Brain injury: Difference between revisions
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In [[medicine]], '''brain injuries''' are "acute and chronic injuries to the brain, including the [[cerebral hemisphere]]s, [[cerebellum]], and [[brain stem]]. Clinical manifestations depend on the nature of injury. Diffuse trauma to the brain is frequently associated with [[diffuse axonal injury]] or [[post-traumatic coma|coma, post-traumatic]]. Localized injuries may be associated with [[neurobehavioral manifestation]]s; [[hemiparesis]], or other focal neurologic deficits.."<ref>{{MeSH}}</ref> | In [[medicine]], '''brain injuries''' are "acute and chronic injuries to the brain, including the [[cerebral hemisphere]]s, [[cerebellum]], and [[brain stem]]. Clinical manifestations depend on the nature of injury. Diffuse trauma to the brain is frequently associated with [[diffuse axonal injury]] or [[post-traumatic coma|coma, post-traumatic]]. Localized injuries may be associated with [[neurobehavioral manifestation]]s; [[hemiparesis]], or other focal neurologic deficits.."<ref>{{MeSH}}</ref> | ||
Types of brain injury include: | Types of brain injury include: | ||
Revision as of 19:26, 7 November 2010
In medicine, brain injuries are "acute and chronic injuries to the brain, including the cerebral hemispheres, cerebellum, and brain stem. Clinical manifestations depend on the nature of injury. Diffuse trauma to the brain is frequently associated with diffuse axonal injury or coma, post-traumatic. Localized injuries may be associated with neurobehavioral manifestations; hemiparesis, or other focal neurologic deficits.."[1]
Types of brain injury include:
- Diffuse axonal injury
- Brain concussion
- Minimal brain injury which may be defined at abnormal x-ray computed tomography of the head and a Glasgow Coma Scale of 14 or 15. Most[2][3][4][5][6][7], but not all[8] studies, suggest that routine repeat x-ray computed tomography of the head is not needed unless the patient shows signs of clinical worsening. In the one study advocating for routine rescans, 5 patients, all with subdural hematomas, required interventions due to worsening scans despite no clinical worsening.[8]
Injury Effects
Primary Brain Injury
Secondary Brain Injury
Secondary effects of a brain injury are those that follow from the body’s compensatory and reactionary mechanisms in response to the injury, both at the organ and cellular level. These effects can permanently damage the patient if not managed properly. They include cerebral swelling, brain tissue ischemia, excitotoxicity, oxidative stress and eventually apoptosis, also referred to as programmed cell death. Theoretically, these effects are both preventable and reversible. [9]
Diagnosis
X-ray computed tomography of the head should be considered, especially if the patient fulfills any criteria from the New Orleans Criteria clinical prediction rule:[10]
- "headache, vomiting, an age over 60 years, drug or alcohol intoxication, deficits in short-term memory, physical evidence of trauma above the clavicles, and seizure"
X-ray of the cervical spine should be considered, especially if the patient fulfills criteria from the Canadian C-Spine Rule clinical prediction rule for neck injury: [11]
- Age 65 years or more
- Paresthesias in extremities
- Dangerous fall ("elevation >=3 ft or 5 stairs; an axial load to the head (e.g., diving); a motor vehicle collision at high speed (>100 km/hr) or with rollover or ejection; a collision involving a motorized recreational vehicle; or a bicycle collision")
- Inability to rotate the neck 45° to the right and left
- Only test if "simple rear-end motor vehicle collision, sitting position in ED, ambulatory at any time since injury, delayed onset of neck pain, or absence of midline C-spine tenderness"[12]
- Glasgow Coma Scale less than 15 (the Canadian C-Spine Rule was only designed for alert patients)
Treatment
Mild injury may not benefit from multidisciplinary[13] or rehabilitation[14] treatment.
