Traumatic Brain / Head Injury

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Traumatic Brain/Head Injury (TBI)

Damage to living brain tissue caused by an external mechanical force. Common cause of death before age 50 yrs (10% of all deaths in USA). Mortality of 50% in severe cases.

Damage occurs to all tissues (neural, blood, meninges) – also get varying amounts of intra- and/or extra-cerebral ischaemia, haemorrhage and oedema. The haemorrhage and oedema act as space occupying lesions  focal neurological deficits. Intracranial swelling  herniation of brain tissue. Cranial fractures may lacerate arteries and meninges  CSF leakage and/or entry of air and bacteria. Large amount of neurotransmitters are released, especially glutamate (excitatory)  activation of ion channels  calcium inlfux into cells --. increase in cellular metabolism and increased production of free radicals  further damage.

Aetiology:
50% are due to motor vehicle accidents; also commonly due to falls, assaults and failed suicide attempts.

Clinical features:
No two cases of head injury are the same.
Concussion (loss of awareness and memory; unresponsiveness); contusions and laceration to cranium  hemiplegia and focal neurological signs. If more severe  rigidity of muscles, coma, hemiplegia, dilated and unreactive pupils, respiratory irregularity); if severe non-penetrating trauma  coma, respiratory irregularity, unresponsive pupils, diffuse motor flaccidity
If subdural haematoma  coma, wide pulse pressure, dilated and fixed pupils, spastic hemiplegia, hyperreflexia, rigidity (mortality and morbidity high following subdural haematoma)
10-40% develop epilepsy, up to several years later
Tend to have more cognitive and behavioural impairments than those with a stroke.

Management:
Initial – stabilise patient; clear airway; control acute bleeding; prevent further damage (eg spinal fracture)
Hospital – airway secured; IV lines; respiratory assistance; determine severity (eg Glasgow Coma Scale); CT or MRI (for determination of bleeding and to determine operable haematomas); neurosurgery for displace cranial fractures; protection against heat loss, fluid imbalances and airway obstruction; monitor for renal failure, convulsions; may need sedation
Rehabilitation – amnesia and post-concussion syndrome are common; physiotherapy and occupational therapy

Scales for measuring function and outcomes of those with TBI – eg Glasgow Outcome Study, Disability Rating Scale, Functional Independence Measure, Western Neuro Sensory Stimulation Scale

Related Topics:
Concussion and Lower Extremity Injury
Concussion in Sport
Neurological Emergencies

External Links:
Concussion and the lower limb and as a public health issue (Podiatry Arena)

Concussion Books:

Back in the Game: Why Concussion Doesn’t Have to End Your Athletic CareerLeague of Denial: The NFL, Concussions, and the Battle for TruthPost-Concussion Syndrome: An Evidence Based ApproachThe Concussion Crisis: Anatomy of a Silent Epidemic
Back in the Game: Why Concussion Doesn’t Have to End Your Athletic CareerLeague of Denial: The NFL, Concussions, and the Battle for TruthPost-Concussion Syndrome: An Evidence Based ApproachThe Concussion Crisis: Anatomy of a Silent EpidemicSports-Related Concussion: Diagnosis and Management
The Athlete's Dilemma: Sacrificing Health for Wealth and FameConcussion (Movie)Chronic Traumatic EncephalopathyConcussion
Sports Concussions Continuum: A Complete Guide to Recovery and Management The Athlete's Dilemma: Sacrificing Health for Wealth and FameConcussion (Movie)Chronic Traumatic EncephalopathyConcussion

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