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Introduction to Traumatic Brain Injury



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Introduction to Traumatic Brain Injury Brian L Edlow MS4 University of Pennsylvania School of Medicine December 4 4 2006 2006 December Goals 1 Understand that traumatic brain injury is a process not an event 2 Understand the 4 main pathophysiologic mechanisms involved in traumatic brain injury 3 Understand basic strategies for treatment Severe Traumatic Brain Injury TBI Definition Head trauma associated with a Glasgow Coma Score of 8 Best Eye Response 1 2 3 4 No eye opening Eye opening to pain Eye opening to verbal command Eye opening spontaneously Best Verbal Response 1 2 3 4 5 No verbal response Incomprehensible sounds Inappropriate words Confused words Appropriate verbal responses Best Motor Response 1 2 3 4 5 6 No motor response Extension to pain Flexion to pain Withdrawal from pain Localizing to pain Obeys commands Severe TBI Demographics 1 5 1 5 million cases per year in U S Causes Motor vehicle vehicle 45 falls falls 30 accident 45 30 occupational accidents 10 recreational accidents 10 assaults 5 Highest risk risk children adolescent young adult elderly men elderly Population 300 million Severe TBI Pathophysiology TBI is a process not an event Secondary injury can be more damaging than primary injury injury primary 4 Main Mechanisms of Brain Injury 1 1 Brain Contusion Contusion Brain 2 2 Increased intracranial intracranial pressure pressure ICP ICP Increased 3 3 Diffuse Axonal Axonal Injury Injury Diffuse 4 4 Stroke ischemic ischemic and or and or hemorrhagic hemorrhagic Stroke Mechanism 1 Brain Contusion A brain contusion is defined by cell death accompanied by hemorrhage leakage leakage of of blood blood hemorrhage The soft soft brain brain tissue tissue is is The vulnerable to contusion in head trauma The contusion contusion often often occurs occurs at at aa The site distant distant from from the the point point of of site impact impact Gross brain image from http neuropathology neoucom edu chapter4 chapter4bContusions dai sbs html contusion Mechanism 2



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