Acquired Brain Injury
Acquired Brain Injury is an umbrella term that:
- Encompasses a wide spectrum of brain injuries
- Has a wide range of impairments affecting physical, neurocognitive, or psychological functioning
- May result from
- Traumatic aetiologies
- Concussion
- Contusions
- Non-traumatic aetiologies
- Subarachnoid haemorrhage
- Traumatic aetiologies
Epidemiology and Risk Factors
Pathophysiology
Aetiology
Assessment
History
Behavioural change is common and may be significant. Features include:
- Impulsivity
- Low frustration tolerance
- Verbal or physical threats and aggression
- Non–adherence
- Disinhibition
- Inappropriate sexual behaviours
- Repetitive behaviour
- Wandering or absconding
- Inappropriate or irresponsible social behaviour
- Intrusiveness
- Self-centeredness
- Manipulative behaviours
- Apathy
Examination
Investigations
Bedside:
Laboratory:
Imaging:
Other:
Diagnostic Approach and DDx
Management
- Staff safety
- Behavioural management
- Non-benzodiazepine sedation
Specific therapy:
Pharmacological management should be secondary to non-pharmacological means.
- Pharmacological
- Aggression/behavioural control
- Avoidance of benzodiazepines
- Propranolol 5mg TDS-QID
Uptitrate as haemodynamic tolerance permits, up to 160mg (total) per day. - Valproate 100-200mg BD
Second-line agent for aggression and behaviours of concern. - Atypical antipsychotics
May be appropriate if an agent is required for acute agitation.
- Aggression/behavioural control
- Procedural
- Physical
Supportive care:
- D
- Behavioural management
Will require multidisciplinary engagement. Considerations include:- Detection and avoidance of exacerbating factors
- Build rapport
- Behavioural management
Disposition:
Preventative:
Marginal and Ineffective Therapies
Anaesthetic Considerations
Complications
- D
- Mental health diagnoses
Common following ABI, and include:- Depression
- Anxiety
- Psychosis
- Mental health diagnoses