associated with
latent effects. Often
symptoms get worse
with time.
of TBI
 Epilepsy (recurrent
seizures) can begin
months after injury.
TBI and age
 TBI most common in young and old.
 Classic ‘Bathtub’ function.
 Children run into things, do not attend

well.
TBI and age
 Adolescents drive cars and are often
addled by testosterone.
 Older individuals often fall.
Reporting findings
 How do we describe
anatomy to others?
 We could use
anatomical names, but
often hard to identify.
Reporting findings
 How do we describe
anatomy to others?
 We could use
Brodmann’s Areas, but
this requires histology –
not suitable for invivo
research.
Reporting findings
 Both show large
between-subject
variability.
 Requires anatomical
coordinate system.
Ambiguous Coordinates
D
Rat  Human brain rotated
R C
relative to spine
V
 Ambiguous
D
Human dimensions
R
R
C
 Dorsal / ventral
V
V D
 Rostral / caudal
C
Ambiguous Coordinates
D
Rat  Unambiguous
R C
dimensions
V
 Head / Foot
D
Human
 Superior / Inferior
R C
R  Anterior / Posterior
V D
V
C
Anatomy – Common Terms
lateral < medial > lateral Posterior <> Anterior coronal sagittal
Inferior <>
Superior
Posterior <>
Anterior
axial
 Radiological convention: Left on right side

 Neurological convention: Left on left side
Brain Coordinates
 On Earth: North,
South, East and West.
 0˚N/S explicitly
defined by spheres
rotation (equator).
Brain Coordinates
 On Earth: North,
South, East and West.
 0˚E/W arbitrary
(Greenwich by
convention).
Brain Coordinates
 For brain: Left/Right,
Sup./Inf., Ant./Post.
 Origin of L/R
explicitly defined
(brain symmetry)
Brain Coordinates
 For brain: Left/Right,
Sup./Inf., Ant./Post.
 Origin of S/I and A/P
arbitrary.
Coordinates - Talairach
 Anterior Commissure (AC) is the origin for
neuroscience.
 We measure distance from AC
 57x-67x0 means ‘right posterior middle’.
Coordinates - Talairach
 Anterior Commissure (AC) is the origin for
neuroscience.
 We measure distance from AC
 Three values: left-right, posterior-
anterior, ventral-dorsal
Recognizing the cortical lobes
 Cortical lobes: Frontal, Parietal, Occipital
Temporal, Insula.
Recognizing the cortical lobes
 N.B. Cerebellum and subcortical gray matter.
Recognizing
the cortical
lobes
The major sulci
 Postcentral easy to find: becomes intraparietal.
Precentral easy to find- attached to superior frontal.
Between these is the Central (Rolandic).
Sylvian (lateral) fissure
Interhemispheric fissure
Major sulci
 You can usually
find the central
suclus’ motor hand
area (omega shape
on axial slice)
Major sulci
Gyri and sulci
 Naming of most gyri (ridges) and sulci
(valleys) follows simple pattern of position
(superior, middle, inferior) and lobe name.
Gyri and sulci
Gyri and sulci
Thank You

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INTRODUCTION:

 Damage to any nodes or white

 Damage to white matter sufficient to

 PTA: Post traumatic Amnesia.

 Complicated mTBI: injury visible in

 Concussion: mTBI ~ brain clearly

 Classic ‘Bathtub’ function.

 Children run into things, do not attend

 Radiological convention: Left on right side

Sylvian (lateral) fissure

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