Traumatic Brain Injury (TBI) Definitions
- AAOX [1, 2 or 3]: Acronym for Awake, Alert, and Oriented Times 1 (person), Times 2 (person and place) and Times 3 (person, place, and time). It is a clinical shorthand for the findings in a physical examination of a patient, referring to a patient who is responsive to his/her environment, knows who he/she is, where he/she is and the approximate time.
- Altered Mental Status (AMS): A disruption in how the brain works resulting in changes in behavior. AMS ranges from confusion, total disorientation, increased sleepiness, and coma.
- Biological Marker (Biomarker): Measurable substance in an organism whose presence indicates some biological state or condition, like a disease, infection, injury or environmental exposure.
- Computerized Axial Tomography (CAT) Scan: An imaging method that uses X-rays to create pictures of cross-sections of the body.
- Concussion: The American Association of Neurological Surgeons defines concussion as an injury to the brain that results in temporary loss of normal brain function.1 “The formal medical definition of concussion is a clinical syndrome characterized by immediate and transient alteration in brain function, including alteration of mental status and level of consciousness, resulting from mechanical force or trauma.”
- Contusion: A bruise (bleeding) on the brain.
- Coup and countrecoup injury: In head injury, a coupe occurs on the site of impact. A countrecouup occurs on the side opposite of the area of impact. For example, when the brain accelerates forward, hits the side of the skull, and then bounces off the other side of the skull.
- Diffuse Axonal Injury (DAI): It falls under the category of a diffuse brain injury. This means that instead of occurring in a specific area, like a focal brain injury, it occurs over a more widespread area. DAI is one of the most common and devastating types of traumatic brain injury, and is a major cause of unconsciousness and persistent vegetative state after head trauma.
- Diffusion Tensor Imaging (DTI): Is a MRI-based neuroimaging which allows to visualize the location, orientation, and composition of the brain’s white matter tracts. According to some studies, this method may be a reliable way to diagnose and monitor mild traumatic brain injury.
- Electroencephalogram (EEG): Is a neurological test that uses an electronic monitoring device to measure and record the electrical activity in the brain.
- Focal Brain Injury: Is an injury that is confined to one area of the brain. In most cases, the brain tissue is damaged at the site where the injury occurred. A Focal Brain Injury can be closed when there is no penetration of the skull, or open when an object pierces the skull and enters brain tissue.
- Glasgow Coma Scale (GCS): A neurological scale which aims to give a reliable and objective way of recording the conscious state of a person for initial and subsequent assessment. It is the summation of scores for eye, verbal and motor responses. The scale ranges from a minimum of 3, which indicates deep coma or brain-dead state, to the maximum of 15, which indicates a fully awake patient. The original maximum was 14, but the score has been modified since then.
- Head Injury: By definition, an injury to the skull. Should not be confused with brain injury which by definition is an injury to the brain and which may result from a head injury.
- Hematoma: A mass of clotted blood that forms in a tissue, organ, or body space as a result of a broken blood vessel.
- Loss of Consciousness (LOC): A partial or complete interruption of awareness of oneself and one’s surroundings.
- Magnetic Resonance Angiography (MRA): A series of techniques which are based on MRI to visualize and image blood vessels.
- Magnetic Resonance Imaging (MRI) Scan: An imaging test that uses magnets and radio waves to create pictures of the body and/or its organs. It does not use radiation.
- Magnetic Resonance Spectroscopy: Also known as nuclear magnetic resonance (NMR) spectroscopy, which is a non-invasive, ionizing radiation free analytical technique that has been used to study metabolic changes in brain tumors, strokes, seizure disorders, Alzheimer’s disease, depression, and other diseases affecting the brain.
- Mild traumatic brain injury (mTBI)2: A patient with a mild traumatic brain injury has had a traumatically induced physiological disruption of brain function. An MTBI manifests with at least one of the following:
- Any period of loss of consciousness;
- Any loss of memory for events immediately before or after the accident;
- Any alteration in mental state at the time of the accident (eg., feeling dazed, disoriented, or confused); and/or
- Focal neurological deficit(s) that may or may not be transient;
But the severity of the injury does not exceed the following:
- Loss of consciousness of approximately 30 minutes or less;
- After 30 minutes, an initial Glasgow Coma Scale (GCS) of 13-15; and
- Posttraumatic Amnesia (PTA) not greater than 24 hours.
It is worth mentioning that this definition differs from other conventional mTBI definitions in that the cause of the MTBI is not limited to head blows. This definition also suggests that the brain can be injured as a result of an acceleration/deceleration movement without direct external trauma to the head (i.e. whiplash, shaken baby syndrome).
2 Developed by the Mild Traumatic Brain Injury Committee of the Head Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitation Medicine.
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