Presentation
The pathomechanisms of brain edema and tissue injury studied in experimental models have been also presented. [books.google.com]
Patients typically present with a combination of reduced Glasgow Coma Scale (GCS), nausea/vomiting and/or amnesia 3. [radiopaedia.org]
If one or more of these signs is present, no tube should be placed by the nasal route Adapted from reference [10]. [cps.ca]
It is the infant who presents with vomiting, lethargy or irritability who can be missed during the initial presentation. [clinicaladvisor.com]
The meta-analysis of ten recent studies including the present study is consonant with recent literature showing improved outcomes and reduced mortality with unilateral DC (2,28,29,40, present study). [springerplus.springeropen.com]
Entire Body System
- Fatigue
[…] disoriented; headache; memory or concentration problems; dizziness or loss of balance; nausea or vomiting; blurred vision; ringing in the ears; bad taste in the mouth; sensitivity to light or sound; mood changes or mood swings; feeling depressed or anxious; fatigue [fortherecordmag.com]
The most common is the headaches, fatigue, they have like a brain fog. Their mood can change. They become very edgy. They as I said, their skin can be more sensitive. But for most of them, it’s the sleep disturbances. [voanews.com]
They may include, as an adult, attention deficit and fatigue, impaired planning and problem solving, lack of initiative, inflexibility, impulsiveness, irritability and temper tantrums, opposition, and socially inappropriate behavior. [braininjury.com]
[…] injury The signs and symptoms of mild traumatic brain injury may include: Physical symptoms Loss of consciousness for a few seconds to a few minutes No loss of consciousness, but a state of being dazed, confused or disoriented Headache Nausea or vomiting Fatigue [mayoclinic.org]
[…] severe headache weakness and numbness in hands, feet, arms or legs The following signs and symptoms can also indicate a need for urgent attention: confusion changes in mood memory problems inability to remember what happened before or after the incident fatigue [medicalnewstoday.com]
- Malaise
The categories are as follows: “(1) headache, dizziness, malaise, fatigue, noise intolerance (2) irritability, depression, anxiety, emotional lability (3) subjective concentration, memory, or intellectual difficulties without neuropsychological evidence [internationalbrain.org]
Respiratoric
- Respiratory Distress
The study also suggested that TBI patients with in-hospital seizures have higher rates of complications such as pneumonia, acute respiratory distress syndrome, acute kidney injury, and increased intracranial pressure. [emedicine.medscape.com]
(Figure 3) At this point it is worth mentioning acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). The incidence of ALI/ARDS in TBI is reported between 10 % and 30 % [53, 54]. [intechopen.com]
This was followed by electrolyte and respiratory issues including the adult respiratory distress syndrome (ARDS). Next to occur were infectious complications most notably pneumonia and urinary tract infections. CNS infections also occurred. [springerplus.springeropen.com]
Gastrointestinal
- Constipation
Underlying constipation and/or impaired communication and mobility are often the causes of bowel incontinence. The use of oral stool softeners, laxatives, and rectal suppositories may facilitate full bowel evacuation and improve incontinence. [emedicine.medscape.com]
Eyes
- Periorbital Ecchymosis
Disability (D) Perform rapid assessment, including: Glasgow Coma Scale score adapted to age pupil size and reactivity to light tone, reflex and movement of all four limbs fontanelle (infants) signs of basal skull fracture: Periorbital ecchymosis (‘raccoon [cps.ca]
Psychiatrical
- Anxiety Disorder
Most occur with depression, anxiety disorder, conversion disorder, or schizophrenia. However, the literature would indicate that seizures and pseudo-seizures can coexist in up to 20% of the cases. [scarlettlawgroup.com]
Urogenital
- Renal Insufficiency
It is an osmotic diuretic and should be used cautiously in patients with renal insufficiency. It is important to ensure that the patient does not become hypovolemic after the administration of mannitol. [consultant360.com]
Mannitol must be used cautiously in patients with severe coronary artery disease, heart failure, renal insufficiency, or pulmonary vascular congestion because mannitol rapidly expands intravascular volume. [merckmanuals.com]
Neurologic
- Forgetful
[…] reformation (thin slices with smallFOV)• If suspect C-spine fracture do C-spine CT 13. www.RiTradiology.com CT in TBI: Checklist• Look at all three windowsBrain Subdural Bone 14. www.RiTradiology.com CT in TBI: Checklist• Look for primary lesions• Don’t forget [slideshare.net]
Workup
An appropriate workup to evaluate GU symptoms and rule out infection is indicated. When the causes of urinary incontinence are impaired communication and mobility, a trial of a timed voiding is indicated to manage overflow incontinence. [emedicine.medscape.com]
Treatment
Treatment for TBI After testing, the SLP will work with you to improve your skills. What you do in treatment will depend on the problems you have. [asha.org]
The doctors apply the treatments according to the patient's condition. [journals.plos.org]
