![]() However, the vast majority of service members and veterans experience a TBI in a non-deployed setting (diagnosed in up to 80%) due to the nature of their training or participation in sports and leisure activities. Per the Journal of Pediatrics, cases of TBI in children of age 18 and under were believed to be caused mainly by sports and recreation-related concussions. Unfortunately, many incidents of mild-moderate traumatic brain injuries in our everyday life do not even present to the emergency room or other healthcare settings, especially when they are associated with sports-related or recreation-related settings. Diffuse laminar necrosis is typically seen on autopsy. Such shearing forces cause the neuronal axon to be stretched, and the subsequent damage to the cytoskeleton may lead to axonal swelling, increased permeability, calcium influx, detachment, and axonal death. ![]() This phenomenon is mainly seen at the junction of the gray and white matter where neuronal axons are entering a more dense, fatty (myelinated), and less fluid-filled white matter. This can underlie mild to moderate TBI and potentially results from any shearing, stretching, or twisting injuries to the neuronal axons. It commonly occurs over the convexity, whereas SAH secondary to aneurysmal rupture occurs in the basal cisterns. ![]() Subarachnoid hemorrhage is most commonly caused by trauma and results from the tearing of small capillaries with blood subsequently entering into the subarachnoid space. Coup contusions occur at the site of impact, whereas contrecoup injuries typically take place on the contralateral side of impact, usually the basi-frontal lobe and anterior temporal lobe. SDH can result from the bleeding of a bridging vein and can be acute or chronic.Ĭontusions (bruising of the brain) can be a coup or contrecoup type. EDH usually results from bleeding from the middle meningeal artery and its branches or a fracture and is usually acute. This is common in athletes and can lead to psychiatric disturbances and suicidal behavior, attention deficits, and derangements in memory and executive functions.Įxtra-axial hematomas include both epidural hematomas (EDH) and subdural hematomas (SDH). Second impact syndrome: The initial event is often a concussion, but if the patient (often an athlete) starts to play without fully recovering from this and sustains another injury, there can be a rapid evolution of malignant cerebral edema, ensuing over a short-time course of time.Ĭhronic Traumatic Encephalopathy (CTE): This is usually a delayed manifestation of repetitive mild TBI. Special sequence MRI like diffusion tensor imaging and functional MRI may result in earlier diagnosis of concussion. It causes a transient altered mental status, which can range from confusion to loss of consciousness. This cannot be diagnosed with a routine computed tomogram (CT) scan or magnetic resonance imaging (MRI) scan. This is usually a mild TBI without any gross structural damage and occurs secondary to a nonpenetrating TBI. It usually results from acceleration/deceleration forces occurring secondary to a direct blow to the head. The following are the different types of TBI commonly encountered : When an additional compartment is introduced (like a hematoma), there must be a compensatory reduction in another compartment in order to prevent intracranial hypertension. Cerebral perfusion pressure (CPP) is defined as mean arterial pressure (MAP) – intracranial pressure (ICP). When the ICP increases, the CPP will be reduced and can lead to secondary cerebral ischemia and infarct. The goal of TBI management is to prevent this secondary insult. The Monro-Kellie hypothesis states that the total intracranial volume (composed of brain tissue, cerebrospinal fluid, venous blood, and arterial blood) should always remain a constant since the cranium is a rigid and non-expansile container.
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