Traumatic Brain Injury and C-Spine Management

2018 ◽  
Author(s):  
Matthew Wecksell ◽  
Kenneth Fomberstein
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Cellular Responses ◽  
Older Patient ◽  
Initial Management ◽  
Helmet Use ◽  
Different Types ◽  
Secondary Injuries ◽  
Injury Falls ◽  
Primary Injury

Traumatic brain injury encompasses two different types of pathology: that caused at the time of the initial physical insult, called primary injury, and then further, secondary injury caused by either host cellular responses such as oxidative injury and inflammation or by physiological insults such as ischemia, hypoxia, hypo- or hypercapnia, intracranial hypertension, and hypo- or hyperglycemia. While primary injury falls to the realm of public health (e.g., encouraging helmet use for sports, discouraging impaired driving, etc.), many secondary injuries are avoidable with proper medical management. As the stem case for this chapter, an older patient experiences a fall and is incoherent on presentation to the emergency room. This case concerns her initial management, stabilization, diagnosis, and airway management. With progression of her traumatic brain injury, the authors discuss intracranial pressure management, surgical management, and resuscitation as well as likely postoperative sequelae.

Traumatic brain injury in dogs and cats

2019 ◽  
Vol 24 (9) ◽  
pp. 480-487 ◽  
Author(s):  
Neus Elias ◽  
Ana-Maria Rotariu ◽  
Tobias Grave
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Companion Animals ◽  
Treatment Strategies ◽  
Secondary Injury ◽  
Different Types ◽  
Veterinary Surgeon ◽  
Primary Injury

Traumatic brain injury is common in companion animals and can occur from many different types of trauma such as road traffic accidents or bites. Following the primary injury, which is beyond control of the clinician, secondary injury occurs minutes to days following the trauma. The secondary injury will lead to neuronal death, and is the focus of treatment strategies for the emergency veterinary surgeon. Treatment of traumatic brain injury includes nursing strategies, intravenous fluid therapy, hyperosmolar therapy and diuretics, pain management, maintenance of oxygenation and ventilation, temperature regulation, anticonvulsant therapy and glycaemic control. All of these are discussed in this clinical review.

Oxidative Stress: Major Threat in Traumatic Brain Injury

2018 ◽  
Vol 17 (9) ◽  
pp. 689-695 ◽  
Author(s):  
Nidhi Khatri ◽  
Manisha Thakur ◽  
Vikas Pareek ◽  
Sandeep Kumar ◽  
Sunil Sharma ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mitochondrial Dysfunction ◽  
Calcium Influx ◽  
Neuronal Cell Death ◽  
Neuronal Cell ◽  
Physical Assault ◽  
Mortality And Morbidity ◽  
Primary Injury

Background & Objective: Traumatic Brain Injury (TBI) is one of the major causes of mortality and morbidity worldwide. It represents mild, moderate and severe effects of physical assault to brain which may cause sequential, primary or secondary ramifications. Primary injury can be due to the first physical hit, blow or jolt to one of the brain compartments. The primary injury is then followed by secondary injury which leads to biochemical, cellular, and physiological changes like blood brain barrier disruption, inflammation, excitotoxicity, necrosis, apoptosis, mitochondrial dysfunction and generation of oxidative stress. Apart from this, there is also an immediate increase in glutamate at the synapses following severe TBI. Excessive glutamate at synapses in turn activates corresponding NMDA and AMPA receptors that facilitate excessive calcium influx into the neuronal cells. This leads to the generation of oxidative stress which further leads to mitochondrial dysfunction, lipid peroxidation and oxidation of proteins and DNA. As a consequence, neuronal cell death takes place and ultimately people start facing some serious disabilies. Conclusion: In the present review we provide extensive overview of the role of reactive oxygen species (ROS)-induced oxidative stress and its fatal effects on brain after TBI.

