Traumatic Brain Injury
Case Studies
Case Study #1
16 year old male, jumping from bridge, slipped
and struck head on railing before hitting the
water.
Came up above water, but appears dazed and
slow to respond to questions.
His mother brings him to the local emergency
department.
On your initial assessment, he is amnestic to the
events surrounding his injury, oriented to
person, place and time, and is complaining
that “the back of my head hurts”. The rest of
his exam is unremarkable.
Does this patient require a head CT?
A. Yes
B. No
This Head CT Shows:
1. Epidural Hematoma
2. Subdural Hematoma
3. Subarachnoid
Hemorrhage
4. Shear injury
5. No acute injury
Based on his physical exam, mental status and
head CT results, he should:
A. Have another CT scan in 6
hours
B. Be discharged to home
with his mother
C. Be admitted to the
Trauma Service for at
least 24 hours
D. Spend the night in the
Emergency Department
As you are preparing his discharge paperwork,
he says, “GOOD! I have football practice
tomorrow!” Can he play?
A. Yes
B. No
When can he return to football?
A. When he says he feels
fine
B. When his mother thinks
he is well enough to play
C. After further evaluation
demonstrates that he is
no longer suffering from
post concussive
symptoms.
Case Study #2
75 year old woman, tripped over dog, striking head on
floor. She sustained a brief + loss of consciousness,
prior to waking up with her daughter at her side.
Daughter transports her to local Emergency
Department.
She is awake and alert, and complains of “the
worst headache of my life”
She is evaluated by the ED staff, who call you
once they see her head CT
This Head CT shows:
A. Epidural Hematoma
B. Subdural Hemorrhage
C. Subarachnoid
Hemorrhage
D. SAH & EDH
E. SDH & EDH
F. No acute injury
Epidural Hematomas are often associated with
A. Cervical spine
fractures
B. Parietal skull
fractures
C. “the worst headache
of my life”
D. Venous bleeding
Subarachnoid hemorrhages frequently
A. Require surgical
evacuation
B. Produce “the worse
headache of my life”
C. Produce significant
“mass effect”
D. A & C
E. All of the above
F. None of the above
She is admitted to the trauma service,
hemodynamically stable and in no acute distress.
Your two main goals of care in the immediate future?
A. Get her a diet and a
blanket
B. Consult PT and OT
C. Prevent hypoxia and
hypovolemia
D. Contact case
management and
arrange for transfer to
skilled nursing facility
Does she require a repeat Head CT?
A. Yes
B. No
Case Study #3
22 year old man s/p single vehicle MVC vs. tree.
EMS finds him unresponsive (GCS 3). He is
intubated without drugs, IV access is initiated
and he is transported to the ED for evaluation.
Trauma evaluation notes a right forearm
deformity, and scattered abrasions.
Prior to admission to the Trauma Service, he is
taken through the CT scanner:
This Head CT shows:
1.Epidural Hematoma
2.Subdural Hematoma
3.Subarachnoid
Hemorrhage
4.Shear injury
5.No acute injury
Your two main goals during his resuscitation are
to prevent ________ and ________.
A. Pressure ulcers,
contractures
B. Family arguments,
disagreements
C. Hypoxia,
hypovolemia
D. Pain, discomfort
He has an ICP monitor placed, with ICP’s ranging 8-10.
He remains hemodynamically stable, and is cleared to
have his forearm repaired by the Orthopaedic
service.
On Hospital Day #4, he is trached and PEG’d, and
weaned from the ventilator by hospital day #5.
His ICP monitor is discontinued.
His family asks you, “When will he wake up?”
A. He may never wake up
B. The longer he remains comatose,
the less likely it is for him to wake
up
C. If he wakes up, he will likely
emerge through several phases
of the RLA scoring system.
D. It will take up to a year to
determine his long term, “new
normal”, baseline.
E. All of the above
F. None of the above
Speech Therapy is consulted for a cognitive
evaluation. They report that he is functioning at
a RLA II level. You can expect him to have:
A. No response
B. Confusion with
agitation
C. Generalized responses
D. Confusion without
agitation
E. Appropriate responses
He progresses to a RLA III (localized response)
emerging IV (confused, agitated). PT and OT
come to evaluate him.You anticipate they will
recommend
A. Skilled Nursing
Facility
B. Inpatient
Rehabilitation
C. Home with Family
D. LTAC