Scribd Logo
Upload

Welcome to Scribd!

  • 75 views

    Traumatic Brain Injury

    Uploaded by

    Satwik Macharla
    Head trauma is the leading cause of death from physical injury. Traumatic brain injury (TBI) occurs when an external force causes damage to the brain. TBI can be focal, affecting one area, or diffuse, affecting wide areas. There are two main types - closed injuries without skull fractures and open injuries with skull fractures or penetration. Primary injuries occur at impact and include bruising, bleeding, and axonal shearing. Secondary injuries develop over time from issues like swelling, lack of oxygen, and high blood pressure. Managing TBI aims to prevent secondary injuries by controlling intracranial pressure, maintaining adequate blood flow to the brain, and treating any complications early.

    Copyright:

    © All Rights Reserved
    Download as KEY, PDF, TXT or read online from Scribd

    Traumatic Brain Injury

    Uploaded by

    Satwik Macharla
    75 views19 pages
    Head trauma is the leading cause of death from physical injury. Traumatic brain injury (TBI) occurs when an external force causes damage to the brain. TBI can be focal, affecting one area, or diffuse, affecting wide areas. There are two main types - closed injuries without skull fractures and open injuries with skull fractures or penetration. Primary injuries occur at impact and include bruising, bleeding, and axonal shearing. Secondary injuries develop over time from issues like swelling, lack of oxygen, and high blood pressure. Managing TBI aims to prevent secondary injuries by controlling intracranial pressure, maintaining adequate blood flow to the brain, and treating any complications early.

    Copyright

    © © All Rights Reserved

    Available Formats

    KEY, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Head trauma is the leading cause of death from physical injury. Traumatic brain injury (TBI) occurs when an external force causes damage to the brain. TBI can be focal, affecting one area, or diffuse, affecting wide areas. There are two main types - closed injuries without skull fractures and open injuries with skull fractures or penetration. Primary injuries occur at impact and include bruising, bleeding, and axonal shearing. Secondary injuries develop over time from issues like swelling, lack of oxygen, and high blood pressure. Managing TBI aims to prevent secondary injuries by controlling intracranial pressure, maintaining adequate blood flow to the brain, and treating any complications early.

    Copyright:

    © All Rights Reserved
    Download as KEY, PDF, TXT or read online from Scribd
    Download as key, pdf, or txt
    75 views19 pages

    Traumatic Brain Injury

    Uploaded by

    Satwik Macharla
    Head trauma is the leading cause of death from physical injury. Traumatic brain injury (TBI) occurs when an external force causes damage to the brain. TBI can be focal, affecting one area, or diffuse, affecting wide areas. There are two main types - closed injuries without skull fractures and open injuries with skull fractures or penetration. Primary injuries occur at impact and include bruising, bleeding, and axonal shearing. Secondary injuries develop over time from issues like swelling, lack of oxygen, and high blood pressure. Managing TBI aims to prevent secondary injuries by controlling intracranial pressure, maintaining adequate blood flow to the brain, and treating any complications early.

    Copyright:

    © All Rights Reserved
    Download as KEY, PDF, TXT or read online from Scribd
    Download as key, pdf, or txt
    of 19

    TRAUMATIC BRAIN

    INJURY

    By
    M.SATWIK
    Head trauma is the leading cause
    of death in patients with trauma.
    Traumatic brain injury (TBI)
    is a non-degenerative, non-
    congenital insult to the brain
    from an external mechanical
    force, possibly leading to
    permanent or temporary
    impairment of cognitive,
    physical, and psychosocial
    functions, with an associated
    diminished or altered state of
    consciousness.
    A TBI can be focal or diffuse, meaning damage may
    be isolated to one specific area of the brain in focal
    injuries or wide spread in case of diffuse injuries.

    Types:
    CLOSED BRAIN INJURY
    Without the skull being broken or penetrated and
    the brain has not been exposed.
    Eg: Acceleration-Deceleration movement
    OPEN BRAIN INJURY
    Open or penetrating head injury.
    TRAUMATIC BRAIN INJURIES
    COUP AND CONTRECOUP INJURY
    COUP INJURY: sudden hyperextension of the
    head and neck forces the brain forward against the
    skull.

