Traumatic Brain injury

Types of traumatic brain injury
1. General types
  1. Open TBI
    1. is when the skull is fractured and penetrated
  2. Closed TBI
    1. No skull fracture
  3. Focal TBI
    1. Injury is is localized
  4. Diffuse TBI
    1. Injury of wide area of brain
2. Specific Types
  1. Skull fractures
    1. Linear skull fracture
      1. usually a mild form of fracture that is usually managed by monitoring
      2. 75% of these fractures occur in the parietal bones
    2. Depressed skull fracture
      1. Depresses brain tissue causing increase ICP
      2. Increased ICP presentation
    3. Basilar skull fracture
      1. a very serious type of skull fracture
      2. Racon eyes and CSF leakage
    4. Diastatic skull fracture
      1. It happens in the sutures of the skull that causes them to widen.
  2. Diffuse Axonal injury
    1. Diagnosed by MRI
    2. The movement of a part of the brain relative to another part this will cause damage to the axon integrity and function.
    3. irreversible
    4. it looks like a multiple foci of hemorrhage
  3. Hematomas
    1. Epidural hemorrhage
      1. Fracture, injury of middle meningeal artery
      2. Blood collects between the dura and internal surface of the skull and compresses the brain
      3. The lesion may expand rapidly, cause increased intracranial pressure and herniation
      4. Lucid interval of several hours
      5. Lens-shaped
    2. Subdural hemorrhage
      1. Torn superficial bridging veins between convexities and dural venous sinuses
      2. The blood collects between the dura and the outer layer of the arachnoid.
      3. Contain clotted blood
      4. Stages
        Acute
        Clotted blood
        Hyperdense
        Subacute
        Lysis of clotted blood and granulation tissue development
        Isodense
        Chronic
        Connective tissue capsule
        Hypodense
    3. Subarachnoid hemorrhage
      1. Can lead to communicating hydrocephalus
      2. Hyperdensity in falx, sulci, sylvian fissure
      3. could be traumatic or due to ruptured aneurysm
    4. Intraventricular hemorrhage
      1. Most commonly due to rupture of sub ependymal vessel.
  4. Contusion
    1. bleeding on the brain due to localized trauma
    2. Focal brain hemorrhage
    3. After resolution, depressed yellowish glial scar
    4. Signs and symptoms
    5. Complications
      1. Seizures Increased ICP Cerebral herniation - Loss of memory- Infections
  5. Concussion
    1. widespread brain trauma due to a blow to the head, shaking, or a similar injury.
    2. Associated with
      1. Loss of consciousness
      2. Loss of refelx
      3. Respiratory distress
    3. No permanent structural damage
    4. complete recovery
    5. Signs and symptoms
    6. Complications
      1. Epilepsy Post-concussion Syndrome Second-impact Syndrome Post-traumatic headaches and vertigo
Anatomy
1. External anatomy of brain stem
  1. Medulla
    1. Anterior surface
      1. 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.
      2. Lateral to the pyramid is an oval olive
        position of the inferior olivary nucleus
    2. Posterior surface
      1. Open medulla
        The hypoglossal triangle lies over the hypoglossal nucleus
        The vestibutar area
        The vagal triangle covers the dorsal vagal nucleus
      2. 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.
  2. Pons
    1. Anterior surface
      1. is formed mainly Gf transversely running fibers which pass through the middle cerebellar peduncles (forming a bridge [pons] between two cerebllar hemispheres).
    2. Posterior surface
      1. forms part of the floor of the 4m ventricle
      2. Facial colliculus: undertying root of facial nerve and nucleus of abducent nerve
      3. Locus ceruleus: deeply pigmented nen/e cells at the floor of the upper part of the sulcus limitans.
      4. Area vestibulae: underiying vestibular nuclei.
  3. Midbrain
    1. Anterior surface
      1. Cerebral peduncles
        Posterior perforated substance: between the two cerebral peduncles pierced by multiple central arteries.
    2. Posterior surface
      1. corpora quadrigemina
        Superior colliculi
        visual reflexes
        Inferior colliculi
        auditory function
2. Internal anatomy of brain stem
  1. Medulla
    1. Open medulla
    2. Closed medulla
      1. Decussation of the Medial Lemniscus
      2. Decussation of the Pyramids
  2. Pons
  3. Midbrain
    1. inferior colliculi
    2. superior colliculus.
3. middle cerebral artery
Types of herniation
Clinical presentation of TBI
1. Hutchinson’s pupil
Consciousness
1. arises as the brain forms a model of the world that combines external stimulation with internal experience.
2. States
3. Sleep cycle
Glasgow Coma Scale
Cushing Reflex
1. Cushing reflex occurs in response to increase in the intracranial pressure.
2. It is a triad of hypertension, bradycardia, and irregular breathing (Apnea).
3. Cushing reflex indicates that brain herniation and death is imminent, so it is an emergency situation.
Management of Traumatic Brain Injuries
1. First AID
2. Algorithm for the acute management of the TBI patient.
3. Treatment of Intercraial hypertension
  1. Analgesics and sedatives
  2. Hyperventilation
  3. Hypothermia
  4. Osmotic agents
  5. Decompressive craniotomy
4. Prophylaxis of complications
  1. Antiseizure
    1. Decrease incidence of EARLY seizures (<7days)
    2. Phenytoin
  2. Deep venous thrombosis prophylaxis
5. Burr hole Surgery
  1. Indications
    1. acute subdural hematoma
    2. chronic subdural hematoma
    3. brain cancer
    4. pus around the meninges
    5. Hydrocephalus
  2. Complications
    1. Bleeding Infection Blood clots Brain injury Another surgery required

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Traumatic Brain injury

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	Created by hamda ali over 5 years ago