Optimising the management of severe Traumatic Brain Injury in the military maritime environment

2014 ◽  
Vol 100 (3) ◽  
pp. 293-300
Author(s):  
IA Edgar ◽  
G Hadjipavlou ◽  
JE Smith
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Healthcare Systems ◽  
Secondary Brain Injury ◽  
Eye Protection ◽  
Alternative Approaches ◽  
The Military ◽  
Primary Injury ◽  
Maritime Environment

AbstractSevere Traumatic Brain Injury (sTBI) is a devastating cause of morbidity and mortality, especially among those aged less than 45 years. Advances in clinical practice continue to focus on preventing primary injury through developing ballistic head and eye protection, and through minimising secondary brain injury (secondary prevention).Managing sTBI is challenging in well-developed, well-resourced healthcare systems. Achieving management aims in the military maritime environment poses even greater challenges.Strategies for the management of sTBI in the maritime environment should be in keeping with current best evidence. Provision of specialist interventions for sTBI in military maritime environments may require alternative approaches matched to the skills of the staff and environmental restrictions.

scholarly journals Limited Fronto-Temporo- Parietal Craniectomy in Traumatic Brain Injury: My Experience

2016 ◽  
Vol 12 (1) ◽  
pp. 8-13
Author(s):  
Krishna Sharma
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Single Step ◽  
Temporalis Fascia ◽  
Related Literature ◽  
Primary Surgery ◽  
Injured Brain ◽  
Life Saving ◽  
Second Surgery ◽  
Different Types

Amidst the uncertainty of benefit of decompressive craniectomy (DC) in severe traumatic brain injury (TBI), the procedure is still widely performed as a life saving attempt. Different types of DC have been described. A timely performed limited fronto-temporoparietal (FTP) decompression is found to be adequate enough to reduce the intracranial pressure (ICP) quickly and sufficiently, preventing medial temporal herniation. This can be further augmented by an adequate, liberal and watertight duroplasty to accommodate the swollen injured brain, which can be achieved by using patients’ own tissues like thickened subcutaneous areolar tissue and temporalis fascia. DC is usually considered as a two-step surgery where decompression is done in the first step and cranioplasty in the second. It can be made a single step surgery by replacing the bone in small pieces extradurally during the primary surgery itself, to avoid second surgery (cranioplasty). The details of the procedure and its results have been described and review of related literature has been done.Nepal Journal of Neuroscience 12:8-13, 2015

scholarly journals Evaluating the impact of cycle helmet use on severe traumatic brain injury and death in a national cohort of over 11000 pedal cyclists: a retrospective study from the NHS England Trauma Audit and Research Network dataset

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e027845 ◽  
Author(s):  
Nick Dodds ◽  
Rowena Johnson ◽  
Benjamin Walton ◽  
Omar Bouamra ◽  
David Yates ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Research Network ◽  
Lower Limb Injury ◽  
Helmet Use ◽  
Mortality And Morbidity ◽  
National Cohort ◽  
The Uk ◽  
The Impact