While there is limited evidence-based medicine for the treatment of TBI in children, in 2003 consensus guidelines were established for the treatment of severe TBI. [clinicaladvisor.com]
This may require a combination of medical and surgical treatments. Prompt treatment usually results in quicker and more complete recovery. Without it, some damage may remain. [webmd.com]
Treatment usually consists of lumbar puncture or shunt placement. [emedicine.medscape.com]
Prognosis
Prognosis of these patients has been different in various centers making identification and putting them in high-risk group a critical step [3]. [oatext.com]
The results showed that naloxone could improve the patients' prognosis significantly compared with the placebo group. [journals.plos.org]
Treatment and prognosis Large hematomas with significant mass effect require urgent neurosurgical evacuation. Hydrocephalus can develop and urgent ventricular drainage may be required. [radiopaedia.org]
Prognosis in Diffuse Axonal Injury 90% of individuals with severe DAI remain in a persistent vegetative state indefinitely, and may remain so for decades. [calshipleymd.com]
See Traumatic Brain Injury (TBI) Prognosis References and Links CCC – Traumatic brain injury: Literature Summaries Brain Trauma Foundation Guidelines – Guidelines for the Management of Severe TBI ICN Podcast — 87. [lifeinthefastlane.com]
Etiology
[Crossref] Lohani S, Devkota UP (2011) Hyponatremia in patients with traumatic brain injury: etiology, incidence, and severity correlation. World Neurosurg 76: 355-360. [oatext.com]
In severe brain injury, more often than not there is an organic based etiology. Increased rates of personality disorder involving sensitive-compulsive individuals are often times seen. Social isolation is common. [scarlettlawgroup.com]
Altered mental status can be caused by infectious etiologies such as meningitis or abscesses. It can be caused by metabolic derangements such as hyperglycemia in diabetic ketoacidosis or hyperammonemia seen in liver failure. [clinicaladvisor.com]
Thus, hyperventilation is recommended only as a temporizing measure to reduce an elevated ICP, preferably not below 30 mmHG unless absolutely necessary and only for few minutes while determining an etiology of the intracranial hypertension and initiating [intechopen.com]
These imaging techniques noninvasively monitor brain function, helping to provide information on the disease etiology and can aid in making decisions about patient recovery as well as monitor responsiveness to interventions. [nap.edu]
Epidemiology
Epidemiology. 2011;22(6):836-844. 4. Taylor CA, Greenspan AI, Xu L, Kresnow MJ. Comparability of national estimates for traumatic brain injury-related medical encounters. J Head Trauma Rehabil. 2015;30(3): 150-159. 5. [uspharmacist.com]
Epidemiology and 12-month outcomes from traumatic brain injury in Australia and New Zealand. J Trauma 2008 ;64: 854 - 862 2. Murray GD, Teasdale GM, Braakman R, et al. The European Brain Injury Consortium survey of head injuries. [nejm.org]
Epidemiology Hospital Episode Statistics data for the 2012-2013 annual dataset indicate that there were 171,600 admissions to hospitals in England with a primary diagnosis of head injury. [ 3 ] 70% are males. 33-50% are children under 15 years of age. [patient.info]
Sanchez-Rodriguez Jose Juan 3, Muruato-Araiza Luis Fernando 2, Meyer Frerk 1, Kretschmer Thomas 1, Heinen Christian 1 1 Department of Neurosurgery, Evangelic Hospital Oldenburg, Medical Campus University of Oldenburg, Germany 2 Department of Clinical Epidemiology [asianjns.org]
Epidemiology TBI is a very serious problem in children. Approximately 500,000 children are affected in the United States alone. [clinicaladvisor.com]
Pathophysiology
Therefore, patients with the same TBI severity classification may have a dramatically different pathophysiology ( Figure 254-1 ). [accessmedicine.mhmedical.com]
However, based on the initially proposed pathophysiological mechanism hypocalcemia could interfere with the development of cerebral edema due to neuronal death [Figure 1]. [asianjns.org]
Siesjo BK (1992) Pathophysiology and treatment of focal ischemia. Part I: pathophysiology. J Neurosurg 77:169-184 18. Siesjo BK(1992) Pathophysiology and treatment of focal ischemia. Part II: mechanisms of damage and treatment. [ispub.com]
Figure 1: Proposed pathophysiological mechanism for hypocalcaemia following TBI. Figure 2: Representation at cellular level of the proposed pathophysiological mechanism after TBI in which calcium may be involved. [omicsonline.org]
The risk of heterotopic ossification is greatest during the first 3-4 months after injury. [32] The pathophysiology of heterotopic ossification remains unclear. [emedicine.medscape.com]
Prevention
Prevention Some tips can reduce the risk of a TBI. Never drink and drive. [medicalnewstoday.com]
Chapter 8: Prevention of seizures following traumatic brain injury. In: Sadaka F, ed. Traumatic Brain Injury. [uspharmacist.com]
Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control. Report to Congress on mild traumatic brain injury in the United States: steps to prevent a serious public health problem. [biau.org]
Prevention of growing skull fractures. J Neurosurg Pediatrics 2010;5(2):213-8. [cps.ca]