Manifestations of Types of Traumatic Brain Injury

¶ … manifestations of types of traumatic brain injury (focal, diffuse) and hemorrhage (epidural, subdural, subarachnoid)?

Focal TBI occurs as a result of some mechanical force acting on the skull (and hence the brain) or penetrating injury to the brain. The manifestations of focal TBI will depend on the particular area of the brain that is damaged (Granacher, 2007). For example, damage to the posterior portion of the left frontal lobe will typically result in problems with expressive language and executive functions, whereas damage to the posterior portion of the left temporal lobe is more likely to result in receptive language problems, naming problems, and problems with verbal memory (Granacher, 2007).

The manifestations of diffuse TBI can be quite varied such is the case of the diffuse axonal injury caused by sharing of the axons in the brain. These can range from global effects on cognition, movement, sensation and perception, to more specific problems associated with memory, attention, executive functions, and orientation. The effects of TBI can be quite variable depending on the force involved in the extent of the damage (Granacher, 2007).

Epidural hemorrhage occurs outside of the brain (between the dura matter and the skull; Granacher, 2007). Until there is significant pressure on the brain there may not be any symptoms at all; however, symptoms typically are contralateral muscle weakness, contralateral loss of vision, and dilated pupils with a downward gaze opposite side of the hemorrhage. Subdural hemorrhage involves bleeding between the dura and arachnoid matter and typically manifests itself related to the area of the brain the hemorrhage pressures. Depending on the rate of blood collection the symptoms can take weeks to appear or can appear very rapidly (Granacher, 2007). Subarachnoid hemorrhage occurs between the pia and arachnoid leaders and symptoms typically include headache, dizziness, and double vision or visual loss.

2. Discuss the occurrence and causes of seizure disorders in childhood, with a focus on differential manifestations and treatments.

The majority of seizures occurring in children have no identifiable cause (Engel, 2013). The most common causes seizures in children are febrile seizures, seizures associated with an elevation in body temperature. The vast majority of these are believed to be harmless and not treated unless they are focal (manifest on one side of the brain and result in focal symptoms), prolonged (last longer than 5 minutes), or recur after 24 hours (Engel, 2013). Only a very small percentage of children who experience febrile seizures go on to develop childhood epilepsy.

One of the most common causes of seizure disorders in children worldwide is neurocystircercosis which is caused by the infestation of the pork tapeworm larva, Taenia solium. The drugs albendazole and praziquantel are used extensively to treat neurocysticercosis; however, preventive health measures are the best way to manage this disease. This disease is less prevalent in industrialized nations (Engel, 2013).

Other common causes of seizures in children include infection such as meningitis, TBI, malformations of the brain, brain tumors, and genetic disorders (Engel, 2013). Seizures occurring as a result of infections are often generalized, whereas seizures that occur as a result of trauma, brain malformations, or genetic disorders can be either generalized or focal. The specific treatment will depend on the cause of the seizure, the type of seizure that needs to be treated, the child's medical history, the child's age, and potential interactions with other medications that the child must take (Engel, 2013). Treatment for seizure disorders in children such as epilepsy, seizures due to brain trauma, etc. typically consist of anticonvulsant medications combined with behavior and family interventions.

3. Compare and contrast two different central nervous system tumors commonly found in children.

More than 60% of the brain tumors and occur in children are located in the posterior fossa (cerebellum, brainstem, and the fourth ventricle; Ris & Abbey, 2010). About 20% of all brain tumors occurring in children are medulloblastomas. Medulloblastomas are a type of infratentorial primitive neuroectodermal tumors (PNET), which are very rapidly growing and invasive tumors that spread through the cerebrospinal fluid to other areas of the CNS and to other areas of the body (Ris & Abbey, 2010). The symptoms are typically due to an increase in intracranial pressure due to hydrocephalus as a result of blockage of the fourth ventricle of the brain. Children will often become very listless, have morning headaches, repeated episodes of vomiting, and due to cerebellar involvement may have problems with gait. Due to involvement of the sixth cranial nerve there may be double vision or nystagmus and sometimes there is motor weakness and numbness in the face (Ris & Abbey, 2010).

The second most common form of brain tumors occurring in children are cerebellar astrocytomas which comprise about 15 to 20% of tumors in children. Cerebellar astrocytomas arise from one the supporting cells of the brain, astrocytes, and occur in the cerebellum. They are typically benign and can occur at any age. The most common symptoms are difficulties with walking and difficulties with balance, vomiting, and headache. The nausea and headache due to these tumors typically results from hydrocephalus due to blockage of the fourth ventricle of the brain (Ris & Abbey, 2010).

4. Differentiate among the degenerative disorders of the spine: degenerative disk disease, spondylolysis, spondylolisthesis, and spinal stenosis.

One of the most common causes of low back pain in adolescents, especially adolescent athletes, is spondylolysis, a defect in the vertebra that usually occurs in the fifth lumbar vertebrae in the lower back and can also occur in the fourth lumbar vertebra (the defect occurs in the pars interarticularis, located between the inferior and superior articular processes of the facet joint; Greenburg, 2010). This defect in the vertebra typically leads to stress fractures and pinched nerves causing pain and reduced mobility. If a stress fracture weakens the bone to the point that it is unable to maintain its proper position the vertebrae in this area can shift and if too much slippage occurs the bones can press on the nerves (Greenburg, 2010).

Spondylolisthesis is a displacement, either anterior or posterior, of a vertebrae or the entire spinal column in relation to the vertebrae below it. If the slippage is anterior (forward) to the vertebrae below it is referred to as anterolisthesis, whereas if the slippage is posterior (backward) in reference to the vertebrae below it is referred to as retrolisthesis (Greenburg, 2010). Spondylolisthesis can result in spinal deformities, spinal stenosis, or even pinched nerves.