![]() The Monro-Kellie doctrine holds that the cranial vault is a non-expandable chamber, and as a result, the volume of that chamber remains constant. Whether the insult to brain tissue results from focal impact, diffuse axonal injury, intracranial hemorrhage or the mass effect resulting from it, the syndrome we wish to avoid is increased intracranial pressure. It is the damage to the brain stem that is most likely to cause severe derangements in vascular and respiratory function. ![]() The axonal tracts commonly damaged in DAI are concentrated in the corpus callosum, cerebral hemispheres and the brain stem. Excitatory amino acids such as glutamate and aspartate are released in large quantities after primary injury, and these biochemical transmitters are largely responsible for cellular edema. While it was long thought that the axonal tracts are sheared as a result of primary injury, we now know that these axons are merely damaged, and the biochemical cascade that results in secondary injury is responsible for most of the neuron death. Cerebral axons bridging different brain regions are stretched and damaged by rapid acceleration or deceleration. While focal TBI is primarily caused by direct impact, DAI is caused by indirect force, typically the acceleration-deceleration phenomenon common in automobile accidents, sports impacts, and blast injuries. DAI may be difficult to identify with neuroimaging, as most of the changes are microscopic. Primary injury in TBI can be classified into two broad categories: focal and diffuse.įocal injuries affect one discrete part of the brain and include skull fractures, penetrating wounds, intracranial hematomas and the like, while diffuse injuries are more widespread, such as diffuse axonal injury.ĭiffuse axonal injury is present in nearly half of severe TBI and its primary symptom is prolonged unconsciousness. Traumatic brain injury and hemorrhagic stroke While little can be done in the prehospital realm to limit or reverse primary injury, careful assessment and monitoring, including quantitative waveform capnography, can provide clues to the caregiver of the impending neurological sequelae of secondary injury.Īlthough hemorrhagic stroke - or other causes of intracranial bleeding - has not been typically classified into primary and secondary syndromes, one might consider the mass effect of an expanding intracranial hemorrhage to be a secondary injury. Primary injury occurs at the time of and in the area of the original insult, while secondary injury may occur hours to days or weeks afterward the initial insult. Injury resulting from severe neurological trauma can be classified into two broad categories: primary and secondary. Primary and secondary neurological injury Proper care of these patients can be guided with the use of quantitative waveform capnography. While these three pathologies - traumatic brain injury, spinal cord injury and hemorrhagic stroke - may represent a broad constellation of clinical syndromes ranging from minor to potentially devastating neurological sequelae, we will limit our focus to the most severe of each, which may pose high risk of severe respiratory and vascular dysfunction. These two categories represent over half of SCI patients, and are at highest risk of respiratory dysfunction. Patients with incomplete and complete tetraplegia represent 30.1 percent and 20.4 percent of SCI victims, respectively. Īpproximately 12,500 people in the United States suffer spinal cord injuries every year, and it is estimated that there are as many as 276,000 SCI survivors in the United States as of 2014. All patients with an ICH score of 5 died. Intracerebral hemorrhage volume < 30 cm 3Įach increase in the patient's ICH score is associated with an increase in 30-day mortality those patients with an ICH score of 3 had 72 percent mortality, those scoring 4 had 97 percent mortality. The Intracerebral Hemorrhage score is the most commonly used prognostic indicator for hemorrhagic stroke, and is calculated thusly: The presence of a large volume of blood at presentation and growth of hematoma size are associated with higher mortality. Prognosis in these patients is based upon location, size and severity of hemorrhage as defined by Glasgow Coma Scale. Hemorrhagic stroke accounts for nearly 13 percent of the 795,000 strokes yearly in the United States, of which 3 percent are subarachnoid hemorrhage and 10 percent are intracerebral hemorrhage. The mortality rate for severe TBI - Glasgow Coma Score < 8 - is roughly 33 percent. ![]() Roughly 200,000 TBI victims yearly require hospitalization, at a cost of nearly $4 billion per year in medical expenses, lost wages and productivity. ![]() Traumatic brain injury accounts for nearly 40 percent of all trauma deaths in the United States, approximately 52,000 deaths per year.
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