Traumatic Brain Injury Lec.3 PDF

Traumatic Brain Injury Lec.3 Neurological physiotherapy Dr.Sarkawt S.Kakai KHCMS (Ortho.&Trauma) 10/18/2023 1 Definition • The term “traumatic brain injury” (TBI) refers to the disruption of brain structure and/or function from the sudden application of physical force, usually involving a blow t...

Traumatic Brain Injury Lec.3 Neurological physiotherapy Dr.Sarkawt S.Kakai KHCMS (Ortho.&Trauma) 10/18/2023 1 Definition • The term “traumatic brain injury” (TBI) refers to the disruption of brain structure and/or function from the sudden application of physical force, usually involving a blow to the head or penetration of the skull by a foreign object. • Other descriptions applied to this phenomenon are head injury, concussion, craniocerebral trauma, and posttraumatic encephalopathy. • The term TBI, rather than head injury, is preferred because it correctly indicates the focus of damage. • Traumatic brain injury has been a public health problem for many years and will remain a major source of death and severe disability in the future. • According to the World Health Organization by 2020 traumatic brain injury surpass many diseases as the major cause of death and disability. TBI possesses at least three distinctive characteristics as a disability First, in many other disabling conditions, the cognitive and emotional characteristics of the individual remain intact Second, the psychosocial impact of TBI A third distinguishing feature of TBI as a disability is that it may seem invisible. Mechanism of Injury Closed Head Injury • Often occurs as a result of RTA, or a blow to the head, or a fall where the head strikes the floor or another hard surface. • In closed head injury, the skull is not penetrated, but it is frequently fractured. • Generally, there is both focal and diffuse axonal damage. Open Head Injury • This is caused by a penetrating wound, eg. by a weapon or from a bullet. • In these cases, the skull is penetrated. • The brain injury is usually largely focal axonal damage. Coup-Contracoup Injury • Coup Injury • This occurs beneath the point of impact may be associated with a skull fracture at the site of impact • Contracoup Injury • This occurs when the impact is sufficient to cause the brain to move within the skull; the brain moves in the opposite direction, and hits the opposite side of the skull, causing bruising. • Coup-Contracoup Injury • This is a frequent occurrence where opposite poles of the brain suffer injury. There are various determinants utilized to classify traumatic brain injury. Classification The classification is important for acute management, treatment and prognosis as well as neuro-rehabilitation requirements. Classifications may be based on: • pathoanatomic ie. what damage has occurred and where in the brain; • injury severity, typically using the Glasgow Coma Scale as the measure where a score of 8 or less is defined as severe traumatic brain injury; or • by the physical mechanism causing the injury Clinical Presentation The presentation depends on the areas of the brain which have been damaged. Spasticity is one of the early signs of traumatic brain injury which often develops within a week post-injury. Symptoms include hypertonicity and spasm of the affected muscles and an increase in deep tendon reflexes. The severity of spasticity can range from mild stiffness of the muscles to severe and often painful muscle spasms. Diagnostic procedures Post-acute traumatic brain injury, all patients are encouraged to undergo an urgent neurological examination in addition to a surgical examination. Magnetic Resonance Imaging (MRI) and Computerised Tomography (CT) scanning are frequently used in order to image the brain. CT scanning is indicated in the very early stages of post-injury. A CT scan can show potential fractures and can detail haemorrhages and haematomas in the brain, as well as contusions and swelling. An MRI is often used once the patient is medically stable to give a more detailed view of their brain tissue Initial Medical Management Treatment The aims of initial emergency and early medical management are to limit the development of secondary brain damage while providing the best conditions for recovery from any reversible damage that has already occurred. This involves establishing and maintaining a clear airway with adequate oxygenation and replacement fluids to ensure good peripheral circulation with adequate blood volume. Emergency surgery is often required to decompress the injured brain and minimise damage: Surgery to remove the haematoma and thus reduce pressure on brain tissue. Surgical Interventions Removal of part of the skull in order to relieve pressure. Surgical repair of severe skull fractures, and/or removal of skull fragments from brain tissue. Insertion of intracranial pressure (ICP) Monitoring Device. Post-TBI Medical Interventions Limit secondary damage to the brain: Coma-inducing medication Diuretics Anti-epileptic medication is often provided in the early stages to avoid any additional brain damage, which may be caused if a seizure were to occur.