THE ESSENTIAL BRAIN INJURY GUIDE Neuroanatomy & - PDF document

8/25/2017 THE ESSENTIAL BRAIN INJURY GUIDE Neuroanatomy & Neuroplasticity Section 2 Education & Brain Injury Presented by: Rene Carfi, LCSW, CBIST Outreach Alliance of Manager Connecticut Certified Brain Injury Specialist Training – October 26 & 27, 2017 This training is being offered Presented by Brain Injury Alliance of Connecticut staff: as part of the Brain Injury Rene Carfi, LCSW, CBIST, Education & Outreach Manager Alliance of Connecticut’s & ongoing commitment to Bonnie Meyers, CRC, CBIST, Director of Programs & Services provide education and outreach about brain injury in an effort to improve services and supports for those affected by brain injury. Contributors Erin D. Bigler, PhD Michael R. Hoane, PhD Stephanie Kolakowsky-Hayner, PhD, CBIST, FACRM Dorothy A. Kozlowski, PhD Eric Spier, MD, BIM, CBIS Tina Trudel, PhD 1

8/25/2017 Neuroanatomy and Neuroimaging 4 Learning Distinguish between Understand the symptom patterns anatomy of the due to brain injury Objectives brain, spine, and and syndromes in spinal cord; spinal cord injury Compare the incidence of spinal cord injury to TBI Articulate the methods of neuroimaging which support diagnostic and treatment decisions when a patient has sustained either a brain injury or spinal cord injury. NEUROANATOMY 2

8/25/2017 7 Skull Anatomy  The skull is a rounded layer of bone designed to protect the brain from penetrating injuries  The inside of the skull is rough with many bony protuberances  These ridges can result in injury to the brain during rapid acceleration 8 Cerebrospinal Fluid Lateral Ventricles 3 rd & 4 th Ventricles Lateral Ventricles 3 rd & 4 th Ventricles 9 The Meninges  The meninges are layers of tissue that separate the skull and the brain  There are 3 layers  Pia Mater Subdural space  Arachnoid Subarachnoid space  Dura Mater Essen ential TIP! The Meninges P-A-D the Brain Gray Matter White Matter P ia Mater A rachnoid D ura Mater 3

8/25/2017 Brain Cells AXON AXON Terminals Synapse Cell Dendrites Body NEURONS Dendritic Spines Neurons Communicate via Synapses Neuron B Neuron A Neuron C 12 4

8/25/2017 BRAIN STEM 14 Brain Stem Anatomy Midbrain Pons Medulla 15 Reticular Activating System  Arousal  Alertness  Concentration  Basic biological rhythms 5

8/25/2017 DIENCEPHALON 17 Thalamus and Hypothalamus LIMBIC SYSTEM 6

8/25/2017 19 Limbic System Hippocampus Amygdala Basal Ganglia and Cerebellum Basal Ganglia Cerebellum THE CEREBRAL Two Hemispheres   Four Lobes CORTEX Interconnected  7

8/25/2017 22 Information Processing Right Hemisphere Left hemisphere  Holistic  Linear  Visual Spatial  Verbal-analytic  Intuitive  Logical  Controls left side of body  Controls right side of body  Music, art, shapes  Speaking, reading, writing Sulcus Cerebral Gyri Features Gyri- Elevated ridges • that wind around the brain Sulci- Small grooves • dividing the gyri Fissures- Deep grooves, • usually dividing large regions/lobes of the Fissure brain Primary Motor Cortex 24 Prefrontal Frontal Cortex Lobe Frontal Poles 8

8/25/2017 25 Frontal Lobe Functions  Planning  Organizing  Problem Solving  Judgment  Impulse Control  Decision Making  Working Memory 26 Temporal Lobe 27 Expressive and Receptive Speech Broca’s Area Wernicke’s Area 9

8/25/2017 28 Occipital Lobe Primary Visual Cortex 29 Visual Pathway Left Visual Field Right Visual Field 30 Parietal Primary Sensory Somatosensory Cortex Cortex Lobe 10

