A presentation about traumatic brain injury. This presentation composed of the definition, types, pathophysiology, clinical feature, diagnosis, treatment and prognosis of the traumatic brain injury.

2. Traumatic brain
injury

3. • Traumatic brain injury (TBI) is:
• Physical injury to brain tissue that temporarily or permanently
impairs brain function.
• In the US, as in much of the world, TBI is a common cause of death
and disability.

4. • Injuries are commonly categorized as:
I. Open injury (involve penetration of the scalp and skull, and usually
the meninges and underlying brain tissue).
II. Closed injury:
• Occur when the head is struck, strikes an object, or is shaken violently,
causing rapid brain acceleration and deceleration.
• Acceleration or deceleration can injure tissue at the point of impact (coup), at
its opposite pole (contrecoup), or diffusely.
• Axons, blood vessels, or both can be sheared or torn. Disrupted blood vessels
leak, causing contusions, intracerebral or subarachnoid hemorrhage, and
epidural or subdural hematomas.

7. I. Brain function may be immediately impaired by direct damage of brain tissue.
II. TBI can cause cerebral edema and decrease brain blood flow.
III. Consequently, any swelling from edema or an intracranial hematoma has nowhere
to expand and thus increases ICP.
IV. Cerebral blood flow is proportional to the cerebral perfusion pressure (CPP), which
is the difference between mean arterial pressure (MAP) and mean ICP.
V. Thus, as ICP increases (or MAP decreases), CPP decreases. When CPP falls below
50 mm Hg, the brain may become ischemic.
VI. Ischemia and edema may trigger various secondary mechanisms of injury (eg,
release of excitatory neurotransmitters, intracellular Ca, free radicals, and
cytokines), causing further cell damage, further edema, and further increases in
ICP.
VII. Excessive ICP causing brain herniation and death.

8. • Initially, most patients with moderate or severe TBI lose consciousness
(usually for seconds or minutes).
• Patients with minor injuries have only confusion or amnesia (amnesia is
usually retrograde and results in memory loss of a period of seconds to a few
hours before the injury).
• Some patients have seizures, often within the first hour or day.
• After these initial symptoms, patients may be fully awake and alert, or
consciousness and function may be altered to some degree, from mild
confusion to stupor to coma.
• Duration of unconsciousness and severity of obtundation are roughly
proportional to injury severity but are not specific.

9. I. Initial rapid trauma assessment (A, B, C, D, E evaluation and stabilization
of Airway, Breathing, Circulation, Disability (neurologic status),
and Exposure/environmental control).
II. Glasgow coma scale and neurologic examination. (see pic)
III. CT and MRI.

11. • The most commonly used scale to assess outcome in TBI patients is
the Glasgow Outcome Scale.
• On this scale the possible outcomes are:
I. Good recovery (return to previous level of function).
II. Moderate disability (capable of self-care).
III. Severe disability (incapable of self-care).
IV. Vegetative (no cognitive function).
V. Death.
• Over 50% of adults with severe TBI have a good recovery or only
moderate disability.

12. • Merk manual website:
• http://www.merckmanuals.com/professional/injuries-
poisoning/traumatic-brain-injury-tbi/traumatic-brain-injury