This chapter provides summative information on the biomechanics, classification, and metabolism of traumatic brain injury (TBI). Impact, impulse, static/quasistatic loading, and related biomechanical sequelae following rotational shear and strain are discussed. Morphological classifications across extradural, acute/chronic subdural, subarachnoid, and intraventricular haemorrhages, as well as cerebral contusions and axonal injuries, are characterized and correlated with injury severity. Management options and implications for penetrating TBI and mild TBI/concussion are described. Cerebral metabolism including pressure/viscosity, CO2 reactivity, and autoregulation are explained in detail to provide for in-depth exploration of a spectrum of secondary injury cascades, encompassing glutamatergic excitotoxicity, autoregulatory loss, and the pressure reactivity index, flow disturbances, elevated intracranial pressure, cortical spreading depression and seizures/epilepsy. Beta-amyloid deposition in response to TBI, and genetic susceptibilities to poor recovery are covered. Current developments to standardize TBI classification systems, establish evidentiary benchmarks for quality of care, and accelerate advances in diagnosis and prognosis are highlighted.
Metabolic Crisis without Brain Ischemia is Common after Traumatic Brain Injury: A Combined Microdialysis and Positron Emission Tomography Study
