NCS Traumatic Brain Injury 2 — Questions and Answers
Question 1: Which pharmacological agent is most commonly used to manage agitation in the acute TBI rehabilitation setting due to its favorable side-effect profile?
- Haloperidol
- Amantadine
- Propranolol (Correct answer)
- Lorazepam
Correct answer: Propranolol
Propranolol (a beta-blocker) is preferred for agitation post-TBI because it reduces autonomic surges without the sedation or seizure-threshold-lowering effects of antipsychotics or benzodiazepines.
Question 2: A patient with severe TBI is in the minimally conscious state (MCS). Which clinical feature best distinguishes MCS from vegetative state (VS)?
- Eyes open spontaneously
- Inconsistent but reproducible purposeful movement (Correct answer)
- Sleep-wake cycles present
- Auditory startle response intact
Correct answer: Inconsistent but reproducible purposeful movement
MCS is defined by inconsistent but reproducible evidence of awareness such as command following, object manipulation, or intelligible verbalization, which are absent in VS.
Question 3: Post-traumatic amnesia (PTA) duration is most useful for predicting which outcome after moderate-to-severe TBI?
- Risk of post-traumatic seizures
- Long-term functional recovery (Correct answer)
- Likelihood of returning to work
- Severity of spasticity
Correct answer: Long-term functional recovery
PTA duration is one of the strongest predictors of long-term functional outcome; PTA >4 weeks is associated with significantly poorer recovery.
Question 4: Heterotopic ossification (HO) after TBI most commonly occurs around which joint?
- Knee
- Shoulder
- Hip (Correct answer)
- Elbow
Correct answer: Hip
The hip is the most frequently affected joint for HO following TBI, often presenting with decreased range of motion and warmth around the hip region.
Question 5: Which EEG finding is most associated with non-convulsive status epilepticus (NCSE) in a TBI patient who has unexplained decreased consciousness?
- Diffuse slowing with theta activity
- Periodic lateralized epileptiform discharges (PLEDs) evolving to ictal pattern (Correct answer)
- Symmetric alpha coma pattern
- Burst suppression pattern
Correct answer: Periodic lateralized epileptiform discharges (PLEDs) evolving to ictal pattern
PLEDs that evolve into rhythmic ictal discharges on EEG are a hallmark finding for NCSE, which can cause unexplained coma or encephalopathy after TBI.
Question 6: According to ACRM guidelines, which intervention has Level I evidence for improving functional outcomes during acute TBI rehabilitation?
- Hyperbaric oxygen therapy
- Early intensive inpatient rehabilitation (Correct answer)
- Transcranial magnetic stimulation
- Pharmacological neuroprotection with progesterone
Correct answer: Early intensive inpatient rehabilitation
Early initiation of intensive, interdisciplinary inpatient rehabilitation is supported by Level I evidence for improving functional outcomes after moderate-to-severe TBI.
Question 7: A veteran with blast-related mild TBI (mTBI) presents with headache, dizziness, and cognitive complaints. Which condition must be carefully distinguished from mTBI sequelae?
- Peripheral vestibular dysfunction only
- Post-traumatic stress disorder (PTSD) with somatic symptoms (Correct answer)
- Migraine without aura
- Cervicogenic headache from cervical fracture
Correct answer: Post-traumatic stress disorder (PTSD) with somatic symptoms
PTSD frequently co-occurs with blast mTBI in veterans and shares overlapping symptoms (cognitive difficulties, sleep disturbance, hyperarousal) that must be differentiated to guide treatment.
NCS Traumatic Brain Injury 2
Which pharmacological agent is most commonly used to manage agitation in the acute TBI rehabilitation setting due to its favorable side-effect profile?