Head trauma (main)
(Redirected from Head Trauma)
This page is for adult patients. For pediatric patients, see: head trauma (peds)
Background
- Also known as Traumatic Brain Injury (TBI): Impairment in brain function from a mechanical force
TBI Pathophysiology
Primary injury
- Contusions
- Bruises to brain parenchyma
- Hematomas
- Epidural hematoma
- Subdural hematoma
- Intraparenchymal
- Intraventricular
- Subarachnoid hemorrhage
- Diffuse axonal injury
- Direct cellular damage
- Neurons
- Axons
- Tearing and shearing of tissues
Secondary injury
Brain swelling causes increased ICP which compresses the tissue causing ischemia with direct compression of the vasculature causing brain tissue herniation and brain death
- Leads to expansion of the original injury (predominantly metabolic insult)
- Calcium and sodium shifts
- Mitochondrial damage
- Production of free radicals
- Ultimately leads to damage to axonal integrity and axonal transport
- Enzyme activity leads to apoptosis
- Microscopic structural injury is often unidentifiable on CT or MRI
Cerebral Blood Flow and Autoregulation
- vasoconstriction
- HTN, Hypocarbia, alkalosis
- No good way to measure cerebral blood flow
- Use CPP as surrogate
- CPP is amount of pressure needed to perfuse the brain
- CPP=MAP-ICP
- When ICP elevates, CPP decreases
- Normal ICP
- 15 in adults
- <10 to 15 in children
- 1.5 to 6.0 in infants
- Use CPP as surrogate
- Autoregulation allows the body to control the cerebral blood flow
- Autoregulatory mechanism is damaged in most TBI patients
Clinical Features
- Adult patient with blunt head trauma
Differential Diagnosis
Head trauma
- Traumatic brain injury
- Orbital trauma
- Maxillofacial trauma
- Scalp laceration
- Skull fracture
- Pediatric head trauma
Neck Trauma
- Penetrating neck trauma
- Blunt neck trauma
- Cervical injury
- Neurogenic shock
- Spinal cord injury
Evaluation
Adult GCS
Eye Opening | Verbal | Motor |
6: Obeys commands | ||
5: Oriented | 5: Localizes to pain | |
4: Spontaneously opens | 4: Confused speech | 4: Withdraws from pain (normal flexion) |
3: Opens to command | 3:Inappropriate words | 3: Decorticate posturing (abnormal flexion) |
2: Opens to pain | 2: Incomprehensible sounds | 2: Decerebrate posturing (extension) |
1: Does not open | 1: No response | 1: No response |
- 14-15: Mild
- 9-13: Moderate
- 3-8: Severe
Workup
Workup is dependent on GCS severity, see:
Management & Disposition
Dependent on underlying diagnosis, see:
- Intracranial hemorrhage
- Moderate-to-severe traumatic brain injury
- Mild traumatic brain injury
- Post-concussive syndrome