![]() ![]() Įxamples of differing viewpoints of TBI severity: However, the assessed degree of severity can effect a person with TBI's available rehabilitation and assistance resources. This situation is not unique to the TBI diagnosis. TBI degree of severity assessment can be context dependent, subjective, and are influenced by the point-of-view and experience of the clinical assessor. ![]() The most serious complication is the brain oedema within constrained space of the skull and resultant increase in the intracranial pressure and compression of brain structures and cranial nerves.Ĥ. A "through-and-through" injury occurs when an object enters the skull, goes through the brain, and exits the skull and has a complex impact on the brain tissue with penetration injuries, additional shearing, stretching, and rupture of brain tissue.Ĭlosed / Non-Penetrating Injury Ī closed injury is an injury to the brain caused by an outside force without any penetration of the skull. The area of damage is determined by the trajectory of the object and possible ricocheting when travelling through different density tissues (i.e., skull compared to the brain). Open/ Penetrating Injury occurs from the impact of a bullet, knife, or other sharp object that forces hair, skin, bone, and fragments from the object into the brain and dura mater is breached. Opened v Closed Injuries Open / Penetrating Injury The images were performed sequentially during the same examination at a 3 Tesla scanner. Susceptibility weighted imaging (C) is even more sensitive than the previous two sequences, exhibiting more conspicuous (circles) and numerous lesions (squares) on both cerebral hemispheres. ![]() While T2 conventional sequences (A) are rather insensitive for hemorrhagic lesions, T2*-GRE (B) shows numerous foci of signal loss (circles) in the subcortical white matter corresponding to areas of extravascular blood. Commonly observed injury is coup-contrecoup injury presenting with a contusion on opposite sides of the brain.Ī 19-year-old male patient with diffuse axonal injury and Glasgow Coma Scale score of 8 after a motorcycle accident. This mechanism is related to the moving of intracranial content in the skull and impinging on in the internal surface of the skull. Contusions are the bleeding on the brain and include fracture contusion, coup contusion (at the site of the impact) and contrecoup contusion (directly opposite to the impact site). Those injuries are detectable by CT, MRI or PET scans. Usually due to contact and causing scalp injury, it might present as skull fracture, contusions and/or intracranial haemorrhage. This contributes to the complexity of traumatic brain injury but also provides a variety of therapeutic targets. Following a traumatic insult to the brain, an extensive series of various cellular processes is initiated that leads to further neuronal dysfunction and death. The outcome of a head injury is determined by the above types, with primary injury extent being only sensitive to preventative measures, and secondary injury extend being susceptible to neuroprotective therapeutic interventions.Ĭellular and Molecular Activities Resulting in Secondary Brain Injury. The secondary damage is caused by casa cade of processes impacting “cerebral blood flow (hyper or hypoperfusion), impaired cerebrovascular autoregulation, cerebral metabolic dysfunction an,d impaired cerebral oxygenation.” The ischemia and oedema are secondary injury types. See Pathophysiology It may be delayed from the moment of impact, and it may superimpose injury on a brain already affected by a mechanical injury. Secondary Injury Ī secondary injury is not mechanically induced. These forces can cause intran acranial hematoma, diffuse vascular injury, and injury to cranial nerves and the pituitary stalk. Primary injury due to acceleration-deceleration results from unrestricted movement of the head and leads to shear, tensile, and compressive strains. an object striking the head or the brain striking the inside of the skull Two main mechanisms that cause primary injury are: Occurs at the time of injury and is induced by mechanical forces. ![]()
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