TBI: a non-degenerative, non-congenital insult to the brain from an external mechanical force, possibly leading to temporary or perimanent impairment of cognitive, physical and psychosocial functions
Aetiology
High risk groups
Young men and elderly
Previous head injuries
Residents of inner cities
Alcohol and drug abuse
Low income
Mechanisms of injury
Assault
Falls
RTCs
Sports
Over 1/2 involve alcohol
Pathophysiology
Importance of managing ICP
Monro Kellie principle states that the sum of volumes of brain, cerebrospinal fluid (CSF) and intracerebral blood is constant
An increase in one should cause a reciprocal decrease in either one or both of the remaining two
Decrease in space for brain within the skull → herniation
Diffuse axonal injury
Severe form of traumatic brain injury due to shearing forces
Occur where density difference is greatest (grey/white interface)
Excitotoxicity and apoptosis
Inflammatory mediator release
Investigations
ATLS - airway with C spine control, breathing, circulation
Secondary survey for other injuries
CT scan
Extradural haematoma - lemon
Injury with LOC
Recovery 'lucid interval'
Rapid progression of neurological symptoms
Acute subdural haematoma - crescent shape, white
Chronic subdural haematoma - crescent shape, dark
Intracerebral haematoma
Diffuse axonal injury
Confirming brainstem death
No pupil response (II, III)
No corneal reflex (V, VII)
No motor response (CN distribution, V, VII)
No vestibulo-ocular reflex (III, VI, VIII)
No gag/cough reflex (IX, X)
No respiration (apnoea test)
Management
Control ICP
Surgical management
Intubated and ventilated, sedated
Maximise venous drainage of the brain - head of bed tilt, cervical collars, ET tube ties
Made with Bullet