ObjectivesIn the last 10 years there has been a significant increase in cycle traffic in the UK, with an associated increase in the overall number of cycling injuries. Despite this, and the significant media, political and public health debate into this issue, there remains an absence of studies from the UK assessing the impact of helmet use on rates of serious injury presenting to the National Health Service (NHS) in cyclists.SettingThe NHS England Trauma Audit and Research Network (TARN) Database was interrogated to identify all adult (≥16 years) patients presenting to hospital with cycling-related major injuries, during a period from 14 March 2012 to 30 September 2017 (the last date for which a validated dataset was available).Participants11 192 patients met inclusion criteria. Data on the use of cycling helmets were available in 6621 patients.Outcome measuresTARN injury descriptors were used to compare patterns of injury, care and mortality in helmeted versus non-helmeted cohorts.ResultsData on cycle helmet use were available for 6621 of the 11 192 cycle-related injuries entered onto the TARN Database in the 66 months of this study (93 excluded as not pedal cyclists). There was a significantly higher crude 30-day mortality in un-helmeted cyclists 5.6% (4.8%–6.6%) versus helmeted cyclists 1.8% (1.4%–2.2%) (p<0.001). Cycle helmet use was also associated with a reduction in severe traumatic brain injury (TBI) 19.1% (780, 18.0%–20.4%) versus 47.6% (1211, 45.6%–49.5%) (p<0.001), intensive care unit requirement 19.6% (797, 18.4%–20.8%) versus 27.1% (691, 25.4%–28.9%) (p<0.001) and neurosurgical intervention 2.5% (103, 2.1%–3.1%) versus 8.5% (217, 7.5%–9.7%) (p<0.001). There was a statistically significant increase in chest, spinal, upper and lower limb injury in the helmeted group in comparison to the un-helmeted group (all p<0.001), though in a subsequent analysis of these anatomical injury patterns, those cyclists wearing helmets were still found to have lower rates of TBI. In reviewing TARN injury codes for specific TBI and facial injuries, there was a highly significant decrease in rates of impact injury between cyclists wearing helmets and those not.ConclusionsThis study suggests that there is a significant correlation between use of cycle helmets and reduction in adjusted mortality and morbidity associated with TBI and facial injury.

scholarly journals Validation of the scandinavian guidelines for initial management of minor and moderate head trauma in children

2020 ◽  
Author(s):  
Caroline Sönnerqvist ◽  
Ole Brus ◽  
Magnus Olivecrona
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Negative Predictive Value ◽  
Head Trauma ◽  
Predictive Value ◽  
Brain Injuries ◽  
Head Injuries ◽  
Traumatic Brain Injuries ◽  
Predictive Values ◽  
Initial Management

Abstract Background Head trauma in children is common, with a low rate of clinically important traumatic brain injury. CT scan is the reference standard for diagnosis of traumatic brain injury, of which the increasing use is alarming because of the risk of induction of lethal malignancies. Recently, the Scandinavian Neurotrauma Committee derived new guidelines for the initial management of minor and moderate head trauma. Our aim was to validate these guidelines. Methods We applied the guidelines to a population consisting of children with mild and moderate head trauma, enrolled in the study: “Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study” by Kuppermann et al. (Lancet 374(9696):1160–1170, https://doi.org/10.1016/S0140-6736(09)61558-0, 2009). We calculated the negative predictive values of the guidelines to assess their ability to distinguish children without clinically-important traumatic brain injuries and traumatic brain injuries on CT scans, for whom CT could be omitted. Results We analysed a population of 43,025 children. For clinically-important brain injuries among children with minimal head injuries, the negative predictive value was 99.8% and the rate was 0.15%. For traumatic findings on CT, the negative predictive value was 96.9%. Traumatic finding on CT was detected in 3.1% of children with minimal head injuries who underwent a CT examination, which accounts for 0.45% of all children in this group. Conclusion Children with minimal head injuries can be safely discharged with oral and written instructions. Use of the SNC-G will potentially reduce the use of CT.

Influence of Helmet Use in Facial Trauma and Moderate Traumatic Brain Injury Victims of Motorcycle Accidents

2012 ◽  
Vol 23 (4) ◽  
pp. 982-985 ◽  
Author(s):  
Josuel Raimundo Cavalcante ◽  
Salomão Cury-Rad Oka ◽  
Thiago de Santana Santos ◽  
Edwaldo Dourado ◽  
Emanuel Dias de Oliveira e Silva ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Facial Trauma ◽  
Helmet Use ◽  
Moderate Traumatic Brain Injury ◽  
Motorcycle Accidents

Impact of helmet use in equestrian-related traumatic brain injury: a matched-pairs analysis