References
- ↑ Anonymous (2024), Brain injury (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ Brown CV, Zada G, Salim A, Inaba K, Kasotakis G, Hadjizacharia P et al. (2007). "Indications for routine repeat head computed tomography (CT) stratified by severity of traumatic brain injury.". J Trauma 62 (6): 1339-44; discussion 1344-5. DOI:10.1097/TA.0b013e318054e25a. PMID 17563645. Research Blogging.
- ↑ Smith JS, Chang EF, Rosenthal G, Meeker M, von Koch C, Manley GT et al. (2007). "The role of early follow-up computed tomography imaging in the management of traumatic brain injury patients with intracranial hemorrhage.". J Trauma 63 (1): 75-82. DOI:10.1097/01.ta.0000245991.42871.87. PMID 17622872. Research Blogging.
- ↑ Sifri ZC, Homnick AT, Vaynman A, Lavery R, Liao W, Mohr A et al. (2006). "A prospective evaluation of the value of repeat cranial computed tomography in patients with minimal head injury and an intracranial bleed.". J Trauma 61 (4): 862-7. DOI:10.1097/01.ta.0000224225.54982.90. PMID 17033552. Research Blogging.
- ↑ Velmahos GC, Gervasini A, Petrovick L, Dorer DJ, Doran ME, Spaniolas K et al. (2006). "Routine repeat head CT for minimal head injury is unnecessary.". J Trauma 60 (3): 494-9; discussion 499-501. DOI:10.1097/01.ta.0000203546.14824.0d. PMID 16531845. Research Blogging.
- ↑ Brown CV, Weng J, Oh D, Salim A, Kasotakis G, Demetriades D et al. (2004). "Does routine serial computed tomography of the head influence management of traumatic brain injury? A prospective evaluation.". J Trauma 57 (5): 939-43. PMID 15580014.
- ↑ Kaups KL, Davis JW, Parks SN (2004). "Routinely repeated computed tomography after blunt head trauma: does it benefit patients?". J Trauma 56 (3): 475-80; discussion 480-1. PMID 15128116.
- ↑ 8.0 8.1 Bee TK, Magnotti LJ, Croce MA, Maish GO, Minard G, Schroeppel TJ et al. (2009). "Necessity of repeat head CT and ICU monitoring in patients with minimal brain injury.". J Trauma 66 (4): 1015-8. DOI:10.1097/TA.0b013e31819adbc8. PMID 19359908. Research Blogging.
- ↑ Bayir, H., P.M. Kochanek, and R.S.B. Clark, Traumatic brain injury in infants and children - Mechanisms of secondary damage and treatment in the intensive care unit. Critical Care Clinics, 2003. 19(3): p. 529-+.
- ↑ Haydel MJ, Preston CA, Mills TJ, Luber S, Blaudeau E, DeBlieux PM (July 2000). "Indications for computed tomography in patients with minor head injury". N. Engl. J. Med. 343 (2): 100–5. PMID 10891517. [e]
- ↑ Stiell IG, Clement CM, McKnight RD, et al (December 2003). "The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma". N. Engl. J. Med. 349 (26): 2510–8. DOI:10.1056/NEJMoa031375. PMID 14695411. Research Blogging.
- ↑ Stiell IG, Wells GA, Vandemheen KL, et al (October 2001). "The Canadian C-spine rule for radiography in alert and stable trauma patients". JAMA 286 (15): 1841–8. PMID 11597285. [e]
- ↑ Ghaffar O, McCullagh S, Ouchterlony D, Feinstein A (August 2006). "Randomized treatment trial in mild traumatic brain injury". J Psychosom Res 61 (2): 153–60. DOI:10.1016/j.jpsychores.2005.07.018. PMID 16880017. Research Blogging.
- ↑ Elgmark Andersson E, Emanuelson I, Björklund R, Stålhammar DA (February 2007). "Mild traumatic brain injuries: the impact of early intervention on late sequelae. A randomized controlled trial". Acta Neurochir (Wien) 149 (2): 151–9; discussion 160. DOI:10.1007/s00701-006-1082-0. PMID 17252176. Research Blogging.