Abstract
Traumatic brain injury is among the most common of serious, disabling neurological disorders. The consequences of trauma to the brain may result are a wide variety of pathophysiological effects, a range of severities, and a multitude of problems. There can be a significant variation in their presentation, course of recovery, response to interventions, and ability to return to functioning even in persons with apparently similar injuries. Spine and spinal cord injury are the most devastating injuries. Every patient presenting following trauma should be assessed for risk of spine injury according to the evidence-based decision rules. If the decision rule indicates high risk of injury, spine imaging is indicated. The evidence-based guidelines for prehospital, early acute management of spinal injuries should be followed. Early decompression of spine is indicated for unstable patients.
Keywords
Assessment tools, Complications, Evidence-based guidelines, Head injury, Spine injury
Outline
Traumatic Brain Injury 536
Introduction 536
Definition 536
Epidemiology 536
Classification of Traumatic Brain Injury 537
Classification Brain Injury by Physical Mechanism 537
Classification by Distribution of Injury 537
Classification by Pathoanatomy 538
Skull Fractures 538
Cerebral Contusions 538
Epidural Hemorrhage 539
Subdural Hemorrhage 539
Subarachnoid Hemorrhage 539
Intraventricular Hemorrhage 539
Classification Based on Pathobiology of Traumatic Brain Injury 539
Physiologic Response to Brain Injury 543
Cerebral Swelling 543
Intracranial Pressure 544
Cerebral Perfusion Pressure 544
Cerebral Metabolic Dysfunction 544
Changes in Cerebral Glucose Metabolism in Traumatic Brain Injury 545
Posttraumatic Brain Injury Energy Crisis 545
Neuroimaging 545
Severity of Traumatic Brain Injury 549
Management of Traumatic Brain Injury 549
Prevention 549
Prehospital Management 549
Emergency Room Management 549
Acute Hospital Care 551
Monitoring in Traumatic Brain Injury 551
Surgical Treatment of Head Injury 552
Medical Management of Severe Traumatic Brain Injury 553
Neuromedical Conditions in Moderate/Severe Brain Injury 558
Recovery and Rehabilitation 558
Outcome 559
Emerging Treatment Modalities 559
Conclusion 560
Spine and Spinal Cord Trauma 560
Introduction 560
Epidemiology 560
Classification of Spinal Injury 561
Classification of Spinal Injury Based on Anatomy 561
Classification Based on Mechanism of Injury 561
Classification Based on Clinical Cord Syndromes Resulting From Injury 561
Classification Based on Pathology 561
Classification Based on Stability 561
American Spinal Injury Association International Standards for Neurological Classification 561
Pathophysiology of Spinal Cord Trauma 563
Acute Phase 564
Secondary Phase 564
Formation of Free Radicals 564
Delayed Calcium Influx 564
Immunologically Mediated Neuroinflammation 564
Apoptotic Cell Death 565
Chronic Phase 565
Spontaneous Healing 565
Systemic Complications of Spinal Cord Injuries 565
Neurogenic Shock 565
Cardiovascular Effects 565
Respiratory Complications 566
Temperature Regulation 566
Thromboembolism 566
Bladder and Bowel Dysfunction 566
Pain 566
Pressure Ulcers 566
Heterotopic Ossification 567
Management of Spine and Spinal Cord Injury 567
Standards of Care 567
Impact of Guidelines 567
Management for Acute Injuries 567
Initial Prehospital Assessment and Management 567
Emergency Management 571
Intensive Care Management of Spinal Cord Injury 573
Emerging Treatment Modalities 578
Conclusion 578
References 582
Related posts:
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
