TBI lecture - Cellular Mechanisms of Traumatic Brain Injury...

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Cellular Mechanisms of Traumatic Brain Injury 1
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PATHOPHYSIOLOGY § PHASES OF TBI § Primary, Primary Evolution, Secondary, Regeneration § TISSUE-LEVEL § CELLULAR-LEVEL § FUNCTIONAL
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PATHOPHYSIOLOGY § PHASES OF TBI § PRIMARY § Direct contusion, shearing and stretching, vascular response § Cessation of blood flow and metabolism § Rupture of cellular and vascular membranes § Release of intracellular contents § Location and magnitude of damage reflect the characteristics injury § Preventative measures
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PATHOPHYSIOLOGY § PHASES OF TBI § SECONDARY INJURY § Delayed process-hours to days § Progressive deterioration § Interplay between ischemic, inflammatory, and cytotoxic processes promoting necrosis and apoptosis § Significantly contributes to post-traumatic neurological disability
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PATHOPHYSIOLOGY § CELLULAR LEVEL § Apoptosis and necrotic cell death § Excitatory amino acid neurotransmitters § Glutamate and aspartate § Glutamate receptor activation § Influx of Ca 2+ (intracellular and extracellular) § Activation of intracellular proteases § Calpains, phospholipases, endonucleases § Free radicals § Superoxides, hydrogen peroxide, hydroxyl radicals, nitric oxide, peroxynitrite
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Intracranial Pressure § Normally: § Brain = 80% of cranial vault space § Blood = 10% of cranial vault space § CSF = 10% of cranial vault space
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16 Why do we need baseline neurocognitive assessments in sports? § ± Nobody in football should be called a genius. A genius is a guy like Norman Einstein. ² -- Football commentator and former player, Joe Theisman
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University of Virginia Football Study TOTAL (10 Universities) 2350 Players Post-injury Protocol: Concussions 195 Orthopedic Injuries 59 Student Controls 48
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TRAIL MAKING B Pre-Season and Post-Injury Performances (Timed in Seconds) 0 10 20 30 40 50 60 PRE SEASON 24 HRS 5 DAYS 10 DAYS POST SEASON FOOTBALL PLAYERS CONTROLS
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Percentage of Players Reporting Symptoms Following Mild Concussion Pre-season 24-Hours 5 Days 10 Days Headaches 27.0 70.6 54.3 27.2 Memory 2.3 33.9 26.7 8.8 Dizziness 2.3 34.8 21.6 9.4
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20 UVA Mild Head Injury in Football (Barth, et al., 1989) § 10 University Prospective Study (n=2350) § 195 Concussions § 107 Student/Red Shirt Athlete Controls § Single Concussion: §
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