8/25/2017 SPINE AND SPINAL CORD 32 Spinal Column Divisions Cervical Spine showing Lateral, Anterior, and Posterior view Thoracic Vertebrae showing Lateral, Anterior, and Posterior views Lumbar Vertebrae showing Lateral, Anterior, and Posterior views 33 Vertebral Bodies Spinal Cord Disk Meninges Nerve Root Vertebra 11

8/25/2017 34 Spinal Cord Spinal Cord Afferent Sensory Information Efferent Signals A fferent Nerves Essen ential TIP! A scend upward 35 Spinal Cord Syndromes Central Cord Syndrome Brown-Sequard Syndrome Anterior Cord Syndrome Posterior Cord Syndrome NEUROIMAGING 12

8/25/2017 Computed Tomography (CT) 38 Magnetic Resonance Imaging (MRI) Functional MRI (fMRI) Diffusion Tensor Imaging (DTI) 39 Brain Symmetry & Imaging 13

8/25/2017 Mechanisms of TRAUMATIC IMPACT TRAUMATIC INERTIAL Contact Injury Non-Contact Injury Traumatic Injury Head struck by or against an object Brain moves within skull Categories of Brain Injury OPEN Rotatio ional/Ang ngular r Forces CLOSED (Penetrating) Focal Non-Contact Injury (Non-Penetrating) Skull ll Fr Fracture Brain moves within skull Meninges Breach Contusions  Lesions  FOCAL PRIM IMARIL ILY PRIM IMARIL ILY Y DIF IFFU FUSE Hematomas  - OR - FOCAL (MULTIF IFOCAL) L) DIFFU FFUSE Diffuse Epi pidu dural Diffuse Axonal Injury  Brain n Cont ntusions ns Hematomas Hemorrhage Brain n Lacerations ns  Diffuse Axo xona nal Inj njury Subdu dural Intracerebral Hematomas White Matter Lesion Hemorrhage Intracerebral Hemorrhage Diffuse Axo xona nal Hemorrhage Injury Infections ns 41 http://www.calshipleymd.com/ Mechanism of Injury medical-animation/neurology- library/diffuse-axonal-injury-dai/ Acceleration-Deceleration (Traumatic Inertial) 42 Mechanism of Injury Coup Contrecoup  The bouncing of the brain in the skull can result in injury in two sites The initial site of injury (coup) The contrecoup injury 14

8/25/2017 43 Mechanism of Injury: Intracranial Pressure Neuroprotection and Neuroplasticity 44 Be able to Learning Be able to explain articulate the factors leading to effects of brain Objectives neurodegeneration injury and injury following TBI severity Understand the Be able to articulate conceptions of the two main neuroprotection, areas of the brain neuroplasticity, and known to be sites of neurodegeneration neurogenesis Be able to distinguish between rehabilitative training models appropriate for TBI and those for stroke 15

8/25/2017 NEUROPLASTICITY 47 Early Research on Neuroplasticity Thumb D2 D2 D3 D3 D4 D4 D5 D5 48 Synaptogenesis Definition : the formation of synapses between neurons The greater the numbers of synapses within a grouping of neurons, the greater the speed and efficiency with which those neurons communicate Dendritic spines have the ability to change in response to experience 16

8/25/2017 Neuroplasticity Post-TBI Plasticity: the ability of • the nervous system to change, grow or compensate for injury 50 Neuroplasticity: TBI Research NEUROPROTECTION 17

8/25/2017 52 Biological Cascade Following TBI  Primary Injury - direct damage to the brain  Secondary Injury - causes additional damage  Excitotoxicity  Edema  Apoptosis 53 Potential Neuroprotective Agents for TBI  Neuroprotective agents limit neuronal death following injury and/or enhance recovery Neuroprotective Agent Intervention Target Animal Models Showing Human Studies Showing Efficacy (Stroke) Efficacy (TBI) Magnesium Increase Mg2 (decreased Failed Mg2 results in excessive S production of free radical and mild inflammation) Progesterone Decrease cerebral Initial Efficacy; Follow Up S edema Trial Nicotinimide Reduce injury volume; Unknown decrease glial activation; ? reduce BBB breaches; reduce edema Q & A 18

8/25/2017 200 Day Hill Road, Suite 250 Thank You! Windsor, CT 06095 Office 860.219.0291 Helpline 800.278.8242 general@biact.org BIACT.org 19