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Spinal Cord; Spinal Cord Injury THE ESSENTIAL BRAIN INJURY GUIDE Neuroanatomy & Neuroplasticity Section 2 Presented by: Rene Carfi, Education & Brain Injury LCSW, CBIST Outreach Alliance of Manager Connecticut Certified Brain Injury Specialist Training – October 26 & 27, 2017 Presented by Brain Injury Alliance of This training is being offered Connecticut staff: Rene Carfi, LCSW, CBIST, Education & as part of the Brain Injury Outreach Manager & Alliance of Connecticut’s Bonnie Meyers, CRC, CBIST, Director of ongoing commitment to Programs & Services provide education and outreach about brain injury in an effort to improve services and supports for those affected by brain injury. Contributors Erin D. Bigler, PhD Michael R. Hoane, PhD Stephanie Kolakowsky-Hayner, PhD, CBIST, FACRM Dorothy A. Kozlowski, PhD Eric Spier, MD, BIM, CBIS Tina Trudel, PhD Neuroanatomy and Neuroimaging 4 Distinguish between Understand the symptom patterns Learning anatomy of the due to brain injury brain, spine, and and syndromes in Objectives spinal cord; spinal cord injury Compare the incidence of spinal cord injury to TBI Articulate the methods of neuroimaging which support diagnostic and treatment decisions when a patient has sustained either a brain injury or spinal cord injury. NEUROANATOMY 7 Skull Anatomy . The skull is a rounded layer of bone designed to protect the brain from penetrating injuries . The inside of the skull is rough with many bony protuberances . These ridges can result in injury to the brain during rapid acceleration 8 Cerebrospinal Fluid Lateral Ventricles 3rd & 4th Ventricles Lateral Ventricles 3rd & 4th Ventricles 9 The Meninges . The meninges are layers of tissue that separate the skull and the brain . There are 3 layers . Pia Mater Subdural space . Arachnoid Subarachnoid space . Dura Mater Essential TIP! The Meninges P-A-D the Brain Gray Matter White Matter Pia Mater Arachnoid Dura Mater AXON Brain Cells AXON Terminals Synapse Cell Body Dendrites NEURONS Dendritic Spines Neurons Communicate via Synapses Neuron A Neuron B Neuron C 12 BRAIN STEM 14 Brain Stem Anatomy Midbrain Pons Medulla 15 Reticular Activating System . Arousal . Alertness . Concentration . Basic biological rhythms DIENCEPHALON 17 Thalamus and Hypothalamus LIMBIC SYSTEM 19 Limbic System Hippocampus Amygdala Basal Ganglia and Cerebellum Basal Ganglia Cerebellum . Two Hemispheres THE CEREBRAL . Four Lobes . Interconnected CORTEX 22 Information Processing Right Hemisphere Left hemisphere . Holistic . Linear . Visual Spatial . Verbal-analytic . Intuitive . Logical . Controls left side of body . Controls right side of body . Music, art, shapes . Speaking, reading, writing Sulcus Cerebral Gyri Features • Gyri- Elevated ridges that wind around the brain • Sulci- Small grooves dividing the gyri • Fissures- Deep grooves, usually dividing large regions/lobes of the Fissure brain Primary Motor Cortex 24 Prefrontal Cortex Frontal Lobe Frontal Poles 25 Frontal Lobe Functions . Planning . Organizing . Problem Solving . Judgment . Impulse Control . Decision Making . Working Memory 26 Temporal Lobe 27 Expressive and Receptive Speech Broca’s Area Wernicke’s Area 28 Occipital Lobe Primary Visual Cortex 29 Visual Pathway Left Visual Field Right Visual Field 30 Primary Sensory Somatosensory Parietal Cortex Cortex Lobe SPINE AND SPINAL CORD 32 Spinal Column Divisions Cervical Spine showing Lateral, Anterior, and Posterior view Thoracic Vertebrae showing Lateral, Anterior, and Posterior views Lumbar Vertebrae showing Lateral, Anterior, and Posterior views 33 Vertebral Bodies Spinal Cord Disk Meninges Nerve Root Vertebra 34 Spinal Cord Spinal Cord Afferent Sensory Information Efferent Signals Essential TIP! Afferent Nerves Ascend upward 35 Spinal Cord Syndromes Central Cord Syndrome Brown-Sequard Syndrome Anterior Cord Syndrome Posterior Cord Syndrome NEUROIMAGING Computed Tomography (CT) 38 Magnetic Resonance Imaging (MRI) Diffusion Tensor Imaging (DTI) Functional MRI (fMRI) 39 Brain Symmetry & Imaging TRAUMATIC IMPACT TRAUMATIC INERTIAL Mechanisms of Contact Injury Non-Contact Injury Traumatic Injury Head struck by or against an object Brain moves within skull Categories of Brain Injury OPEN Rotational/Angular Forces CLOSED (Penetrating) Non-Contact Injury Focal (Non-Penetrating) Skull Fracture Brain moves within skull Meninges Breach . Contusions . Lesions FOCAL PRIMARILY PRIMARILY DIFFUSE - OR - . Hematomas FOCAL (MULTIFOCAL) DIFFUSE Diffuse Epidural Brain Contusions . Diffuse Axonal Injury Hematomas Brain Lacerations . Hemorrhage Subdural Diffuse Axonal Injury Intracerebral Hematomas White Matter Lesion Hemorrhage Intracerebral Hemorrhage Diffuse Axonal Hemorrhage Injury Infections http://www.calshipleymd.com/ 41 medical-animation/neurology- Mechanism of Injury library/diffuse-axonal-injury-dai/ Acceleration-Deceleration (Traumatic Inertial) 42 Mechanism of Injury Coup Contrecoup . The bouncing of the brain in the skull can result in injury in two sites The initial site of injury (coup) The contrecoup injury 43 Mechanism of Injury: Intracranial Pressure Neuroprotection and Neuroplasticity 44 Be able to explain Be able to Learning factors leading to articulate the neurodegeneration effects of brain following TBI injury and injury Objectives severity Understand the Be able to articulate conceptions of the two main neuroprotection, areas of the brain neuroplasticity, and known to be sites of neurodegeneration neurogenesis Be able to distinguish between rehabilitative training models appropriate for TBI and those for stroke NEUROPLASTICITY 47 Early Research on Neuroplasticity Thumb D2 D3 D4 D5 48 Synaptogenesis Definition: the formation of synapses between neurons The greater the numbers of synapses within a grouping of neurons, the greater the speed and efficiency with which those neurons communicate Dendritic spines have the ability to change in response to experience Neuroplasticity Post-TBI • Plasticity: the ability of the nervous system to change, grow or compensate for injury 50 Neuroplasticity: TBI Research NEUROPROTECTION 52 Biological Cascade Following TBI . Primary Injury - direct damage to the brain . Secondary Injury - causes additional damage . Excitotoxicity . Edema . Apoptosis 53 Potential Neuroprotective Agents for TBI . Neuroprotective agents limit neuronal death following injury and/or enhance recovery Neuroprotective Agent Intervention Target Animal Models Showing Human Studies Showing Efficacy (Stroke) Efficacy (TBI) Magnesium Increase Mg2 (decreased Failed Mg2 results in excessive production of free radical and mild inflammation) S Progesterone Decrease cerebral Initial Efficacy; Follow Up edema STrial Nicotinimide Reduce injury volume; Unknown decrease glial activation; reduce BBB breaches; reduce edema ? Q & A 200 Day Hill Road, Suite 250 Windsor, CT 06095 Thank You! Office 860.219.0291 Helpline 800.278.8242 [email protected] BIACT.org.
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