    CONTRECOUP INJURY: hyperflexion of


    the head and neck forces the brain backward
    against the skull.
    WHIPLASH INJURIES
    Consequences of whiplash
    injuries:
    Aetilogy:
    Falls
    RTAs
    Violence
    Gunshot injuries
    Child abuse
    Shaken baby syndrome
    Sport injuries
    Scoccer
    Boxing
    Pathophysiolog
    y
    TBI may be divided into
    Primary injury — induced by mechanical
    forces and occurs at the moment of injury.
    Secondary injury — not mechanically
    induced.
    Systemic insults due to TBI are ⬆️
    intracranial pressure & ⬇️cerebral
    perfusion pressure.
    Clinical features:
    loss of consciousness (few minutes - seconds)
    Memory or concentration problems
    Headache
    Dizziness
    Loss of balance
    Nausea
    Vomiting
    Difficultly Sleeping
    loss of consciousness (few minutes - hours)
    Slurred speech
    Loss of coordination
    Weakness
    Numbness
    Brain injury: LUCID INTERVAL:
    The period of time between regaining
    Can result in hypoxia or hypertension consciousness after a short period of
    unconsciousness, resulting from a head injury
    Grading is done by GCS and deteriorating after onset of neurological
    Minor ——15/15 without loss of consciousness signs and symptoms caused by that injury.
    Mild ——14/15 with loss of consciousness
    Moderate—9-13
    Severe ——<8
    GLASGOW COMA SCALE:
    Eye opening
    Verbal response
    Motor response
    Brain injury is of two types:
    1. Primary brain injury
    2. Secondary brain injury
    PRIMARY BRAIN INJURY:
    The 2 main mechanisms are contact and acceleration-deceleration.
    Contact injuries result in skull fractures and surface contusions.
    Acceleration-deceleration injuries results in shear, tensile and compressive strains.
    1. Concussion
    Mild
    Colorado classification
    Type 1: confusion
    Types 2: amnesia
    Types 3: loss of consciousness
    Chronic traumatic encephalopathy aka Post Concussion Syndrome
    1. Diffuse Axonal Injury
    Most severe
    Shearing force between grey and white matter
    Investigation of choice - MRI ( punctuate hemorrhages at
    grey and white mater junction Corpus callosum.
    Worst prognosis.
    1. Intracranial hemorrhages
    Most common cause of death
    4 types
    Epidural hemorrhage
    Subdural hemorrhage
    Subarachnoid hemorrhage
    Intraparenchymal hemorrhage
    1. Extra cranial hemorrhages
    Scalp lacerations
    Nasal injuries
    Facial and neck injuries
    EPIDURAL HEMORRHAGE:
    High velocity impact
    Usually caused by temporal bone fracture and rupture of middle meningeal
    artery
    Investigation of choice: NCCT
    BICONVEX LENS SHAPED BLEED (bleeds between skull and dura)
    Management:
    Craniotomy
    >30cc clot size
    > 5mm midline shift
    > 1.5cm thickness
    Burr hole
    Sx done at site of bleed
    If we can’t localise site of bleed do Sx on side of pupillary dilatation
    False localising sign: (KERNOHAN NOTCH PHENOMENON)
    Pupillary dilatation
    6th CN palsy
    Hemiparesis( ipsilateral to lesion)
    B/L plantar extension
    SUBDURAL HEMORRHAGE:
    Trauma is most common cause
    Rupture of bridging veins in sub dural space
    Investigation of choice: NCCT
    CONCAVO-CONVEX BLEED (crescentric)
    Bleeds between dura and arachnoid
    Management:
    Sx—craniotomy and burr hole
    >1cm thickness
    >5mm midline shift
    Fall in GCS >2 points
    Fixed/delated pupil
    ICP > 20 mmhg
    Extent of brain damage more in SDH>EDH
    SUBARACHNOID HEMORRHAGE:
    Trauma is most common cause
    Rupture of berry aneurysm
    Conservative management
    INTRA PARENCHYMAL
    HEMORRHAGE:
    Most common traumatic type
    Temporal > frontal region
    SECONDARY BRAIN INJURY:
    occurs due to ⬆️ICT which is due to edema.
    Compounded by hypoxia, hypercapnia, hypotension.
    Monro kellie doctrine -states that brain has tremendous capacity to
    compensate, but once the point of decompensation is met, there
    can be sudden decompression and hermination of brain.
    Cerebral perfusion pressure
    Complications:
    Altered consciousness
    Coma
    Vegetative state
    Minimally conscious state
    Locked in syndrome
    Investigations:
    Imaging tests done are
    Infections
    CT, MRI Blood vessel damage leads
    to stroke, blood clots
    Nerve damage
    Management: Mx of mild head injury
    Adequate Oxygenation Evaluate
    Adequate perfusion by maintaining SBP> 100 Do CT If indicated
    mmhg Discharge if GCS 15/15
    Avoid hyperglycaemia Normal CT
    IV mannitol Not under influence of alcohol/drugs
    Hyperventilation Accompanied by responsible adult
    Barbiturate coma Mx of moderate head injury
    Hypothermia Admit
    Steroids CT
    Prophylactic anti epileptics
    monitor and do serial CECT
    Diuretics
    Mx of severe head injury GCS<8
    Goals:
    Intubation
    ICP: 20-25mmhg
    NCCT
    CPP: >60mmhg
    PaO2: >100 mmhg Brain death
    PbtO2(brain tissue oxygen tension)>15mmhg GCS=3
    Serum Na+ : 135-145 Non reactive pupils
    Glucose: 80-180mg/dl Absent brain stem reflex
    Physiotherapy No spontaneous ventilatory effort
    Thank you

    You might also like