Mapa mental

Traumatic Brain injury

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Types of traumatic brain injury
- General types
  - Open TBI
    - is when the skull is fractured and penetrated
  - Closed TBI
    - No skull fracture
  - Focal TBI
    - Injury is is localized
  - Diffuse TBI
    - Injury of wide area of brain
- Specific Types
  - Skull fractures
    - Linear skull fracture
      - usually a mild form of fracture that is usually managed by monitoring
      - 75% of these fractures occur in the parietal bones
    - Depressed skull fracture
      - Depresses brain tissue causing increase ICP
      - Increased ICP presentation
    - Basilar skull fracture
      - a very serious type of skull fracture
      - Racon eyes and CSF leakage
    - Diastatic skull fracture
      - It happens in the sutures of the skull that causes them to widen.
  - Diffuse Axonal injury
    - Diagnosed by MRI
    - The movement of a part of the brain relative to another part this will cause damage to the axon integrity and function.
    - irreversible
    - it looks like a multiple foci of hemorrhage
  - Hematomas
    - Epidural hemorrhage
      - Fracture, injury of middle meningeal artery
      - Blood collects between the dura and internal surface of the skull and compresses the brain
      - The lesion may expand rapidly, cause increased intracranial pressure and herniation
      - Lucid interval of several hours
      - Lens-shaped
    - Subdural hemorrhage
      - Torn superficial bridging veins between convexities and dural venous sinuses
      - The blood collects between the dura and the outer layer of the arachnoid.
      - Contain clotted blood
      - Stages
        Acute
        Clotted blood
        Hyperdense
        Subacute
        Lysis of clotted blood and granulation tissue development
        Isodense
        Chronic
        Connective tissue capsule
        Hypodense
    - Subarachnoid hemorrhage
      - Can lead to communicating hydrocephalus
      - Hyperdensity in falx, sulci, sylvian fissure
      - could be traumatic or due to ruptured aneurysm
    - Intraventricular hemorrhage
      - Most commonly due to rupture of sub ependymal vessel.
  - Contusion
    - bleeding on the brain due to localized trauma
    - Focal brain hemorrhage
    - After resolution, depressed yellowish glial scar
    - Signs and symptoms
    - Complications
      - Seizures Increased ICP Cerebral herniation - Loss of memory- Infections
  - Concussion
    - widespread brain trauma due to a blow to the head, shaking, or a similar injury.
    - Associated with
      - Loss of consciousness
      - Loss of refelx
      - Respiratory distress
    - No permanent structural damage
    - complete recovery
    - Signs and symptoms
    - Complications
      - Epilepsy Post-concussion Syndrome Second-impact Syndrome Post-traumatic headaches and vertigo
Anatomy
- External anatomy of brain stem
  - Medulla
    - Anterior surface
      - The anterior median fissure is located ventrally and continues into the spinal cord. On either side of the anterior median fissure the pymmids are located.
      - Lateral to the pyramid is an oval olive
        position of the inferior olivary nucleus
    - Posterior surface
      - Open medulla
        The hypoglossal triangle lies over the hypoglossal nucleus
        The vestibutar area
        The vagal triangle covers the dorsal vagal nucleus
      - Closed medulla
        Posterolateral to the olive is the inferior cerebellar peduncle (connect medutla to cerebellum). Dorsally there is a posterior median sulcus
        On each side of the suicus Is the gracile tubercle and lateral to it is the cuneate tubercle.
  - Pons
    - Anterior surface
      - is formed mainly Gf transversely running fibers which pass through the middle cerebellar peduncles (forming a bridge [pons] between two cerebllar hemispheres).
    - Posterior surface
      - forms part of the floor of the 4m ventricle
      - Facial colliculus: undertying root of facial nerve and nucleus of abducent nerve
      - Locus ceruleus: deeply pigmented nen/e cells at the floor of the upper part of the sulcus limitans.
      - Area vestibulae: underiying vestibular nuclei.
  - Midbrain
    - Anterior surface
      - Cerebral peduncles
        Posterior perforated substance: between the two cerebral peduncles pierced by multiple central arteries.
    - Posterior surface
      - corpora quadrigemina
        Superior colliculi
        visual reflexes
        Inferior colliculi
        auditory function
- Internal anatomy of brain stem
  - Medulla
    - Open medulla
    - Closed medulla
      - Decussation of the Medial Lemniscus
      - Decussation of the Pyramids
  - Pons
  - Midbrain
    - inferior colliculi
    - superior colliculus.
- middle cerebral artery
Types of herniation
Clinical presentation of TBI
- Hutchinson’s pupil
Consciousness
- arises as the brain forms a model of the world that combines external stimulation with internal experience.
- States
- Sleep cycle
Glasgow Coma Scale
Cushing Reflex
- Cushing reflex occurs in response to increase in the intracranial pressure.
- It is a triad of hypertension, bradycardia, and irregular breathing (Apnea).
- Cushing reflex indicates that brain herniation and death is imminent, so it is an emergency situation.
Management of Traumatic Brain Injuries
- First AID
- Algorithm for the acute management of the TBI patient.
- Treatment of Intercraial hypertension
  - Analgesics and sedatives
  - Hyperventilation
  - Hypothermia
  - Osmotic agents
  - Decompressive craniotomy
- Prophylaxis of complications
  - Antiseizure
    - Decrease incidence of EARLY seizures (<7days)
    - Phenytoin
  - Deep venous thrombosis prophylaxis
- Burr hole Surgery
  - Indications
    - acute subdural hematoma
    - chronic subdural hematoma
    - brain cancer
    - pus around the meninges
    - Hydrocephalus
  - Complications
    - Bleeding Infection Blood clots Brain injury Another surgery required