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📚 Traumatic Brain Injury (TBI) – Detailed Version

🔍 1. What is TBI?

  • Definition:
    A Traumatic Brain Injury (TBI) occurs when external mechanical force (e.g., blow, fall, accident) causes brain dysfunction.

  • It may result in temporary or permanent impairment of cognitive, physical, and psychosocial functions.

  • Common causes: falls, motor vehicle accidents, sports injuries, assaults.

🧬 2. Pathophysiology

TBI involves primary injury (at the moment of trauma) and secondary injury (delayed damage due to physiological responses).

🔸 A. Primary Injury

Occurs at the time of trauma:

  • Focal injuries: contusions, hematomas (e.g., epidural, subdural, intracerebral).

  • Diffuse injuries: diffuse axonal injury (DAI), due to rotational/shearing forces causing axonal stretching.

  • Penetrating injuries: e.g., gunshot wounds.

🔸 B. Secondary Injury

Occurs minutes to days later due to:

  • Ischemia (impaired blood flow).

  • Cerebral edema (swelling → ↑ intracranial pressure).

  • Excitotoxicity (excess glutamate → calcium influx → cell death).

  • Inflammation and free radical damage.

🎭 3. Types of TBI

🔹 A. By Severity (based on Glasgow Coma Scale – GCS):

  • Mild (GCS 13–15): e.g., concussion.

  • Moderate (GCS 9–12).

  • Severe (GCS ≤8): risk of coma, death.

🔹 B. By Mechanism:

  • Closed (blunt): skull intact but brain injured.

  • Open (penetrating): skull and dura breached.

🔹 C. By Location:

  • Epidural hematoma (arterial bleed, e.g., middle meningeal artery).

  • Subdural hematoma (venous bleed, bridging veins).

  • Intracerebral hemorrhage (within brain tissue).

  • Subarachnoid hemorrhage (bleeding into subarachnoid space).

📝 4. Clinical Features

🔸 Immediate Symptoms

  • Loss of consciousness (seconds to hours).

  • Confusion, disorientation, memory loss.

  • Headache, dizziness, nausea, vomiting.

  • Seizures.

  • Pupil changes, hemiparesis if severe.

🔸 Signs of Increased Intracranial Pressure (ICP):

  • Headache, vomiting, papilledema.

  • Cushing’s triad (hypertension + bradycardia + irregular breathing).

🔸 Long-term Deficits

  • Cognitive impairment (memory, attention).

  • Behavioral changes (irritability, depression).

  • Motor deficits (weakness, spasticity).

🏥 5. Diagnosis

🔹 A. Clinical Assessment

  • Glasgow Coma Scale (GCS): assesses eye opening, verbal, and motor response.

  • Neurological exam.

🔹 B. Imaging

  • CT scan (non-contrast): first-line for detecting fractures, bleeding.

  • MRI: better for detecting diffuse axonal injury.

🔹 C. Other Tests

  • Blood tests: coagulation profile, electrolytes.

  • Monitor for hypoxia, hypotension.

💊 6. Management

🔸 A. Immediate Care (ABCDE)

✅ Airway – ensure patency, consider intubation.
✅ Breathing – oxygenation, avoid hypoxia.
✅ Circulation – maintain blood pressure to ensure cerebral perfusion.
✅ Disability – assess neurological status (GCS).
✅ Exposure – check for other injuries.

🔸 B. Specific Interventions

  • Monitor ICP in severe TBI.

  • Osmotic agents (mannitol, hypertonic saline) to reduce brain swelling.

  • Surgical evacuation of hematomas if needed.

  • Seizure prophylaxis (e.g., phenytoin).

  • Avoid hypotension and hypoxia, as they worsen secondary injury.

🔸 C. Supportive Care

  • Head elevation (30°).

  • Temperature control.

  • Nutrition support.

  • Deep vein thrombosis (DVT) prophylaxis.

🏃‍♂️ 7. Rehabilitation

  • Physiotherapy: motor function, balance, gait training.

  • Speech and language therapy.

  • Cognitive rehabilitation: memory, attention, problem-solving.

  • Psychological support: mood, behavior.

🚨 8. Complications

  • Seizures (post-traumatic epilepsy).

  • Hydrocephalus.

  • Chronic subdural hematoma.

  • Infections (e.g., meningitis if open injury).

  • Neuropsychiatric problems (depression, aggression).

  • Persistent vegetative state (severe cases).

🎓 9. Summary Table

Feature Description
Definition Brain dysfunction due to trauma
Severity Mild (GCS 13–15), Moderate (9–12), Severe (≤8)
Mechanisms Focal (contusion, hematoma), Diffuse (DAI)
Diagnosis Clinical + CT/MRI
Acute treatment ABCs, reduce ICP, surgery if needed
Long-term treatment Rehabilitation, cognitive and motor recovery
Complications Seizures, hydrocephalus, infection


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