Traumatic brain injury in adults

Abstract

Traumatic brain injury (TBI) remains a major public health problem. This review aims to present the principles upon which modern TBI management should be based. The early management phase aims to achieve haemodynamic stability, limit secondary insults (eg hypotension, hypoxia), obtain accurate neurological assessment and appropriately select patients for further investigation. Since 2003, the mainstay of risk stratification in the UK emergency departments has been a system of triage based on clinical assessment, which then dictates the need for a CT scan of the head. For patients with acute subdural or extradural haematomas, time from clinical deterioration to operation should be kept to a minimum, as it can affect their outcome. In addition, it is increasingly recognised that patients with severe and moderate TBI should be managed in neuroscience centres, regardless of the need for neurosurgical intervention. The monitoring and treatment of raised intracranial pressure is paramount for maintaining cerebral blood supply and oxygen delivery in patients with severe TBI. Decompressive craniectomy and therapeutic hypothermia are the subject of ongoing international multi-centre randomised trials. TBI is associated with a number of complications, some of which require specialist referral. Patients with post-concussion syndrome can be helped by supportive management in the context of a multi-disciplinary neurotrauma clinic and by patient support groups. Specialist neurorehabilitation after TBI is important for improving outcome.

Should an increase in cerebral neurochemicals following head kicks in full contact karate influence return to play?

“…33 Research suggests that patients with severe and moderate TBI and post-concussion syndrome should be managed in multidisciplinary neuroscience centres, regardless of the need for neurosurgical intervention to improve outcome. 34 In conclusion, a recent review provided evidence that cognitive function only improved in the month after mild TBI (MTBI) and that verbal learning can be impaired up to 6 months after MTBI. Evidence also exists that MTBI is associated with a significant increase in the incidence of psychiatric disorders, and a three-fold increase in the risk for suicide.…”

Intraspinal pressure and spinal cord perfusion pressure after spinal cord injury: an observational study

“…In traumatic brain injury (TBI), increased intracranial pressure (ICP) may impede cerebral blood flow as it reduces cerebral perfusion pressure (CPP), which is calculated as the difference between arterial blood pressure (ABP) and ICP. 8,14,16,21 Similarly, ISP affects the spinal cord perfusion pressure (SCPP), which is the difference between ABP and ISP. 25 Therefore, knowledge of ISP behavior in such Intraspinal pressure and spinal cord perfusion pressure after spinal cord injury: an observational study situations can provide valuable information concerning the condition of the spinal cord in cases of TSCI.…”

“…3,[6][7][8]10,24 In TBI cases, both ICP and its derived indices are well known to have a strong association with outcome and are part of the clinical assessment for deciding the therapeutic management of a patient. 3,8,9,15,16,24 Based on the inherent similarities with ICP, this observational study aims to qualitatively describe the biophysics of ISP and explore its morphology regarding different components in the time and frequency domains.…”

Mortalidad asociada a la presión arterial de ingreso a urgencias en pacientes con trauma encéfalo-craneano: un estudio de cohorte retrospectiva

“…Cada año, solo en el Reino Unido, 1.500 de cada 100.000 habitantes son atendidos por TEC en departamentos de urgencias; 225 a 300 son hospitalizados, 10 a 15 son admitidos a las unidades de neurocirugía y 6 a 10 mueren por esa causa (1). Aunque su incidencia está disminuyendo en la mayoría de los países occidentales, según algunas estimaciones el TEC grave será la tercera causa más común de muerte y discapacidad en el mundo en el año 2020.…”