2017 ◽  
Vol 32 (1) ◽  
pp. 37-43 ◽  
Author(s):  
Georg Bier ◽  
Malte N. Bongers ◽  
Ahmed Othman ◽  
Johann-Martin Hempel ◽  
Volker Vieth ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Matched Pairs ◽  
Helmet Use

scholarly journals Survival Following Traumatic Brain Injury in Drosophila Is Increased by Heterozygosity for a Mutation of the NF-κB Innate Immune Response Transcription Factor Relish

Genetics ◽  
2020 ◽  
Vol 216 (4) ◽  
pp. 1117-1136 ◽  
Author(s):  
Laura C. Swanson ◽  
Edna A. Trujillo ◽  
Gene H. Thiede ◽  
Rebeccah J. Katzenberger ◽  
Evgenia Shishkova ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Immune Response ◽  
Brain Injury ◽  
Innate Immune Response ◽  
Genetic Background ◽  
Cellular Response ◽  
Expression Profiles ◽  
Innate Immune ◽  
Immune Response Genes ◽  
Secondary Injuries

Traumatic brain injury (TBI) pathologies are caused by primary and secondary injuries. Primary injuries result from physical damage to the brain, and secondary injuries arise from cellular responses to primary injuries. A characteristic cellular response is sustained activation of inflammatory pathways commonly mediated by nuclear factor-κB (NF-κB) transcription factors. Using a Drosophila melanogaster TBI model, we previously found that the main proximal transcriptional response to primary injuries is triggered by activation of Toll and Imd innate immune response pathways that engage NF-κB factors Dif and Relish (Rel), respectively. Here, we found by mass spectrometry that Rel protein level increased in fly heads at 4–8 hr after TBI. To investigate the necessity of Rel for secondary injuries, we generated a null allele, Reldel, by CRISPR/Cas9 editing. When heterozygous but not homozygous, the Reldel mutation reduced mortality at 24 hr after TBI and increased the lifespan of injured flies. Additionally, the effect of heterozygosity for Reldel on mortality was modulated by genetic background and diet. To identify genes that facilitate effects of Reldel on TBI outcomes, we compared genome-wide mRNA expression profiles of uninjured and injured +/+, +/Reldel, and Reldel/Reldel flies at 4 hr following TBI. Only a few genes changed expression more than twofold in +/Reldel flies relative to +/+ and Reldel/Reldel flies, and they were not canonical innate immune response genes. Therefore, Rel is necessary for TBI-induced secondary injuries but in complex ways involving Rel gene dose, genetic background, diet, and possibly small changes in expression of innate immune response genes.

Central Nervous System Injury

2017 ◽  
Author(s):  
Brandon R Bruns ◽  
Deborah M Stein
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Perfusion Pressure ◽  
Intracranial Pressure Monitoring ◽  
Pressure Monitoring ◽  
Cerebral Contusion ◽  
Different Types ◽  
Hospital Visits

Traumatic brain injury (TBI) accounts for 2.5 million hospital visits annually and is the leading cause of death and disability in patients age 1 to 44 years. Evaluation of patients with suspected TBI requires prompt physical examination with a focus on calculation of the Glasgow Coma Score and pupillary examination as early treatments can be initiated at this stage in patient management. Diagnostic studies include basic laboratory parameters and prompt evaluation with brain computed tomography to identify space-occupying lesions (blood) within the rigid calvarium. Distinction between the different types of traumatic intracerebral hemorrhage is imperative and enables prompt neurosurgical consultation, as well as initiation of appropriate medical therapies to treat elevated intracranial pressure and maintain cerebral perfusion pressure. Paramount in managing patients with suspected TBI is the avoidance of hypotension and hypoxia. Intracranial pressure monitoring remains controversial but is a cornerstone in TBI management. Patients with TBI may have lifelong complications and require careful follow-up. Many new prognostic tools are currently available. This review contains 4 figures, 4 tables, and 47 references. Key words: cerebral contusion, epidural hematoma, intracranial pressure monitoring, subdural hematoma, traumatic brain injury 

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