Acute Traumatic Brain Injury: A Review of Recent Advances in Imaging and Management

Abstract

Acute traumatic brain injury (TBI) is a major cause of death and disability in young persons worldwide, producing a substantial economic burden on health services. New technology in computed tomography and magnetic resonance imaging is allowing the acquisition of more accurate and detailed information on cerebral pathology post-TBI. This has greatly improved prognostic ability in TBI and enables earlier identification of pathology, making it potentially amenable to therapeutic intervention. Recent advances in the management of TBI have been hampered by a lack of class I evidence arising from difficulties in applying strict study protocols to a patient subset as heterogeneous as post-TBI patients. The most definite benefits in terms of survival after TBI come from admission to a specialist neurosurgical centre, with goal-targeted therapy and intensive care services. Some traditional therapies for the treatment of acute TBI have been proven to be harmful and should be avoided. A number of management strategies have proved potentially beneficial post-TBI, but there is insufficient evidence to make definitive recommendations at present. Future therapies that are currently under investigation include decompressive craniectomy, progesterone therapy, and possibly therapeutic hypothermia.

Prehospital and Early Clinical Care of Infants, Children, and Teenagers Compared to an Adult Cohort

“…This rate was significantly less than the results in the other age-dependent groups (74.7-77.8%). However, CT imaging has become essential in the imaging evaluation of trauma patients and is being used with progressively increasing frequency [27,28], caused by the well documented benefit for the outcome of trauma patients [9,29,30]. Nevertheless, a byproduct of the increased use of CT has been the more frequent exposure of injured children to potentially harmful ionizing radiation [27].…”

The prevalence of sodium abnormalities in moderate to severe traumatic brain injury patients in a level 1 Trauma unit in Durban

“…11,12,14 Neurological dysfunction is the principal manifestation of hypernatremia especially in patients with intracranial pathology. 5,6 Hypernatremia was associated with a threefold increase in ICU mortality in one study. 3 This study confirms a poor outcome as defined by the GOS in patients with hypernatremia as the GOS of patients with DI tended to be poorer ranging from severe disability to death.…”

“…2,3,4 Sodium, the major extracellular cation, plays a critical role in fluid balance and abnormalities are not uncommon in the moderate to severe traumatic brain injury population. 4,5,6 . As a result of its osmotic activity, both elevated and decreased abnormalities in serum concentrations have the potential to cause severe secondary brain injury.…”

“…As a result of its osmotic activity, both elevated and decreased abnormalities in serum concentrations have the potential to cause severe secondary brain injury. 6…”

Young Adults With Traumatic Brain Injury in Long-Term Care Homes: A Population-Based Study

“…Traumatic brain injury (TBI) is a leading cause of death and disability in persons under 45 years of age in North America, with incidence typically peaking in young adults (ages 15-25 years) (Pickett, Simpson, & Brison, 2004). Advances in medicine, medical technology and rehabilitation have improved survival rates of persons who have suffered a TBI, and over time, increasingly more seriously injured persons are surviving (Strettles, Bush, Simpson & Gillet, 2003;Wilson & Green, 2009). Given the life-long effects of TBI, longterm care and support for people living with the effects of TBI is a major issue.…”